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HIV for Physicians

To qualify for hospice, a patient with HIV must have a terminal prognosis as evidenced by:

CD4+ Count < 25 cells/mcL or persistent viral load > 100,000 copies/ml with on of the following:

  • CNS lymphoma
  • Untreated or not responsive to treatment wasting (loss of 33% lean body mass)
  • Mycobacterium avium complex (MAC) bacteremia, untreated, unresponsive to treatment, or treatment refused
  • Progressive multifocal leukoencephalopathy
  • Systemic lymphoma with advanced HIV disease and partial response to chemotherapy
  • Visceral Kaposis Sarcoma unresponsive to therapy
  • Renal failure in absence of dialysis
  • Cryptosporidium infection
  • Toxoplasmosis unresponsive to therapy
  • Decreased performance status, as measured by the Karnofsky Performance scale equal to or less than 50

The following are not required but support a referral:

  • Chronic persistent diarrhea for one year
  • Persistent serum albumin < 2.5
  • Concomitant, active substance abuse
  • Advanced AIDS Dementia complex
  • Age > 50 years
  • Toxoplasmosis
  • Absence of antiretroviral, chemotherapeutic and prophylactic drug therapy related specifically to HIV disease
  • CHF symptomatic at rest