What Palliative Care-Related Problems Do Patients Experience at HIV Diagnosis? A Systematic Review of the Evidence

Context. Palliative care is an essential element of HIV care throughout the disease trajectory, but there is a lack of information to guide clinical care at HIV diagnosis. Objectives. This systematic review aimed to identify and appraise the evidence of palliative care-related problems at HIV diagnosis. Methods. The search strategy combined the term "HIV'' with seven key words derived from the World Health Organization definition of multidimensional palliative care, in a systematic search of four databases. Abstracts and papers were screened to identify those recording problems within six months of HIV diagnosis in adults. Sample descriptions, aims, methods, and prevalence findings were extracted from these papers into common tables. Results. Of 5443 titles retrieved, 65 met the inclusion criteria and 34 were retained. Papers included 27 original studies and seven secondary analyses of patient's records, with great heterogeneity in design, sample definition, and outcome measures. Physical and psychological symptoms were highly prevalent (pain 11%-76%, weight loss 8%-89%, fever 32%-89%, diarrhea 6%-54%, anxiety 36%-95%, and depression 18%-47%). At HIV diagnosis, well-being was impaired, suicidal thoughts were frequent, and peace and calmness were reduced. Participants lacked emotional support and feared the reaction of their families. Practical problems included hunger, homelessness, reduced ability to work, and need for childcare. Studies had methodological failings such as the use of unvalidated tools and lack of clarity reporting results. Conclusion. People who have recently been diagnosed with HIV have multidimensional palliative care-related problems. HIV care and support services need to assess and manage problems using integrated palliative care, with referral for complex problems. Patient centeredness must be a principle of HIV clinical research. J Pain Symptom Manage 2011;42:734-753. (C) 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.