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Clinical Perspective End of Life Care for HIV Dr. Ann S tewart, - PowerPoint PPT Presentation

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Clinical Perspective End of Life Care for HIV Dr. Ann S tewart, Medical Director, Casey House Obj ectives To review local data on end of life care for patients with HIV/ AIDS in Toronto To look at changing cause of death To

  1. Clinical Perspective End of Life Care for HIV Dr. Ann S tewart, Medical Director, Casey House

  2. Obj ectives  To review local data on end of life care for patients with HIV/ AIDS in Toronto  To look at changing cause of death  To discuss recent cases of admission for end of life care  To look at strategies for end of life care planning www. caseyhouse.com

  3. Presenter Disclosure • Dr. Ann Stewart • Employee of Casey House www. caseyhouse.com

  4. www. caseyhouse.com

  5. Deaths at Casey House 100.00% 90.00% 80.00% 70.00% 60.00% 50.00% Percentage of admissions 40.00% 30.00% 20.00% 10.00% 0.00% 1988 2010 2012 2014 www. caseyhouse.com

  6. Casey House Chart Review, 2008  Average age of death 48 +/ - 2.4 years  Average number of years living with HIV 14.6 +/ -7.6  Pre-HAART average age of death 39 +/ - 2.4 years  Mean number of years of living with HIV pre-HAART 1.5 +/ - 0.2 Halman et al, 2013; To et al, 2011 www. caseyhouse.com

  7. Cause of Death: Pre and Post HAART Deaths Post-HAART Deaths Pre-HAART (1988) (2006-2008) AIDS related deaths 19% 25% AIDS related deaths Non-AIDS related deaths 81% Non-AIDS related 75% deaths Mycobacterium Avium Non‐AIDS malignancy, liver Complex, Toxoplasmosis, disease, respiratory Pneumocystis Pneumonia, disease, organ failure Kaposi Sarcoma From To et al. CAHR 2011 www. caseyhouse.com

  8. Mature patients  Present in late forties and fifties  On ARV therapy, suppressed  Develop malignancy  Do poorly on chemo and radiation  May be well-supported by friends and family – may not have much of a plan  S low decline, with many hospital interventions www. caseyhouse.com

  9. Y oung patients  Can present in their 20’s  May have history of opioid use with inj ection, and/ or mental health issues  Often unhoused with few personal connections  Unable to tolerate regular medication regimes  Develop multiple complications of immuno- suppression and infectious disease: MAC, C Diff, CMV , endocarditis  S till die of the classic complications of AIDS www. caseyhouse.com

  10. Next….. • Claire Kendall • Associate Professor, Department of Family Medicine, University of Ottawa • Greg Robinson • Physician and community activist from Toronto • Richard Harding • Reader in Palliative Care, King’s College London UK www. caseyhouse.com

  11. Thanks  OHTN  Fellow presenters  Terrific team at Casey House www. caseyhouse.com

  12. Complexity Frequency Percentage Homeless: no home, shelter, with friends/family, on street 16 19.3% Psychiatric: more than 1 Axis 1 diagnosis 77 92.8% Medical: more than 2 medical co-morbidities 28 33.7% 7 patients (8.4%) experienced all three complexities  Only 1 (1.2%) patient had no complexity  From Halman et al 2013, chart review of all patients admitted in 2008 N= 83  www. caseyhouse.com

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