Management of the HIV Infected Patient

The past two decades, and certainly the past five or six years, have seen remarkable changes in state-of-the-art diagnosis of and therapy for HIV-1 infection. Some advances in the field, such as highly active antiretroviral therapy (HAART), have been nothing short of revolutionary. Completely revised and updated, Management of the HIV-Infected Patient, Second Edition is an authoritative resource on the care of the HIV-infected patient.

The book contains state-of-the-art information on the clinical presentation, diagnosis, and management of the various manifestations of HIV infection. The editors have gathered a diverse panel of authors to discuss the significant changes that have occurred over the past few years. New chapters cover recent advances such as increased emphasis on the use of laboratory test for diagnosis and for monitoring disease progression, existing chapters have been brought up-to-date and extended. Drawing on the best expertise available in the United States, Australia, and Europe, the text is an excellent, thorough review of the clinical presentation and management of patients afflicted with HIV.

It is difficult to think of a topic in biomedicine about which it is harder to write a textbook than human immunodeficiency virus type 1 (HIV-1) and AIDS. The past two decades, and certainly the past five or six years, have seen remarkable changes in state-of-the-art diagnosis of and therapy for HIV-1 infection. Some advances in the field, such as highly active antiretroviral therapy (HAART), have been revolutionary. A textbook on this topic could be out of date before it even comes to print. Lately, however, the field has matured. HIV-1 infection, at least in the developed world, has begun to take on the aspects of a chronic, outpatient disease. In addition, treatments against the virus, as well as against opportunistic infections and AIDS-related tumors, are stabilizing. For these reasons, the second edition of this excellent textbook appears at an opportune moment. It is likely that it will remain an up-to-date and useful resource for some time to come. The editors have enlisted a diverse group of authors to review the diagnosis and treatment of HIV-1 infection and its sequelae. Each chapter is well thought out, and there is a nice progression from basic and translational science to clinical medicine. There is also a chapter on how treatment methods may differ in the developing world. It is difficult to cover this immense topic in its entirety, but the editors and the authors do a very solid job of making this book readable and useful for clinical scientists who investigate HIV-1 infection as well as for other infectious-disease specialists and general internists. It will serve physicians who treat patients with HIV-1 infection in academic medical centers or private practice. It will also be extremely useful for fellows in clinical infectious disease as they enter and proceed through training. Any book that attempts to cover such a wide body of information will have some faults or omissions. I would like to have seen more information on the developing immune-based therapeutic approaches to HIV-1 infection, including structured treatment interruptions and the use of interleukin-2 to increase the levels of CD4+ T lymphocytes in patients with profoundly decreased CD4+ counts who do not have a response to HAART. A full chapter on viral resistance would help clinicians understand this complex topic. More coverage of salvage therapy would complement the discussion of viral resistance. A more complete discussion of the various presentations of the immune reconstitution syndrome, which occurs after the initiation of HAART in patients with subclinical infections, and a more detailed discussion of the interactions between HIV-1 and hepatitis C virus would be useful. Finally, although Mycobacterium avium complex is thoroughly covered, other atypical mycobacteria are not. The chapters on antiretroviral treatment are quite complete and progress logically. There will surely be some changes in the guidelines for the use of this type of therapy. As fusion inhibitors and chemokine-receptor antagonists are developed, there will be important changes in the therapeutic armamentarium over the next few years. If clinically useful integrase inhibitors can be developed, they will constitute another new class of antiretroviral agents. Finally, as patients with HIV-1 infection live longer and more productive and healthy lives because of antiretroviral therapy, issues such as organ transplantation in HIV-1-infected persons will have to be addressed. One highlight of this book is the moving and appropriate dedication to Drs. Jonathan Mann and Mary Lou Clements-Mann, who gave so much to the field of AIDS research before their untimely deaths in an airplane accident. This book will be an extremely useful and important addition to the libraries of physicians and medical scientists who are interested in clinical HIV-1 infection. Care of the HIV-1-infected patient is still a moving target, but the second edition of this textbook clearly hits the mark. It nicely summarizes what we now understand and what still requires further research. Roger J. Pomerantz, M.D.
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