HIV and palliative care

Since the discovery of HIV in 1983, there have been dramatic advances in the management of people living with the virus due to the availability of effective antiretroviral medication (ARV). Prior to this, acquisition of the virus would lead to the development of AIDS and eventual death within ten years for the majority. By 1996, a regime of triple therapy antiretroviral medication was developed which could sustainably suppress HIV viral replication and viral load in the blood. People living with HIV now have near-normal life expectancies, and opportunistic infection rates have reduced in the UK. Despite these advances, people living with HIV experience a high level of symptoms. Symptoms can be direct effects of the HIV virus, side effects of HIV treatment, or consequences of advanced disease. In the UK, advanced disease is still seen with late presentation of infection and poor adherence to ARV medication. Advanced HIV disease is associated with an impaired immune system, leading to high risk of developing opportunistic infections and HIV-associated malignancies. Painful peripheral neuropathy occurs at all stages of HIV infection and is resistant to many neuropathic pain treatments.