On August 13, 2003,1 authors Peter A.
Selwyn, MD, MPH, and Marshall Forstein, MD, introduced Claude, a 33-year-old
African American man with advanced human immunodeficiency virus (HIV) infection,
who had been diagnosed in 1992. Claude was under the care of Dr K, who felt
stymied by the fact that Claude's HIV viral load remained elevated despite
ongoing antiretroviral therapy. His complicated and debilitating course included
multiple opportunistic infections, as well as rectal carcinoma, scrotal carcinoma
in situ, peripheral neuropathy, and chronic wasting syndrome. He lived at
home with his aunt, Ms D, who was his primary caregiver. Although his clinical
course was often dramatic and although he had enrolled and disenrolled in
hospice on 3 separate occasions, his persistent will to live ultimately charted
the course of ongoing therapies taken by his physician and family.
Markowitz AJ, Rabow MW. Overcoming the False Dichotomy of "Curative" vs "Palliative" Care for Late-Stage HIV/AIDS"Let Me Live the Way I Want to Live, Until I Can't". JAMA. 2004;291(4):492. doi:10.1001/jama.291.4.492