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.