Barriers to Treatment Resulting in Multiple Coexisting Infections and Hospice in a Young Person With Acquired...

Barriers to treatment in people with human immunodeficiency virus (HIV) are often multifactorial and can lead to devastating outcomes. The authors present the case of a young woman with HIV who eventually developed acquired immunodeficiency syndrome (AIDS) attributed to barriers to continuous treatment, including difficulty attending appointments, obstacles to obtaining medication, untreated depression, lack of a support system, and other unmet social needs. She unfortunately developed multiple complications related to her AIDS diagnosis, including numerous hospital admissions and several severe infections. At only 27 years old, she entered hospice. While treatment for HIV has greatly improved, treatment interruptions continue to contribute to dangerous and potentially lethal sequelae. These barriers are often intricately intertwined with systemic failures in care delivery and support systems. This case underscores the need for more comprehensive implementation of multi-level interventions that address both individual barriers and systemic failures in the delivery of care for people with HIV. Evidence-based, patient-centered strategies that should be more widely enacted include multidisciplinary care teams with case management and social work, assistance with essential needs such as housing and food, flexible appointment scheduling, accessible medication programs, and individually tailored care delivery models. More effectively addressing social determinants of health such as housing instability, food insecurity, and transportation barriers is critical to improving care retention and treatment adherence.