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HIV DISEASE

The patient has:

  • CD4 + Count < 25 cells/mcL or
  • Persistent viral load > 100,000 copies/ ml plus
  • CNS Lymphoma
  • Wasting (loss of 33%lean body mass), untreated, or not responsive to treatment
  • Mycobacterium avium complex (MAC) bactermia, untreated, unresponsive to treatment, or treatment refused
  • Progressive multifocal leukoenecephalopathy
  • Systemic lymphoma
  • Visceral Kaposi’s sarcoma unresponsive to therapy
  • Renal failure in the absence of dialysis
  • Cryptosporidium infection
  • Toxoplasmosis, unresponsive to therapy
  • Karnofsky Performance Status (KPS) < 50%
  • Advanced AIDS dementia complex

Supporting documentation:

  • Chronic persistent diarrhea for one year
  • Persistent serum albumin < 2.5
  • Concomitant, active substance abuse
  • Age > 50 years
  • Absence of antiretroviral, chemotherapeutic and prophylactic drug therapy related specifically to HIV disease
  • Congestive heart failure, systematic at rest

A physician may determine that a patient has a life expectancy of six months or less even if the above findings are not present. Co-morbidities also support eligibility for hospice care.