Primary care and HIV disease

Nearly one million Americans are infected with the human immunodeficiency virus (HIV). With the advent of increasingly effective therapy, including intervention early in the course of infection, there will be a growing need for physicians technically and attitudinally prepared to provide primary care for HIV-infected individuals. For any disease, however, determination of which physicians provide the bulk of care depends on several factors, including the prevalence and chronicity of the disease, the complexity, rate of change, and toxicity of therapy, and the socioeconomic characteristics of patients with the disease. General internists will clearly constitute a large part of the pool of practitioners caring for HIV-infected patients, especially in the earlier stages of infection. It seems reasonable to expect every general internist to be competent in four aspects of HIV care: counseling about transmission and prevention; the proper administration and interpretation of diagnostic tests; monitoring and care of patients in early stages of infection; and recognition of complications of advanced infection for proper management or referral. Academically based generalists will have a major role in research, teaching, and patient care in the AIDS epidemic. The organization and delivery of primary and specialty care for HIV-infected people in future years will continue to evolve with changes in therapy and in the demography of the epidemic.