Hospice Eligibility - HIV/AIDS

1 SHOULD BE MET.

1. Impairment of Functional Status (both a and b must be met)
a. Is Karnofsky Performance Status (KPS) < 50?
b. Is Palliative Performance Status (PPS) < 50?

2. Burden of Illness – Documented
a. Is CD+4 Count < 25 cells/mcl
b. Persistent viral load > 100,000 copies/ml (two or more assays at one month apart)
c. Any one of the following is present:
(i) CNS lymphoma
(ii) Untreated, or despite persist treatment, wasting? (loss of at lease 10% lean body mass)
(iii) Mycobacterium avium complex (MAC) bacteremia, either untreated, unresponsive to treatment, or treatment refused?
(iv) Progressive Multifocal leukoencephalopathy?
(v) Systemic lymphoma, with advanced HIV disease and partial response to chemotherapy?
(vi) Visceral Kaposi’s sarcoma unresponsive to therapy?
(vii) Renal failure in the absence of dialysis?
(viii) Cryptosporidium infection?
(ix) Toxoplasmosis, unresponsive to therapy?