ATTITUDES AND PRACTICES OF PHYSICIANS CARING FOR HIV-INFECTED CHILDREN

Objective: The objective of our study was to describe the practices an d attitudes of physicians who manage children with HIV infection. Meth ods: A 32-question survey was sent to the medical directors of 256 ped iatric HIV centers. Results: Fifty-four percent of centers responded. Seventy-two percent of practitioners had been involved in HIV-related care for more than 5 years. The most common subspecialities of respond ents were infectious diseases (37%) and general pediatrics (28%). Alth ough 65% of respondents found their HIV practice more stressful than t heir other responsibilities, the majority of physicians (65%) felt tha t their HIV-related responsibilities enhanced their careers. Sixty-eig ht percent had some concern about contracting HIV and 24% had been exp osed to HIV by needle stick injury. Polymerase chain reaction and HIV culture were the main diagnostic tests used, 78 and 62%, respectively. Trimethoprim/sulfamethoxazole for prophylaxis against Pneumocystis ca rinii pneumonia and zidovudine therapy for primary HIV infection were the first line drugs used by almost all respondents. Only 9% were usin g intravenous immunoglobulin routinely. Fifty-two percent routinely ad vocated zidovudine for prophylaxis of HIV infection with needle stick injury. Eighty-three percent of those surveyed thought that all pregna nt women should be tested for HIV and 88% advocated treating mother/in fant pairs with zidovudine if the mother is HIV-infected. Conclusions: While HIV practitioners find their work stressful, the majority feel their careers are enhanced by their HIV-related work. There is agreeme nt among most practitioners with regards to diagnostic tests, first-li ne drug therapies and the Limited use of intravenous immunoglobulin. T he vast majority of physicians advocate testing pregnant women for HIV infection and treating the mother/infant pair with zidovudine if the mother is infected.