Attitudes and practices of physicians caring for HIV-infected children

The objective of our study was to describe the practices and attitudes of physicians who manage children with HIV infection.

A 32-question survey was sent to the medical directors of 256 pediatric HIV centers.

Fifty-four percent of centers responded. Seventy-two percent of practitioners had been involved in HIV-related care for more than 5 years. The most common subspecialities of respondents were infectious diseases (37%) and general pediatrics (28%). Although 65% of respondents found their HIV practice more stressful than their other responsibilities, the majority of physicians (65%) felt that their HIV-related responsibilities enhanced their careers. Sixty-eight percent had some concern about contracting HIV and 24% had been exposed to HIV by needle stick injury. Polymerase chain reaction and HIV culture were the main diagnostic tests used, 78 and 62%, respectively. Trimethoprim/sulfamethoxazole for prophylaxis against Pneumocystis carinii pneumonia and zidovudine therapy for primary HIV infection were the first line drugs used by almost all respondents. Only 9% were using intravenous immunoglobulin routinely. Fifty-two percent routinely advocated zidovudine for prophylaxis of HIV infection with needle stick injury. Eighty-three percent of those surveyed thought that all pregnant women should be tested for HIV and 88% advocated treating mother/infant pairs with zidovudine if the mother is HIV-infected.

While HIV practitioners find their work stressful, the majority feel their careers are enhanced by their HIV-related work. There is agreement among most practitioners with regards to diagnostic tests, first-line drug therapies and the limited use of intravenous immunoglobulin. The vast majority of physicians advocate testing pregnant women for HIV infection and treating the mother/ infant pair with zidovudine if the mother is infected.