The ambulatory care of HIV-infected persons

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Abstract
Objective:To describe the use of various counseling practices, examinations, and laboratory tests used by general internists in the primary care of HIV-infected persons. Design:Mailed questionnaire survey. Subjects:Random sampling of members of the Society of General Internal Medicine. Results:Based on a 64% response rate (131/205), there are many areas of physician agreement in the ambulatory care of HIV-infected persons. Greatest physician consensus was seen in the use of viral serologic testing, vaccinations, and Pap tests. Most (70–80%) primary care physicians do not use surrogate markers such as β 2-microglobulin and p24 antigen to follow disease progression; instead, they rely mostly on CD4 lymphocyte counts. Sixty percent of physicians continue to order CD4 lymphocyte counts when a baseline count is under 200 cells/mm 3.All studies are ordered more frequently for patients with more advanced disease. As a group, those physicians following the largest number of patients do not manage patients significantly differently from the less HIV-experienced physicians. Conclusions:Despite some variation, there is substantial consensus on the “routine” management of HIV-infected persons. Clinical guidelines would be one mechanism for defining appropriate care of HIV-infected patients. The majority judgments of the practitioners studied here could be one component among various sources of information used by expert panels to define guidelines except where studies clearly indicate a different and more effective approach. Such incorporation might increase guideline acceptance by practicing clinicians.