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HIV Infection: A Clinical Manual
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Second edition. Howard Libman and Robert A. Witzburg; eds. 555 pages. Boston: Little, Brown; 1993. $32.50.
Those who care for patients with human immunodeficiency virus (HIV) infection, teach others about it, and perform clinical research as I do have amassed various local educational materials such as printed guides and manuals. The intended audience is usually medical students and resident physicians, with good reason because they provide an increasingly disproportionate amount of care to HIV-infected persons in this country. Several academic centers have taken their local educational manuals "public" in the past few years, and as more practicing physicians begin caring for patients with HIV and the acquired immunodeficiency syndrome (AIDS), willingly or not, the demand for current, accurate, and practical information for outpatients and inpatients will increase.
A group at Boston University School of Medicine has revised and rewritten its local manual, designed primarily for students and residents, and is offering HIV Infection: A Clinical Manual to the public. The price, soft cover, and weight (525 g for the metrically experienced) are appealing to those seeking an overview text that could actually be read in several 3- or 4-hour readings and also serve as an affordable, quick reference for guidance in daily patient care. The constantly changing knowledge base requires frequent updates, and the cost of this manual is fiscally responsible. More comprehensive and costly texts, such as AIDS: Etiology, Diagnosis, Treatment, and Prevention, third edition, edited by DeVita and colleagues (Philadelphia: J.B. Lippincott, 1993) and Pediatric AIDS, second edition, edited by Pizzo and Wilfert (Baltimore: Williams & Wilkins, 1993), are more appropriate for those extensively involved in HIV and AIDS care or as library-based reference resources. Does this manual meet the objectives indicated by the editors? The succinct answer is yes for some objectives but no for several others.
The manual has 49 authors and is divided into four major sections with 37 chapters. Part I is An Overview of HIV Infection; Part II is Clinical Syndromes; Part III is Opportunistic Diseases; and Part IV is Special Topics. It is impossible to be current in this field, but the chapters present state-of-the-art material through 1992. A text intended to offer practical clinical information with so many authors, however, suffers from the lack of a coherent approach. Although a cliche, this criticism fits particularly well here. For example, useful chapters on many primary care issues, such as the care of the ambulatory patient, women, and illicit drug users, are placed near the end of the text within Part IV, Special Topics. Such chapters should be placed at the beginning of the text and could then better serve as a framework for ensuing chapters on organ-based topics and specific opportunistic diseases. Better arrangement of the sequence of these contributions would help, but too many sections do not offer a careful analysis of cost–benefit issues and do not properly emphasize the need for clinical trials to resolve controversies. The chapters on nutrition and cardiac disorders are particularly lacking in these considerations. This manual, after all, is intended for those with limited to intermediate-level experience in clinical HIV and AIDS care; if some management or diagnostic strategies were taken at face value, they could amount to great cost and arguable benefit. However, several notable chapters provide thorough and balanced updates, such as "HIV Diagnostic Testing" by Craven and Steger, "Syphilis" by Steinberg, and "Dermatologic Manifestations" by Koh and Davis.
I rely on two sources for daily reference when caring for patients with HIV and AIDS: The Medical Management of AIDS, third edition, edited by Sande and Volberding (Philadelphia: W. B. Saunders, 1992), which is approximately the same size and length but has more consistently comprehensive discussions than the Libman text, and the yearly updated, truly pocket-sized Guide to HIV/AIDS Therapy—1993 edited by Sanford and coworkers (Dallas, Texas: Antimicrobial Therapy, Inc.). The latter provides complete advice on anti-infective regimens and doses relevant to HIV and AIDS. The incredible pace of new information and the volatility of accepted clinical strategies requires relatively small, affordable, and portable texts and guides. HIV Infection: A Clinical Manual would be a reasonable place for the student and resident to begin in this enormous field, but better choices are available for those seeking daily clinical advice and explication as they care for the increasing number of patients with HIV and AIDS.
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