Palliative Care Research in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome: Clinical Trials of Symptomatic Therapies

With the widespread introduction of highly active antiretroviral therapies (HAARTs), mortality rates among patients with advanced human immunodeficiency virus (HIV) disease have declined dramatically. While death rates from AIDS have been halved by the introduction of HAART, AIDS remains a disease without a definitive treatment. This chapter reviews the major areas of research in AIDS palliative care and begins with research addressing the important issues of pain and fatigue. It discusses studies dealing with the major neuropsychiatric syndromes of delirium and dementia. This is followed by an overview of the research focusing on major psychiatric illnesses, including depression, anxiety, and psychosis. It also describes intervention trials for endocrinopathies and AIDS-related cachexia. The chapter concludes with a brief look at two complex end-of-life issues: physician-assisted suicide and desire for death in the terminally ill.