CHALLENGES TO DELIVERING END-OF-LIFE CARE FOR ADOLESCENTS WITH AIDS

摘要

We evaluated the care and suffering at the end of life of children who died of AIDS. During the interval 2002-2003, 10 out of 480 HIV horizontally infected adolescents admitted in Babes Hospital for Infectious Diseases, Bucharest, died of AIDS (mortality: 2.08%). The median age at death was 13.86(+-)1.7 years, the median interval from the confirmed HIV infection to death was 8.12(+-)2.7 years, and the median time of hospitalization before death was 284(+-)204 days. Seven out of the ten deceased patients were TB co-infected. The main causes of death were CNS infections (5 patients), bronchopneumonia with respiratory failure (4 patients), overwhelming sepsis (4 patients) and disseminated non-Hodgkin lymphoma (2 patients). All patients received day-to-day aggressive treatment at the end of life: 12.6(+-)3.9per-os medications, 11.5(+-)5.8 by intravenous route and 1.9(+-)1.9 by subcutane or intramuscular route. The most commonly treated symptoms were pain and dyspnea; however, treatment of these symptoms was successful in less than 30% of children. Antiretroviral therapy had significantly reduced HIV-related mortality, but a complex mixture of disease-specific and opportunistic complications need palliative care for the late stage of AIDS.