Prognosis of HIV Disease Based On Hospice Admission Criteria

What follows is the prognosis for HIV disease based on hospice admission criteria. If a patient meets these criteria he or she is eligible for hospice care which means that he or she has six months or less to live.

To meet the CMS Disease Specific Criteria For terminal (6 months or less prognosis for) HIV disease, the patient must meet the following:

A patient is eligible for hospice services if he
meets these three criteria:
1) has a Palliative Performance Scale of less than 70% [Resource (2)]
2) is dependent on at least two Activities of Daily Living [Resource (3), and
3) meets the Disease Specific Guideline for HIV disease [Resource (1)] below:

HIV Disease
Patients will be considered to be in the terminal stage of
their illness (life expectancy of six months or less) if they
meet the following criteria. (1 and 2 should be present;
factors from 3 will add supporting documentation.)

1. CD4+ Count <25 cells/mcl or persistent (2 or more assays at least one month apart) viral load >100,000 copies/ml, plus one of the following:

  • a. CNS lymphoma;
  • b. Untreated, or persistent despite treatment, wasting (loss of at least 10% lean body mass);
  • c. Mycobacterium avium complex (MAC) bacteremia, untreated, unresponsive to treatment, or treatment refused;
  • d. Progressive multifocal leukoencephalopathy;
  • e. Systemic lymphoma, with advanced HIV disease and partial response to chemotherapy;
  • f. Visceral Kaposi’s sarcoma unresponsive to therapy;
  • g. Renal failure in the absence of dialysis;
  • h. Cryptosporidium infection;
  • i. Toxoplasmosis, unresponsive to therapy.

2. Decreased performance status, as measured by the
Karnofsky Performance Status (KPS) scale, of less than or
equal to 50%.

3. Documentation of the following factors will support
eligibility for hospice care:

a. Chronic persistent diarrhea for one year;
b. Persistent serum albumin <2.5;
c. Concomitant, active substance abuse;
d. Age >50 years;
e. Absence of or resistance to effective antiretroviral,
chemotherapeutic and prophylactic drug therapy
related specifically to HIV disease;
f. Advanced AIDS dementia complex;
g. Toxoplasmosis;
h. Congestive heart failure, symptomatic at rest;
i. Advanced liver disease.


1. Determining Hospice Eligibility In Terminally Ill Patients Hospice by The Bay – An Affiliate Of USCF Health, Updated 3-2014

2. The Palliative Performance Scale For Determination Of Hospice Eligibility
Posted on March 29, 2018 by Tom Wade MD

3. Instruments For The Assessment Of The Activities Of Daily Living [ADLs]
Posted on March 30, 2018 by Tom Wade MD


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