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With improvements in therapy, patients who are compliant with treatment should have near normal life spans. A population-based study conducted in Denmark found that HIV-infected persons at age 25 years without hepatitis C had a life expectancy similar to that of an uninfected 25-year-old. Unfortunately, not all HIV-infected persons have access to treatment. Studies consistently show less access to treatment for Blacks, the homeless, and injection drug users. For patients whose disease progresses even though they are receiving appropriate treatment, palliative care must be provided (see Chapter 5), with attention to pain control, spiritual needs, and family (biologic and chosen) dynamics.

When to Refer

  • HIV-infected patients in whom viral loads cannot be fully suppressed on one of the initial recommended regimens should be referred to specialists.

  • Specialty consultation is particularly important for those patients with detectable viral loads on antiretroviral treatment; those intolerant of standard medications; those in need of systemic chemotherapy; and those with complicated opportunistic infections, particularly when invasive procedures or experimental therapies are needed.

When to Admit

Admit patients with opportunistic infections who are acutely ill (eg, who are febrile, who have had rapid change of mental status, or who are in respiratory distress) or who require intravenous medications.

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