Introduction

HIV/AIDS clinical care has improved dramatically over the decades, given the availability of new medications and a better understanding of how best to use antiretrovirals and deliver primary care to persons living with HIV/AIDS. Positive change on such a massive scale, however, brings with it new demands on clinicians.

Along with innovations in HIV drug therapies, HIV/AIDS care has become more complex than ever before due to increasing comorbidities that are attributable to HIV treatment and the aging of the HIV-infected population in the United States. Patient needs also have expanded across a broad spectrum of medical, psychological, behavioral, and social issues. Notably, significant numbers of infected individuals are identified and enter care late in the course of their HIV disease, confronting clinicians with complex and immediate care challenges.

Since the early days of the epidemic, clinicians have received training in HIV/AIDS clinical care through the AIDS Education and Training Centers (AETCs) Program -- the clinical training arm of the Ryan White HIV/AIDS Program that is administered by the Health Resources and Services Administration (HRSA) and its HIV/AIDS Bureau (HAB). The AETC network trains approximately 150,000 health care providers each year during more than 18,000 training events.

The Guide for HIV/AIDS Clinical Care is a pillar of the Ryan White HIV/AIDS Program's mission to continuously improve HIV/AIDS clinical care. The Guide was first published in 1993 as a collaborative effort of several regional AETCs and was subsequently updated and expanded in 2006. The version before you incorporates many new insights, but the time-tested format has been retained -- easy access to crucial facts for a busy clinician. The developers of the Guide strive to be responsive to how HIV/AIDS clinical care is provided today.

  • With more routine HIV testing in medical settings, a large number of individuals are entering care via primary care sites that have relatively limited experience managing HIV/AIDS disease.
  • A notable proportion of HIV/AIDS primary care in the United States is provided by advanced practice nurses and physician assistants.
  • Shortages in the health care work force are worsening. Experienced staff members are aging and retiring, a limited number of new clinicians are entering primary care and specializing in HIV/AIDS care, and fewer clinicians are available in geographic areas with limited resources.

As a result, front line primary care providers may be less familiar with management of HIV/AIDS disease, as outlined in U.S. Department of Health and Human Services treatment guidelines and clinical practices presented in this Guide.

By presenting best practices in the clinical management of HIV/AIDS disease, the Guide can help us continue the remarkable advances in HIV/AIDS care that have made the Ryan White HIV/AIDS Program a model for health care delivery for our Nation and for the world.

Laura W. Cheever, MD, ScM
Deputy Associate Administrator
HIV/AIDS Bureau
U.S. Department of Health and Human Services
Health Resources and Services Administration (HRSA)