HIV management during the final 90 days of life in people living with HIV and advanced cancer: a retrospective cohort study

Non-acquired immunodeficiency syndrome-defining malignancies (NADM) are a major cause of death among people living with human immunodeficiency virus (PLWH). Nonetheless, little is known about the extent to which human immunodeficiency virus (HIV) infection remains controlled during the end-of-life period, which may complicate clinical decision-making and limit access to palliative care services. We aimed to characterize HIV control and antiretroviral therapy (ART) use during end-of-life care in PLWH with NADM. A retrospective study of PLWH at our institution was conducted between 2011 and 2024. PLWH who died from advanced NADM were included. Clinical data from the final 90 days of life were extracted from medical records. Descriptive statistics were used to summarize clinical characteristics and outcomes. Overall, 46 patients were included. The median age at death was 60.5 years, and most patients were male. At baseline, 89.1% were receiving integrase inhibitor-based ART. During the final 90 days of life, 58.7% of patients received systemic anticancer therapy. ART was continued until shortly before death in most patients, with a median interval of 2 days between discontinuation of ART and death. Most patients (84.8%) exhibited peak HIV ribonucleic acid levels of < 200 copies/mL within 90 days before death, and no AIDS-defining opportunistic infections were observed. The most common place of death was our institution (63.0%), followed by home (28.3%), palliative care units (6.5%), and general wards at other hospitals (2.2%). Among PLWH with NADM and well-controlled HIV infection receiving care at a specialized referral center, HIV infection remained well controlled during the final 90 days of life, even in those with advanced cancer. Continuation of ART while oral administration remains feasible appears to be a reasonable approach, and routine ART regimen modification solely because of terminal cancer may not be necessary.