hospice guidelines for determining prognosis, HIV

Guidelines: 1) CD4+ count < 25 cells/uL 2) viral load persistently > 100,000 copies/mL 3) life-threatening complications* a) CNS lymphoma (2.5) b) progressive multifocal leukoencephalopathy (4) c) cryptosporidiosis (5) d) wasting, with loss of >33% of lean body mass (< 6) e) MAC bacteremia, untreated (< 6) f) visceral Kaposi's sarcoma, unresponsive to therapy (6) g) renal failure, refusing dialysis (<6) h) advanced AIDS dementia complex (6) i) toxoplasmosis (6) 4) other factors significantly reducing survival a) chronic persistent diarrhea for 1 year, regardless of etiology b) serum albumin < 2.5 mg/dL c) concurrent substance abuse d) age > 50 years e) decision to forego antiviral therapy & prophylaxis related to HIV (PCP) f) congestive heart failure, NYHA class IV * median survival in months in parentheses

References

Medical Guidelines for Determining Prognosis in non-Cancer Diseases, 2nd edition, Stuart et al (eds), National Hospice Organization, Arlington, VA, 1996