Holistic HIV care with HAART
Highly active antiretroviral therapy has transformed the management and prognosis of patients with HIV. Alison Bradley and Anthony France wonder if doctors are stepping up to their new role
Highly active antiretroviral therapy (HAART) has redefined HIV in industrial countries as a chronic rather than a terminal illness, changing the doctor's role from carer to treatment manager.1 But patients are more than their CD4 and T cell counts. Why should increasing technology in HIV care replace and not complement holistic care? By exploring stigma, psychosocial factors, palliative care, and the controversy surrounding certification of death, this article considers the holistic role of doctors caring for patients with HIV in the HAART era.
In this information age many in the general public would prefer a diagnosis of cardiac failure with impaired left ventricular systolic function (five year survival 25.2%)2 or non-small cell lung carcinoma (eight month survival with chemotherapy)3 rather than HIV, despite its better prognosis (three year survival up to 50%).4 This shows the unremitting stigma surrounding HIV that has penetrated the HAART era because of several perceptions.