Clinical Infectious Diseases and the Evolving Human Immunodeficiency Virus Epidemic

HIV Care as a SpecialtyThe AIDS epidemic has been a traumatic and catalytic phenomenon on many levels, transforming diverse intellectual domains, from molecular virology to public health to medical consumer activism.During the AIDS era the specialty of infectious diseases has also undergone a dramatic metamorphosis.In 1980, the Infectious Diseases Society of America (IDSA) had ∼1000 members, most of whom were affiliated with academic medical centers.Now it has 15000 members, of whom ∼60% indicate that their primary activity is clinical practice and more than half spend a significant amount of their time providing care for people living with HIV (A.Mucha [IDSA] and J. Bartlett [Johns Hopkins University], personal communications).Of the remaining 40% who are doing research or working in industry, a substantial number focus on HIV-related issues.The advent of highly active suppressive (but not curative) antiretroviral therapy has increased the need for careful, long-term clinical monitoring of persons living with HIV.In addition to HIV care, infectious diseases (ID) specialists still have to grapple with other important clinical and public health challenges (e.g., nosocomial infections and other immunocompromised hosts).In this context, it is gratifying to witness the emergence of highly experienced and motivated generalists who are offering superb HIV clinical care.These dedicated and talented professionals have learned on the job with the help of an extensive array of educational opportunities, including Continuing Medical Education courses, national HIV-oriented conferences (including the Interscience Conferences on Antimicrobial Agents and Chemotherapy [ICAAC] and IDSA meetings), several AIDS-specific journals, and web-based learning.HIV-clinical care has become increasing complex, involving the management of a chronic immunosuppressive illness with complex therapeutic combinations, many of which have attendant morbidities. Who Should Represent HIV Care Providers?Intense discussions are currently under way in an effort to sort out how to maximize patient care and ensure optimal pro-