The philosophy of palliative care is that it aims to maximise the quality of life, and also aims to make death as comfortable as possible when it comes. Palliative care teams support the whole family unit, whoever they may be, and seeks to help those around the patient to come to terms with the diagnosis, to support them during the length of the disease, and to assist them into the bereavement phase. The palliative care team is multidisciplinary, and may consist of a doctor, nurse, social worker, dietician, occupational therapist, physiotherapist, psychologist, and spiritual professionals of many or no fixed denominations.

HIV care services have been progressive and multiprofessional in their care mix, but without the palliative care element these is a potentially significant loss to patient care. While not all patients will need palliative care, and palliative care may need to be introduced and withdrawn as different complex problems emerge and are resolved, it is crucial that links and referral systems operate to ensure that such care is available.

The addition of specialist input to address complex pain and symptom issues, and to support patients and families through challenging life changes, can make a large difference to clinical team services and assist in case loads. The evidence suggests that palliative care improves the health and wellbeing of people with HIV, particularly in the domains of pain and symptom control, anxiety, insight and spiritual well-being (Harding).

The challenges of HIV in the era of antiretroviral therapy have presented a new model of palliative care integration, necessitating a revised model from one of steadily increasingly palliative input as curative options lessen in cancer care (Figure 1). Figure 2 shows that in HIV care, palliative staff may increase their input and then withdraw according to need. The uncertain prognosis we currently face means that the palliative care team may not necessarily need to provide terminal care due to improved mortality with new therapeutic regimes. However, they will be often be required to assist in the management of pain and symptoms, psychosocial and spiritual problems. The models show that palliative care has taken an increasing role in improving the quality of life and as well helping the patent and family to face its end.