The clinical management of patients with HIV infection and AIDS

The clinician is faced with a number of problems when treating patients infected with the human immunodeficiency (HIV) virus. Firstly, there is a lack of accurate data on the numbers of people infected by the HIV virus and uncertainty as to the natural history of the infection. This limits the ability to plan health care strategies for the future. Secondly, it is difficult to encompass detailed knowledge of the variety of illnesses which occur in patients with HIV infection and AIDS and the even broader range of therapies and outcomes reported in the literature. Thirdly, the clinician has to keep pace with the rapidly changing nature of the models for HIV pathogenesis and possible therapeutic interventions. However, despite these gaping holes in our knowledge, the main message of this clinical review is that a general awareness of the wide spectrum of conditions associated with HIV infection, coupled with a well organised, multidisciplinary and pragmatic approach, will provide the patients with the best chance of being correctly diagnosed and treated. Furthermore, it must be remembered that, while seeking scientific knowledge and experimenting for a cure, AIDS remains a universally fatal condition. It is essential that palliative care is available alongside and within facilities which are providing potentially curative clinical drug trials. It is equally vital that the patients be given autonomy in deciding which of these aspects of care they choose at any time. Such an approach, and the experience of caring for patients with HIV infection who pass from apparent health to fatal disease, will continue to test the skills and reserves of physicians well into the next century.