News & Analysis
Physicians Focus on Primary Care for Patients With HIV Bridget M. Kuehn, MSJ
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any patients with HIV infection who receive treatment can now expect to live a near-normal life span. Rapid progress in the treatment of HIV has changed the diagnosis from a death sentence in the 1980s and early 1990s to a treatable but life-shortening illness in the 2000s. Today, HIV infection is a condition that many patients may successfully manage into their golden years, according to data presented by Robert S. Hogg, PhD, professor of health sciences at Simon Fraser University, and colleagues at the International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention (http://bit.ly/1cXihmg). Yet this triumph of modern medicine has created a new set of challenges for clinicians. Many patients with HIV are living long enough to develop chronic conditions, such as heart disease, that are common in the overall primary care population. That means that HIV specialists and primary care physicians who treat patients with HIV now have to learn to integrate their HIV patients’ primary care needs into their overall treatment. To help them do
so, the HIV Medicine Association (HIVMA) has released an updated guideline on primary care for patients with HIV (Aberg JA et al. Clin Infec Dis. doi:10.1093/cid /cit665 [published online November 13, 2013]). Helping HIV specialists bring their primary care skills up-to-date is a key focus of the HIVMA guideline, according to Joel Gallant, MD, associate medical director of specialty services at Southwest CARE Center in Santa Fe, New Mexico, and chair of the HIVMA board of directors. “Therapy for HIV is so effective, most patients come to us with issues that are primary care issues,” explained Gallant. Some of the primary concerns facing these patients are specific to HIV; some are the same as those facing the general population. For example, patients with HIV may be at greater risk for bone density loss as a result of their condition or treatment. So the new guideline recommends that men with HIV as well as postmenopausal women be screened for bone density loss.
New Focus, Need for Training Speeding the adoption of advances in HIV care into practice has been a focus of HIV specialists and public health organizations since the epidemic emerged. This emphasis has helped translate new discoveries into practice within months, rather than the years it typically takes for clinical advances to make their way into medicine, said Laura W. Cheever, MD, ScM, associate administrator of the HIV/AIDS Bureau at the Health Resources and Services Administration. The bureau administers the Ryan White HIV/AIDS Program, which was established in 1990 by the US government to provide comprehensive care for vulnerable populations with HIV. Recently the community health centers have begun emphasizing a new set of treatment challenges, including better management of cholesterol and smoking cessation. Cheever noted that for many specialists, these are newer considerations; when patients had only 6 months to live, she said, physicians were likely to tell patients “they can smoke as much as they want.” The general shift in focus means many HIV specialists must brush up on their
Persons Living With Diagnosed HIV Infection, by Year and Selected Characteristics: United States, 2008–2010 2008
2009
Estimateda Age at End of Year, y
Physicians Focus on Primary Care for Patients With HIV Bridget M. Kuehn, MSJ
M
any patients with HIV infection who receive treatment can now expect to live a near-normal life span. Rapid progress in the treatment of HIV has changed the diagnosis from a death sentence in the 1980s and early 1990s to a treatable but life-shortening illness in the 2000s. Today, HIV infection is a condition that many patients may successfully manage into their golden years, according to data presented by Robert S. Hogg, PhD, professor of health sciences at Simon Fraser University, and colleagues at the International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention (http://bit.ly/1cXihmg). Yet this triumph of modern medicine has created a new set of challenges for clinicians. Many patients with HIV are living long enough to develop chronic conditions, such as heart disease, that are common in the overall primary care population. That means that HIV specialists and primary care physicians who treat patients with HIV now have to learn to integrate their HIV patients’ primary care needs into their overall treatment. To help them do
so, the HIV Medicine Association (HIVMA) has released an updated guideline on primary care for patients with HIV (Aberg JA et al. Clin Infec Dis. doi:10.1093/cid /cit665 [published online November 13, 2013]). Helping HIV specialists bring their primary care skills up-to-date is a key focus of the HIVMA guideline, according to Joel Gallant, MD, associate medical director of specialty services at Southwest CARE Center in Santa Fe, New Mexico, and chair of the HIVMA board of directors. “Therapy for HIV is so effective, most patients come to us with issues that are primary care issues,” explained Gallant. Some of the primary concerns facing these patients are specific to HIV; some are the same as those facing the general population. For example, patients with HIV may be at greater risk for bone density loss as a result of their condition or treatment. So the new guideline recommends that men with HIV as well as postmenopausal women be screened for bone density loss.
New Focus, Need for Training Speeding the adoption of advances in HIV care into practice has been a focus of HIV specialists and public health organizations since the epidemic emerged. This emphasis has helped translate new discoveries into practice within months, rather than the years it typically takes for clinical advances to make their way into medicine, said Laura W. Cheever, MD, ScM, associate administrator of the HIV/AIDS Bureau at the Health Resources and Services Administration. The bureau administers the Ryan White HIV/AIDS Program, which was established in 1990 by the US government to provide comprehensive care for vulnerable populations with HIV. Recently the community health centers have begun emphasizing a new set of treatment challenges, including better management of cholesterol and smoking cessation. Cheever noted that for many specialists, these are newer considerations; when patients had only 6 months to live, she said, physicians were likely to tell patients “they can smoke as much as they want.” The general shift in focus means many HIV specialists must brush up on their
Persons Living With Diagnosed HIV Infection, by Year and Selected Characteristics: United States, 2008–2010 2008
2009
Estimateda Age at End of Year, y
