Who is an HIV specialist?

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Dear FORUM,

I posted my comments in continuation of debate on Cd4 testing etc. this was in

response to Dr swami iyer's poser to Ravi Saini. I am not sure whether they were

delivered or not. So I am sending you atleast one article regarding " Who is an

HIV specialist? " question worrying him

Rakesh Bharti

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Necessary Experience for Treating HIV Patients?

Question

What is the current expert consensus on the necessary qualifications for a

clinician with HIV patients in his/her practice? Is there agreement on how much

and what type of experience or formal training clinicians need for responsible

HIV care?

Response from G. Powderly, MD

Professor of Medicine, Department of Medicine, Division of Infectious Disease,

Washington University School of Medicine, St. Louis, Missouri.

There is increasing interest in the issue of HIV expertise. Several studies have

shown that outcomes for patients are better if care is provided by physicians

with experience in HIV infection.[1,2] This has led to legislative efforts in

some jurisdictions to attempt to ensure that HIV-infected patients have access

to " experts. " What has not been settled is the definition of such experts.

Recently, the HIV Medicine Association (HIVMA) of the Infectious Diseases

Society of America, which was established in 2000 as a forum for physicians and

others interested in HIV disease, developed a definition of HIV expertise based

on experience and continuing education.

This definition suggested that to be an HIV specialist, an individual should be

able to document:

clinical management of at least 25 HIV-infected patients during a 1-year period

a minimum of 15 hours of HIV-specific continuing medical education (including at

least 5 hours related to antiretroviral therapy) per year

These criteria are similar to those being developed by other HIV physician

groups. The HIVMA document also noted that these criteria represented an ongoing

professional commitment to HIV medicine. Currently, for example, training in

infectious diseases in the United States provides sufficient experience to allow

newly qualified trainees to classify themselves as HIV experts.

However, the HIVMA document goes on to state that given the rapid pace of change

in HIV medicine, board certification in infectious diseases does not guarantee

sufficient knowledge to assure that an ID specialist will remain an expert in

HIV disease.

Therefore, to retain HIV specialty credentialing, all physicians (including ID

physicians) must meet the experience-based criteria on an annual basis.

It is difficult to obtain formal training in HIV disease in the United States

except in the context of an infectious diseases fellowship. Informal training

can be obtained, however, in AIDS clinics and at some centers where there is a

more formal AIDS program.

Definitions of specialty based on experience, education, and professional

interest should allow physicians, whatever their background, to be identified as

experts in HIV disease.

References

Kitahata MM, Koepsell TD, Deyo RA, Maxwell CL, Dodge WT, Wagner EH. Physicians'

experience with the acquired immunodeficiency syndrome as a factor in patients'

survival. N Engl J Med 1996;334:701-706.

Kitahata MM, Van Rompaey SE, Shields AW. Physician experience in the care of

HIV-infected persons is associated with earlier adoption of new antiretroviral

therapy. J Acquir Immune Defic Syndr. 2000;24:106-114.

Medscape HIV/AIDS 7(1), 2001. © 2001 Medscape

http://www.medscape.com/viewarticle/413238