Therapeutic and diagnostic procedures in hospitalized AIDS patients with terminal illness

Clinical charts of 235 consecutive patients with AIDS who died in our in-patient Department between 1985-94 have been evaluated in order to assess the delivery of care during the last week of life, regarding drug administration and diagnostic procedures. The management of the 81 subjects who died between 1985 and 1990 (period A) was compared with that of the 154 patients who died between 1991 and 1994 (period B). Patients followed during period B were treated with a greater number of antimicrobial agents (p < 0.001), supportive drugs (p < 0.001), and blood and blood products units (p < 0.005), while no significant difference was found for agents used for pain management. When assessing diagnostic procedures, during period B our patients had a greater number of plain radiological and ultrasonographic exams (p < 0.001), tomographic and scintigraphic scans (p < 0.005), while the use of other invasive diagnostic techniques did not change significantly. As suggested by our evaluation of possible indicators of curative or palliative care, during recent years the availability of more advanced, diagnostic techniques and new treatments for AIDS complications seemed to have influenced the management and medication of terminal disease in a potentially curative rather than palliative way.