The changing epidemiology of HIV disease in the era of HAART has resulted in new and evolving roles for palliative care. The shift has been from the more conventional (terminal) HIV palliative care of the 1980’s and early 1990’s to a greater focus on symptom-control in patients with a chronic disease like diabetes. These patients may continue to live for an extended period, and may need active treatment for one HIV-related condition and palliation for another simultaneously (Easterbrook). The likelihood of active and palliative treatment, and the specialist skills that might be required of the two approaches, underline the importance of joint working. There are numerous examples of strong links and working systems of care between HIV medicine and palliative care, and these are the result of a sound understanding and respect for each other’s roles, sound assessment of patient needs, and good communication. It is essential that HIV health professionals and palliative care teams work closely together. Both teams have specialist knowledge that may benefit the patient. The palliative care team need to be aware of signs of HIV disease progression, the implication of symptoms in the context of immune suppression, the importance of strict adherence to antiretroviral therapy and that drug interruptions must be supervised, the high level of drug interactions and adverse effects. Close liaison with the HIV team will enable the palliative care team to refer back for active treatment as appropriate. Also both teams’ services may change and joint care ensures that individuals receive all available help and support.

Palliative

Diagnosis

Curative

Bereavement

Figure 1 Integration of palliative care in life-threatening malignant disease

Death

         Figure 2 Integration of palliative care in HIV disease

Diagnosis

Death?

Bereavement?

Prognosis?

Initiation of therapy