Preventive care among HIV-positive patients in a general medicine practice

We randomly selected a cohort of human immunodeficiency virus (HIV)-positive patients from a large university-based general medicine practice to determine how often recommended disease prevention services are received. We used a standardized medical record review protocol to gather data from the records of 159 randomly selected HIV-positive adults followed in a university general medicine practice. We set 80% as the minimum acceptable rate of receipt of each recommended preventive service. Within three months of initiating HIV care, 88% of patients had CD4+ cell counts. Within six months, 75% had serology for syphilis, 64% had purified protein derivative tuberculin skin tests, 64% had hepatitis B serology, and 49% had pneumococcal vaccinations. Within one year, 33% had influenza vaccinations. Of 50 subjects eligible for Pneumocystis carinii prophylaxis (CD4+ cells < 200/mm3), 88% had started prophylaxis within six months. Of 56 subjects eligible for antiretroviral therapy (CD4+ cells < 500/mm3), 77% had started an antiretroviral within six months. Within one year, 22% of 23 subjects with documented nonimmunity to hepatitis B began hepatitis vaccination; only one subject completed the series of three vaccinations. Many HIV-positive patients did not receive appropriate screening tests for tuberculosis and syphilis or vaccinations for pneumococcal pneumonia, influenza, and hepatitis B. Patients did receive CD4+ cell counts, Pneumocystis carinii prophylaxis, and antiretroviral therapy at acceptable rates.