Immunovirologic Control 24 Months After Interruption of Antiretroviral Therapy Initiated Close to HIV Seroconversion

The authors provide us with a clear message that to improve patients' QoL at the EOL we need to decrease the aggressiveness of care and provide better support to our patients. Hence, urgent change in our practice for patients coming close to the EOL is required. Oncologists need to decrease likely ineffective and toxic chemotherapy, given that this may have a negative impact on both QoL 1 and survival. However difficult, we need to have honest EOL discussions with our patients, which can facilitate this transition from disease-directed therapy to care focusing on palliation of symptoms and improving QoL. Previous work from the CWC study has shown that EOL discussions reduce aggressive care and thus improve QoL, result in EOL care more consistent with patients' preferences, 4 and reduce health care costs in the final week of life. Furthermore, improving patients' symptoms and QoL can be achieved by further training of oncologists in palliative care, 2 by involving other members of the multidisciplinary team (eg, psychologists, chaplains) and by referring patients with advanced, incurable cancer to palliative care.