Here's a relevant Reuter's story:
Management Of The HIV-Infected Patient Needs Rethinking
WESTPORT, Oct 08 (Reuters) - The concept of AIDS as a primary care disease
needs to be reexamined, according to New York-based researchers. Based on the
most recent developments, it appears that the time of the "HIV specialist" has arrived,
say Drs. Abigail Zuger of Albert Einstein College of Medicine and Victoria L. Sharp of
St. Luke's-Roosevelt.
In the current issue of The Journal of the American Medical Association, they point out
that there now is "...a new appreciation of the potential and limitations of antiretroviral
therapy." Advances in the area of HIV pathogenesis, along with the increased
"...penetration of managed care into clinical medicine" have also changed the treatment
scenario.
The original primary care paradigm at the beginning of the decade called for the
monitoring of asymptomatic HIV-positive patients. However, it is becoming apparent
that early treatment intervention is warranted for these patients, the authors point out.
More and more HIV drugs are becoming available through research protocols and
expanded access programs, and some patients are more informed about
state-of-the-art treatments than their physicians.
Recent studies have also found that patients treated by AIDS experts have
"significantly prolonged survival times" compared with patients treated by physicians
with less experience.
Although all physicians should know the basics of HIV prevention and diagnosis, Drs.
Zuger and Sharp say "...full care is necessarily the realm of expert physicians with
ongoing clinical expertise." They believe that "[t]he medical complexities of [patients
with HIV infection] should not be trivialized by well-meaning efforts to mainstream
them."
In a second editorial, which appears in the same issue of the Journal, Dr. Charles E
Lewis of the University of California in Los Angeles agrees that HIV-infected patients
are probably better off with clinicians with have extensive experience. However, the
government's recent "Guidelines for the Use of Antiretroviral Agents in HIV-Infected
Adults and Adolescents" do not provide "...recommendations for the means to
accomplish the suggested pattern of referral between 'experts' and 'nonexperts.'"
One possible benefit of using a primary care physician is that there may be "...a more
extensive and ongoing relationship between physicians and patients and between
physicians and patients' families and significant others." Dr. Lewis also points out that
"...the reality is that a variety of barriers such as geography, economics and
professional pride may thwart the intention of policymakers."
JAMA 1997;278:1131-1134.
-Westport Newsroom 203 319 2700 |
