Changing patterns of presentations of patients with HIV-related disease ata tertiary referral centre and its implications for physician training

Highly active antiretroviral therapy (HAART) has been shown to be highly ef fective in controlling HIV-related disease progression. Our objective was t o determine whether HAART had altered the spectrum of HIV-related disease p resentations at a tertiary medical referral centre and if a change in the c linical presentations of HIV-infected individuals to the hospital had impac ted on physicians' training. A retrospective study which examined all admis sions of HN-infected patients identified between 1 October 1996 to 30 Septe mber 1998 using a hospital-designed computer database was undertaken at the Beth Israel Deaconess Medical Center (BIDMC) tertiary medical referral cen tre. All medical residents were surveyed in order to assess their knowledge of HIV-associated admissions and their confidence treating HIV-infected pa tients. There were significant changes in the admitting diagnosis for HIV-r elated illness between 1996 and 1998. Admissions for opportunistic infectio ns (OIs) declined whereas admissions with bacterial infections increased si gnificantly. Use of HAART remained stable between the 2 years of the study. Physicians' overestimated the use of HAART and only 8% of residents felt v ery comfortable taking care of an HIV-infected patient. In conclusion, the spectrum of presentations with HIV-related disease to a tertiary referral c entre continues to change in the HAART era and impacts on physicians' exper ience of the management of HIV disease.