PREVENTIVE CARE AMONG HIV-POSITIVE PATIENTS IN A GENERAL MEDICINE PRACTICE

We randomly selected a cohort of human immunodeficiency virus (HIV)-po sitive patients from a large university-based general medicine practic e to determine how often recommended disease prevention services are r eceived. We used a standardized medical record review protocol to gath er data from the records of 159 randomly selected HIV-positive adults followed in a university general medicine practice. We set 80% as the minimum acceptable rate of receipt of each recommended preventive serv ice. Within three months of initiating HIV care, 88% of patients had C D4+ cell counts. Within six months, 75% had serology for syphilis, 64% had purified protein derivative tuberculin skin tests, 64% had hepati tis B serology, and 49% had pneumococcal vaccinations. Within one year , 33% had influenza vaccinations. Of 50 subjects eligible for Pneumocy stis carinii prophylaxis (CD4+ cells <200/mm3), 88% had started prophy laxis within six months. Of 56 subjects eligible for antiretroviral th erapy (CD4- cells <500/mm3), 77% had started an antiretroviral within six months. Within one year, 22% of 23 subjects with documented nonimm unity to hepatitis B began hepatitis vaccination; only one subject com pleted the series of three vaccinations. Many HIV-positive patients di d not receive appropriate screening tests for tuberculosis and syphili s or vaccinations for pneumococcal pneumonia, influenza, and hepatitis B. Patients did receive CD4- cell counts, Pneumocystis carinii prophy laxis, and antiretroviral therapy at acceptable rates.