Table 2: Common symptoms in patients with AIDS and possible disease-specific and palliative interventions.

Table 2: COMMON SYMPTOMS IN PATIENTS WITH AIDS AND POSSIBLE DISEASE-SPECIFIC AND PALLIATIVE INTERVENTIONS

	Possible Causes	Disease Specific Rx	Palliative Rx
CONSTITUTIONAL
Fatigue, weakness	AIDS Opportunistic Infections Anemia	HAART treat specific infections erythropoeitin, transfusion	Corticosteroids (prednisone, dexamethasone) Psychostimulants (methylphenidate, pemoline, dextroamphetamine, modafinil)
Weight loss/anorexia	HIV Malignancy	HAART chemotherapy nutritional support/enteral feedings	Corticosteroids Testosterone/androgens Oxandrolone Megestrol acetate Dronabinol Recombinent growth hormone
Fevers/Sweats	DMAC CMV HIV Lymphoma, malignancy	azithromycin, ethambutol ganciclovir, foscarnet HAART chemotherapy	NSAIDS (ibuprofen, indomethicin, cox-2 inhibitors) Corticosteroids Anti-cholinergics (hyoscine, thioridazine) H2-antagonists (cimetidine)
PAIN
Nociceptive -Somatic -Visceral Neuropathic	Opportunistic infections, HIV-related malignancies, non-specific HIV-related peripheral neuropathy CMV VZV dideoxynucleosides (didanosine, zalcitabine, stavudine) other medications (isoniazid)	treat specific disease entities HAART ganciclovir, foscarnet, acyclovir, famciclovir change antiretroviral or other regimen	NSAIDS Opioids Corticosteroids NSAIDS Opioids (esp. methadone) and adjuvants - trycyclic anti-depressants (amitriptyline, imipramine) - benzodiazepines (clonazepam) - anti-convulsants (gabapentin) Corticosteroids Acupuncture
GASTROINTESTINAL
Nausea/ Vomiting	Esphageal candidiasis CMV HAART	fluconazole, amphotericin-B ganciclovir, foscarnet change antiretroviral regimen	Dopamine antagonists (haloperidol, prochloperazine) Prokinetic agents (metoclopromide) Antihistamines (diphenhydramine, promethazine) Anticholinergics (hyoscine, scopalamine) Serotonin antagonists (granisetron, ondansetron, dolasetron) H2- blockers (cimetidine) Proton pump inhibitors (omeprazole) Somatostatin analogues (octreotide) Benzodiazepines (lorazepam) Corticosteroids
Diarrhea	MAI Cryptosporidiosis CMV microsporidiosis Other intestinal parasites Bacterial gastroenteritis Malabsorbtion	azithromycin, ethambutol paromomycin ganciclovir, foscarnet albendazole other anti-parasitic agents other antibiotics	Bismuth, methylcellulose, kaolin diphenoxylate + atropine loperamide octreotide tincture of opium
Constipation	dehydration malignancy anticholingergics, opioids	hydration radiation/chemotherapy medication adjustment	Activity/diet Prophylaxis on opioids Softening agents - surfactant laxatives (docusate) - bulk-forming agents (bran, methylcellulose) - osmotic laxatives (lactulose, sorbitol) - saline laxatives (magnesium hydroxide) Peristalsis-stimulating agents - anthracenes (senna) - polyphenolics (bisacodyl)
RESPIRATORY
Dyspnea	PCP bacterial pneumonia anemia pleural effusion/mass/ obstruction decreased respiratory muscle function	trimethoprim/sulfameth- oxazole, pentamidine, atovaquone etc. other antibiotics erythropoeitin, tranfusion drainage/radiation/surgery	Use of fan, open windows, oxygen, opioids bronchodilators, methyl xanthines, benzodiazepines (lorazepam)
Cough	PCP, bacterial pneumonia TB	anti-infective therapy (as above) anti-tuberculous chemotherapy	Cough suppressants (dextromethorphan, codeine, other opioids) Decongestants, expectorants (various)
Increased secretions ("death rattle")	Fluid shifts, ineffective cough, sepsis, pneumonia	antibiotics as indicated	Atropine, hyoscine, transdermal scopalomine, glycopyrrolate, fluid restriction, discontinue intervenous fluids
DERMATOLOGIC
Dry skin	dehydration end-stage renal disease end-stage liver disease malnutrition	hydration dialysis nutritional support	Emollients +/- salicylates Lubricating ointments
Pruritis	fungal infection end-stage renal disease end-stage liver disease dehydration eosinophilic follicultitis	antifungals dialysis hydration steroids, antifungals	Topical agents (menthol, phenol, calamine, doxepin, capsaicin) Anti-histamines (diphenhydramine) Corticosteroids Serotonin antagonists (ondansetron) Opioid antagonists (naloxone, naltrexone) Anti-depressants Anxiolytics Neuroleptics Thalidomide (?)
Decubiti/Pressure Sores	poor nutrition, decreased mobility, prolonged bed rest	nutrition increase mobility	Prevention (nutrition, mobility, skin integrity) Wound protection (semi-permeable film/hydrocolloid dressing) Debridement (normal saline, enzymatic agents, alginates)
NEUROPSYCHIATRIC
Delirium/agitation	electrolyte imbalances dehydration toxoplasmosis cryptococcal meningitis sepsis	correct imbalances hydration sulfadiazine/pyrimethamine antifungals antibiotics	Neuroleptics (haloperidol, risperidone, chlorpromazine) Benzodiazepines (lorazepam, midazolam)
Dementia	AIDS- related dementia	HAART	Psychostimulants (methylphenidate) Low dose neuroleptics (haloperidol)
Depression	Chronic illness, reactive Depression, major depression	antidepressants (tricyclics, SSRI’s MAO inhibitors, other)	Psychostimulants (methylphenidate, pemoline, dextroamphetamine, modafinil) Corticosteroids (prednisone, dexamethasone)

[Citation: Selwyn PA, Rivard M. Palliative care for AIDS: Challenges and opportunities in the era of highly active anti-retroviral therapy. Innovations in End-of-Life Care. 2002;4(3), www.edc.org/lastacts]

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