With improvements in therapy, patients who are adherent with treatment should have near normal life spans. A population-based study conducted in Denmark found that people aged 25 years living with HIV without hepatitis C had a life expectancy similar to that of a 25-year-old without HIV. Unfortunately, not all people living with HIV have access to treatment. Studies consistently show less access to treatment for Black people living with HIV and those experiencing homelessness or who inject drugs. 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.
People living with HIV in whom viral loads cannot be fully suppressed on one of the initial recommended regimens should be treated in consultation with a specialist.
Specialty consultation is particularly important for those patients with detectable viral loads on ART; 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.
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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