The need for palliative care in HIV treatment is underlined by the high prevalence of pain and symptoms, the toxicity, side effects, and virological failure associated with antiretroviral therapy, emergence of co-morbidities, continued high incidence of malignancies, late presentation of people with HIV disease, and the comparatively higher death rates among the infected individuals," according to the current study.

To evaluate the effect of models of palliative care on patient outcomes, the researchers conducted a systematic review. They devised a detailed search strategy and searched biomedical databases using specific terms relevant to models of palliative care. Data from papers that met the inclusion criteria were extracted into common tables, and evidence was independently graded using well-described hierarchy of evidence.

A total of 34 services met the inclusion criteria. "Of these, 22 had been evaluated, and the evidence was graded as follows: grade 1(n=1); grade 2(n=2); grade 3(n=7); grade 4(n=1); qualitative(n=6). Services were grouped as: home based care(n=15); home palliative care/hospice at home(n=7); hospice inpatient(n=4); hospital inpatient palliative care(n=4); specialist AIDS inpatient unit(n=2); and hospital inpatient and outpatient care(n=2)," explained the researchers. According to the evidence, home palliative care and inpatient hospice care significantly improved patient outcomes in areas of pain and symptom control, anxiety, insight, and spiritual well-being.

Though the review found improvements across domains, the current body of evidence is hindered by the lack of (quasi) experimental methods and standardized measures, the researchers concluded. "The specialism of palliative care is responding to the clinical evidence that integration into earlier disease stages is necessary. Further studies are needed to both identify feasible methods and evaluate the apparent beneficial effect of palliative care on patient outcomes in the post-HAART era."

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