Asymptomatic patients with HIV infection. Keeping them well

Primary care physicians need to be prepared to counsel and manage patients with human immunodeficiency virus (HIV) infection. Asymptomatic seropositive patients should be seen quarterly, and T4 lymphocyte counts should be followed. Other serologic markers that may detect disease progression are p24 antigen and beta 2 microglobulin. Abnormalities in the levels of these markers may influence the decision to initiate early antiretroviral therapy. Therapeutic regimens are now available for delaying progression of HIV disease and for preventing Pneumocystis carinii pneumonia, the most common opportunistic infection to develop in patients with HIV infection. Whether antiretroviral therapy should be initiated in all asymptomatic HIV-positive patients remains to be seen. Physicians can do their part by educating themselves about HIV infection so they can provide competent, nonjudgmental care to patients and by supporting legislation to protect the rights of HIV-infected persons.