HIV Care

by Academy of Clinical Excellence on March 26, 2013

Last week, I attended the 23rd Annual Clinical Care of the Patient with HIV Infection course sponsored by Johns Hopkins and held in Baltimore. The course triggered a lot of reflection on my experiences caring for HIV patients over the past 29 years.

I took care of my first patient with HIV in April 1984 as a medical student on my pediatric rotation in the Bronx, New York.  She was a one year old with perinatal HIV infection who was admitted with pneumonia.  She died after a two week hospitalization, much of it spent on a ventilator in the intensive care unit.

During my subsequent medical residency in Baltimore, I continued to care for large numbers of adults with horrendous complications of HIV infection, including CMV retinitis causing blindness, central nervous system lymphomas and disfiguring Kaposi sarcoma. 

After residency, I continue to care for patients with HIV and in the early 1990s helped direct a sub-acute/hospice unit for AIDS patients.  At the meeting last week, I chatted with three of the physician assistants who worked on that unit with me.  One of the physician assistants reminded me how depressing it was working there, as over 75% of our patients died.

Thankfully, HIV care changed in 1996 with the advent of effective three drugs regimens to treat HIV. Horrible complications are now rare, but still occasionally seen, mostly in individuals who are unaware of their HIV infection or not engaged in care.  Amazingly, the conference had talks on organ transplantation in individuals with HIV and the notion of “functional cures” by attacking latent HIV reservoirs. 

All seemed upbeat until the lunchtime talk on the second day of the conference.  Dr. Chris Beyrer of the Johns Hopkins University School of Public Health presented data on HIV in men who have sex with men.  He shocked the audience with data showing that in the City of Baltimore, 48% of gay black men are HIV infected.  I cannot think of any other disease affecting a demographic group to this extent.  Indeed, despite all the good news and optimism, there is still plenty of work to be done.

- Mike Fingerhood, MD

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