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Human Immunodeficiency Virus Infection in Rural Practice
We read with interest the article by Willard et al,1 which examined the knowledge and treatment of human immunodeficiency virus (HIV) among physicians in rural practice. We agree that the daily management of patients with acquired immunodeficiency syndrome (AIDS) requires physicians to be clinically up-to-date and that this can induce greater confidence of rural and family physicians.
It can be difficult, however, for rural physicians in some areas to gain such clinical experience when the number of patients with HIV that are treated in these areas is low, and the latest treatment methods may not even be available to them. Woffsy et al2 stated, "an AIDS specialist is one who has satisfactorily cared for 3 to 5 AIDS patients and is willing to accept the care of others." Physicians' attitudes, knowledge, and clinical practice with regard to AIDS differ in countries that depend on health system organizations.3 In the Spanish National Health System, which is covered by a national public budget, a family physician cannot prescribe antiretroviral drugs (zidovudine, protease inhibitors) or perform viral load tests, because these drugs and tests must be ordered by a hospital physician (infectious disease specialist, hematologist, oncologist, or internist). In Spain, family physicians in the public health system work only in outpatient facilities (clinics, primary health care centers).
Physicians without access to antiretroviral drugs and tests, isolated family physicians, and physicians with a low volume of patients with AIDS are not able to engage fully in the fight against HIV/AIDS. Results of a study4 in a university hospital showed that many HIV-positive patients did not receive important preventive services, such as appropiate screening tests for tuberculosis and syphilis, or vaccinations for pneumococcal pneumonia, influenza, and hepatitis B. Patients did, however, receive CD4+ cell counts, Pneumocystis carinii prophylaxis, and antiretroviral therapy at acceptable rates.
There is still much that primary care physicians can do in the prevention of HIV/AIDS (education to prevent the sexual spread of HIV; detection of risk be behaviors; and HIV testing and diagnosis) and in the long-term care of patients (counseling; family, partner, and peer support; treatment of the daily illnesses of HIV patients [flu, minor surgery, injuries]; and terminal and home care of patients with HIV). In the absence of antiretroviral drugs and viral load tests, these measures will not win the fight against HIV/AIDS, but will indeed help in education and prevention and in the long-term care of patients.
Esteban González, MD, PhD;
Maria Herrero, MD
Unidad de Medicina de Familia
Centro de Salud Universitario
Villanueva de la Cañiada
28691 Madrid
Spain
1. Willard CL, Liljestrand P, Goldschmidt RH, Grumbach K. Is experience with human immunodeficiency virus disease related to clinical practice? Arch Fam Med. 1999;8:502-508.
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2. Woffsy CB. AIDS care: providing care for the HIV infected. J Acquir Immune Defic Synd. 1988;1:274-283.
3. González E. Conocimientos y opiniones de los médicos sobre el sindrome de inmunodeficiencia adquirida. Med Clin (Barc). 1996;107:664-668.
4. Gifford AL, McPhee SJ, Fordham D. Preventive care among HIV-positive patients in a general medicine practice. Am J Prev Med. 1994;10:5-9.
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Arch Fam Med. 2000;9:790-791.
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