AIDS clinical review最新文献

The underlying degree of immune suppression is an important consideration in the selection of treatment for AIDS-KS. In general, subjects with CD4+ T lymphocytes greater than 500/mm3 require only local therapy unless there is some specific disability caused by the AIDS-KS lesions. Subjects with CD4+ T lymphocytes between 200 and 500/mm3 may respond to recombinant interferon. This therapy is effective in controlling AIDS-KS, can be combined with zidovudine, and has anti-HIV properties. If interferon-alpha with zidovudine is clinically ineffective, systemic chemotherapy may then be required. Subjects with AIDS-KS and CD4+ T lymphocytes less than 200/mm3 should receive PCP prophylaxis, may require systemic chemotherapy, and should be maintained on antiretroviral therapy. Therapy of AIDS-KS is not curative, and a treatment plan of the underlying immune deficiency is essential for planning and implementing rational therapy. AIDS-KS is rarely life threatening but often cosmetically and functionally disabling. Treatment plans remain focused on palliative goals and include reduction of extremity or facial edema, elimination of painful lesions, relief of gastrointestinal disturbances induced by AIDS-KS lesions (including symptoms of outlet obstruction, diarrhea, and rarely blood loss), and reduction of the pulmonary burden of AIDS-KS to improve oxygenation and relieve obstructive pneumonias.

Human immunodeficiency virus disease has presented the medical professional with many challenges over the past 10 years. In the decade ahead, one aspect of working in the field that is certainly becoming an increasingly formidable issue will be dealing with AIDS-related burnout among health care professionals. The risks of AIDS-related burnout are multiple. If providers cannot find effective strategies for coping, it is possible that some of the most sensitive and compassionate workers in the field may leave to seek less stressful career opportunities. Those who focus on the negative impact that HIV disease has had on society will react with increased finger pointing to the risk of burning out as another negative consequence of working with HIV infection. Individual burnout will ultimately impact on the organization requiring interventions at that level as well. Setting up mechanisms for both individuals and organizational systems to combat AIDS-related burnout will, in the short run, add to increased costs of care in a disease already noted for its high treatment expense. However, intervening to prevent AIDS-related burnout will ultimately be cost effective by minimizing its negative effects on individuals and institutions. Learning how to cope with AIDS-related burnout may benefit the medical professional caring for patients with HIV disease as well as the profession as a whole. Facilitation of communication among individuals will certainly be fostered. Already we have seen a reorganization of delivery of health care that encourages the emphasis on integration of the patient into a true partnership with their provider. Becoming aware of the problem of AIDS-related burnout and attempting to prevent it can only serve to foster greater humanism in service professionals. A report of the National Academy of Science Committee for the oversight of AIDS activities recommended in 1988 that "research funding be made available to examine the feasibility and effectiveness of programs to alleviate stress in health care workers who care for AIDS patients." Such funding is long overdue and should be made available immediately. As we enter the second decade of facing the complex challenges of the HIV epidemic, the stress could potentially become overwhelming. Dysfunctional health care providers need not become part of the problem. Now is the time to find solutions.