Generalist physicians and those with little experience caring for HIV/AIDS patients need expert advice for the increasingly complex process of treating them, suggest the results of a survey of physicians in California, Florida, Massachusetts and New York.

This study is another chapter in the long-standing debate over whether general physicians are qualified to treat HIV/AIDS patients.

"Based on the data presented here, generalists in several high HIV-prevalence states may not be prepared to provide state-of-the-art care for those with HIV/AIDS," says author Valerie E. Stone, M.D., M.P.H., who conducted the study while in the department of medicine at Memorial Hospital of Rhode Island, Brown University School of Medicine. She now holds faculty positions at Harvard University and Massachusetts General Hospital.

Stone and colleagues surveyed more than 1,000 general physicians and infectious disease specialists on their treatment recommendations for two hypothetical HIV patients. HIV/AIDS treatment has improved dramatically in recent years but now requires careful management using specific combinations of antiretroviral drugs.

General internal medicine physicians were less likely than infectious disease specialists to recommend treatments consistent with guidelines from the Department of Health and Human Services and the International AIDS Society. Also, physicians with less HIV experience, regardless of specialty, were less likely to choose recommended therapies.

On a positive note: those less knowledgeable about treatment guidelines appeared aware of the gaps in their knowledge.

"Many generalists and those with less HIV experience indicated they would have referred the patients to another physician for management of HIV," Stone notes.

The study results are published in the current issue of the Journal of General Internal Medicine.

"It should be emphasized that the generalists with moderate-to-high HIV experience in this study had high levels of knowledge and prescribing practices that were in line with current standards, and essentially equivalent to those of the infectious disease physicians in the study," Stone says.

The researchers conclude that primary care physicians should consult with an HIV expert when caring for HIV/AIDS patients if they feel they need treatment advice.

"These results suggest physicians are able to gauge their own HIV competency and determine when there is a need for consultation," they say.

This research was supported by an award from the Robert Wood Johnson Foundation, and a grant from Agouron Pharmaceuticals, Inc.

###

The Journal of General Internal Medicine, a monthly peer-reviewed journal of the Society of General Internal Medicine, publishes original articles on research and education in primary care. For information about the journal, contact Renee F. Wilson at (410) 955-9868.