P&S Journal: Spring 1994, Vol.14, No.2
P & S News
Expert Panel Releases New HIV Practice Guidelines
Dr. Wafaa El-Sadr, associate professor of clinical medicine at P&S and chief of infectious diseases at Harlem Hospital Center, co-chaired a 19-member expert panel that released new federal guidelines in January for internists, family doctors, pediatricians, and other "front line" primary care practitioners who provide critically important early care for people newly infected with HIV.
"We have synthesized important information needed to effectively evaluate and manage selected aspects of early HIV infection, and put it in 'clinician-friendly' formats," says Dr. El-Sadr.
According to Dr. Philip Lee, assistant secretary of health for the Department of Health and Human Services, "The guidelines will mostly benefit primary care practitioners who until now have had limited contact with HIV-infected patients or who have not felt confident enough to treat them."
The panel also developed reading material to help the infected individual and family members deal with early stages of the disease. Panel members were physicians, dentists, social workers, nurses, physician assistants, and a man and a woman with HIV.
Some of the issues addressed in the practice guidelines are disclosure counseling, evaluation and care of adults
and adolescents, evaluation and care of infants and children, and case management. "The guideline is a call to arms," says Dr. El-Sadr. "It calls on all providers in this country, especially those who provide primary care, to seek information regarding HIV and to eagerly provide care to those living with the virus."
Dr. El-Sadr has been involved in the HIV epidemic since its beginnings. She provides primary care to a large number of HIV-infected men and women and has developed several innovative programs for providing comprehensive inpatient and outpatient care for people with HIV. She has led efforts to improve access by all communities to clinical trials. She is principal investigator of the Harlem AIDS Treatment Group, an NIAID-funded program, which developed a clinical trials program for patients in the Harlem community.
The guidelines include special recommendations for women, adolescents, and children. Women and adolescents constitute the fastest growing segments of the estimated 40,000 to 60,000 new cases of HIV infection identified each year in the United States, says panel co-chair, Dr. James Oleske, director of allergy, immunology, and infectious diseases in the pediatrics department of the New Jersey Medical School in Newark.
"It is especially important to treat HIV-infected infants aggressively," says Dr. Oleske, "since the disease progresses more rapidly in children than in adults."
The panel calls for women (including pregnant women), adolescents, and children to be included in clinical trials and experimental protocols.
The 197-page publication for caregivers, "Evaluation and Management of Early HIV Infection," is published by the Agency of Health Care Policy and Research in the Public Health Service. Free copies can be requested by calling 1-800-342-2437 (AIDS), 1-800-344-7432 (SIDA) for those who speak Spanish, and 1-800-AIDS-TTY for the deaf.