title: Changing patterns of presentations of patients with HIV-related disease at a tertiary referral centre and its implications for physician training.
abstract: Highly active antiretroviral therapy (HAART) has been shown to be highly effective in controlling HIV-related disease progression. Our objective was to determine whether HAART had altered the spectrum of HIV-related disease presentations at a tertiary medical referral centre and if a change in the clinical presentations of HIV-infected individuals to the hospital had impacted on physicians' training. A retrospective study which examined all admissions of HIV-infected patients identified between 1 October 1996 to 30 September 1998 using a hospital-designed computer database was undertaken at the Beth Israel Deaconess Medical Center (BIDMC) tertiary medical referral centre. All medical residents were surveyed in order to assess their knowledge of HIV-associated admissions and their confidence treating HIV-infected patients. There were significant changes in the admitting diagnosis for HIV-related illness between 1996 and 1998. Admissions for opportunistic infections (OIs) declined whereas admissions with bacterial infections increased significantly. Use of HAART remained stable between the 2 years of the study. Physicians' overestimated the use of HAART and only 8% of residents felt very comfortable taking care of an HIV-infected patient. In conclusion, the spectrum of presentations with HIV-related disease to a tertiary referral centre continues to change in the HAART era and impacts on physicians' experience of the management of HIV disease.
authors.affiliation: Department of Infectious Diseases, Beth Israel and Deaconess Medical Center, Brookline Avenue, Boston, MA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Segal
authors.forename: M C
authors.initials: MC
authors.lastname: Poznansky
authors.forename: L
authors.initials: L
authors.lastname: Connors
authors.forename: K
authors.initials: K
authors.lastname: Sands
authors.forename: T
authors.initials: T
authors.lastname: Barlam
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology*; D001900:Boston / Q000453:epidemiology; D002983:Clinical Competence / Q000592:standards; D015331:Cohort Studies; D003151:Community Health Centers; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D015497:HIV-1; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D010820:Physicians / Q000592:standards*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
chemical_list: D019380:Anti-HIV Agents