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Perspectives on Care at the Close of Life: CODA
January 28, 2004

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

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.

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