The following factors, combined with clinical judgment, may help decide whether
individual patients are hospice appropriate:

1. CD4+ count

_____ > 50 cells/mc/L: Patient probably has a prognosis of > 6 months unless there is a non-HIV-related co-existing life-threatening disease
_____ < 25 cells/mc/L:

_____ measured during a period when patient is relatively free of acute illness
_____ observed disease progression and decline in functional status

2. Viral load

_____ > 100,000 copies/ml: Patient may have a prognosis of less than 6 months
_____ < 100,000 copies/ml and meet the following criteria:

_____ patient has elected to forego antiretroviral and prophylactic medication
_____ functional status is declining
_____ experiencing complications (see 4 below)

3. Life-threatening complications with median survival

4. The following factors have been shown to decrease survival significantly:

_____ chronic persistent diarrhea for one year, regardless of etiology
_____ persistent serum albumin < 2.5 gm/dl
_____ concomitant substance abuse
_____ age greater than 50
_____ decisions to forego antiretroviral, chemotherapeutic, and prophylactic drug therapy related specifically to HIV disease
_____ congestive heart failure, symptomatic at rest