The Clinical Spectrum of the Acquired Immunodeficiency Syndrome: Implications for Comprehensive Patient Care

The clinical spectrum of the acquired immunodeficiency syndrome (AIDS) is broad and presents unique challenges to the health care system. Among the challenges are the unusual presentations, unexpected complications, psychosocial sequelae, and poor outcome of patients with the syndrome. From our experience with hundreds of patients at the San Francisco General Hospital, we propose a system for optimal care for patients with AIDS that requires a high degree of planning and commitment by hospitals and health care providers. In this model, rigid subspecialization is avoided, outpatient care is stressed, and community involvement is solicited. In these ways we can hope to improve the care of patients with AIDS and learn lessons that should be important in other illnesses as well.