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Primary care and specialty care in the age of HAART.


 The advent of complex highly active antiretroviral therapy (HAART) brings to light the issue of whether people with HIV infection or AIDS should be managed by a primary care physician or by an HIV specialist. There is no HIV specialist per se, however, experience can increase the skills needed to treat this disease. Experience is defined as having treated between 5 and 20 patients living with HIV. Primary care physicians have historically developed skills in treating chronic multisystem diseases, but HIV has gained a new complexity with the battery of antiretroviral medications available. Primary care physicians must now learn about viral dynamics and resistance, viral load measurements, and the specifics of each available drug. In addition, educating patients to comply with their regimens requires counseling skills, knowledge of adverse effects management, and managing lifestyle issues. Consulting with experienced practitioners on various aspects of HIV infection and AIDS is useful and the network of medical consultants should always be strengthened. All patients deserve to be treated by a physician with current skills in providing antiretroviral therapy, as well as by a committed primary care physician.
