hospice guidelines for determining prognosis, HIV

Introduction

Guidelines:

• CD4+ count < 25 cells/uL
• viral load persistently > 100,000 copies/mL
• life-threatening complications*
  • CNS lymphoma (2.5)
  • progressive multifocal leukoencephalopathy (4)
  • cryptosporidiosis (5)
  • wasting, with loss of >33% of lean body mass (< 6)
  • MAC bacteremia, untreated (< 6)
  • visceral Kaposi's sarcoma, unresponsive to therapy (6)
  • renal failure, refusing dialysis (<6)
  • advanced AIDS dementia complex (6)
  • toxoplasmosis (6)
• other factors significantly reducing survival
  • chronic persistent diarrhea for 1 year, regardless of etiology
  • serum albumin < 2.5 mg/dL
  • concurrent substance abuse
  • age > 50 years
  • decision to forego antiviral therapy & prophylaxis related to HIV (PCP)
  • congestive heart failure, NYHA class IV

* median survival in months in parentheses

More general terms

• hospice guidelines for determining prognosis