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The medical management of AIDS
Journal
of Hospital
Injection
(1997) 37, 255-256
Book
Review
The Medical Management of AIDS. Sande, M. A., Volberding edn. Philadelphia: Saunders, 1997. E45. ISBN 0-7216-6908-S.
P. A. 5th
All reviews of books on acquired immunodeficiency syndrome (AIDS) usually start with the comment that by the time a book on the subject is published, it is already out of date, and this book (and review) is no exception. If you really want to have up-to-date information on human immundeficiency virus (HIV) disease, one textbook is never going to be enough; you will also need access to Medline, a good library, and preferably copies of abstracts presented at the last four or five major conferences, with access to the Internet thrown in for good measure. If you are going to buy a textbook, however, this is one of the best; it is unique in that it is now in its fifth edition since it was first published in 1988, which is in itself a measure of the book’s success. The preface states that this edition of The Medical Management of AIDS was prepared following a conference in San Francisco in early December 1995. There has been an explosion of new information on the subject of anti-retroviral drug therapy in the last 18 months, particularly following the XI International Conference on AIDS in Vancouver in July 1996. Since the book was prepared before this, much recent information from Vancouver and afterwards is not included. Nevertheless, there are many important advances which are covered in this edition, including data on the prognostic utility of viral load testing, the use of zidovudine for post-exposure prophylaxis following needlestick injuries, and David Ho and George Shaw’s work on the kinetics of viral replication. The chapter on anti-retroviral therapy by Paul Volberding covers all of these recent developments, and reviews, in brief, many of the familiar arguments about when to start antiretroviral drug therapy. It falls down somewhat on the issue of which drugs to use; many would take issue with Volberding’s statement that ‘monotherapy may be an option for some patients’. Despite the fact that monotherapy with either zidovudine or didanosine have been shown to delay disease progression in clinical trials, there is clear consensus that combination therapy with at least two drugs is likely to be a far better option. Similarly, much of the advice offered in a table on ‘Guidelines for secondary HIV therapy’ in patients failing initial therapy is very much open to question in 1997. Perhaps because progress in the prophylaxis and management of opportunistic infections has been less rapid, the section on opportunistic infections is generally excellent. The chapter on ‘Bacillary angiomatosis 0195-6701/97/110255+02$12.00/0
0 1997 The Hospital
255
Infection
Society
256
Book
Review
and unusual infections’ is particularly good, although there is no reference here (or anywhere else in the book) to visceral leishmaniasis as an opportunistic infection, reflecting the generally American bias of the book. The chapter on management of syphilis in HIV-infected persons also guides the reader through the literature on the diagnosis and treatment of syphilis in a way that is helpful, with clear, sensible recommendations for management for areas where the literature provides no clear guidance, such as when to perform lumbar puncture. There are chapters in this book on drug toxicity and drug interactions, and on the use of alternative therapies by patients which I also particularly liked. Sections on these topics should be included in all books on HIV disease, as so many patients take alternative therapies, and all should be aware of the side-effects and major interactions of their drugs (particularly in the case of patients taking protease inhibitors). There are some areas which are not covered in the book. The novel herpes virus associated with Kaposi’s sarcoma (KS-HV or HHV-8) is mentioned hardly at all, and then not in the section on Kaposi’s sarcoma. In the otherwise excellent chapter on tuberculosis by Hopewell, there is little practical advice on how to manage the isolation of patients with multidrug-resistant tuberculosis, a problem faced depressingly frequently in clinical practice today. There is a reference to 1990 guidelines produced by CDC, but I would have liked to know more about how Hopewell himself manages the difficult decisions about how to ensure that these patients receive the best care at the same time as minimizing the risk they might pose to other immunocompromised individuals. These, however, are minor points. This book should have a place in every medical library, and at A45 represents very good value-for-money compared with other larger textbooks on AIDS.
D. Churchill
Department
Imperial
of Genitourinary Medicine and Communicable Diseases, College School of Medicine at St. Mary’s, Praed Street, London W2 lPG, UK
of Hospital
Injection
(1997) 37, 255-256
Book
Review
The Medical Management of AIDS. Sande, M. A., Volberding edn. Philadelphia: Saunders, 1997. E45. ISBN 0-7216-6908-S.
P. A. 5th
All reviews of books on acquired immunodeficiency syndrome (AIDS) usually start with the comment that by the time a book on the subject is published, it is already out of date, and this book (and review) is no exception. If you really want to have up-to-date information on human immundeficiency virus (HIV) disease, one textbook is never going to be enough; you will also need access to Medline, a good library, and preferably copies of abstracts presented at the last four or five major conferences, with access to the Internet thrown in for good measure. If you are going to buy a textbook, however, this is one of the best; it is unique in that it is now in its fifth edition since it was first published in 1988, which is in itself a measure of the book’s success. The preface states that this edition of The Medical Management of AIDS was prepared following a conference in San Francisco in early December 1995. There has been an explosion of new information on the subject of anti-retroviral drug therapy in the last 18 months, particularly following the XI International Conference on AIDS in Vancouver in July 1996. Since the book was prepared before this, much recent information from Vancouver and afterwards is not included. Nevertheless, there are many important advances which are covered in this edition, including data on the prognostic utility of viral load testing, the use of zidovudine for post-exposure prophylaxis following needlestick injuries, and David Ho and George Shaw’s work on the kinetics of viral replication. The chapter on anti-retroviral therapy by Paul Volberding covers all of these recent developments, and reviews, in brief, many of the familiar arguments about when to start antiretroviral drug therapy. It falls down somewhat on the issue of which drugs to use; many would take issue with Volberding’s statement that ‘monotherapy may be an option for some patients’. Despite the fact that monotherapy with either zidovudine or didanosine have been shown to delay disease progression in clinical trials, there is clear consensus that combination therapy with at least two drugs is likely to be a far better option. Similarly, much of the advice offered in a table on ‘Guidelines for secondary HIV therapy’ in patients failing initial therapy is very much open to question in 1997. Perhaps because progress in the prophylaxis and management of opportunistic infections has been less rapid, the section on opportunistic infections is generally excellent. The chapter on ‘Bacillary angiomatosis 0195-6701/97/110255+02$12.00/0
0 1997 The Hospital
255
Infection
Society
256
Book
Review
and unusual infections’ is particularly good, although there is no reference here (or anywhere else in the book) to visceral leishmaniasis as an opportunistic infection, reflecting the generally American bias of the book. The chapter on management of syphilis in HIV-infected persons also guides the reader through the literature on the diagnosis and treatment of syphilis in a way that is helpful, with clear, sensible recommendations for management for areas where the literature provides no clear guidance, such as when to perform lumbar puncture. There are chapters in this book on drug toxicity and drug interactions, and on the use of alternative therapies by patients which I also particularly liked. Sections on these topics should be included in all books on HIV disease, as so many patients take alternative therapies, and all should be aware of the side-effects and major interactions of their drugs (particularly in the case of patients taking protease inhibitors). There are some areas which are not covered in the book. The novel herpes virus associated with Kaposi’s sarcoma (KS-HV or HHV-8) is mentioned hardly at all, and then not in the section on Kaposi’s sarcoma. In the otherwise excellent chapter on tuberculosis by Hopewell, there is little practical advice on how to manage the isolation of patients with multidrug-resistant tuberculosis, a problem faced depressingly frequently in clinical practice today. There is a reference to 1990 guidelines produced by CDC, but I would have liked to know more about how Hopewell himself manages the difficult decisions about how to ensure that these patients receive the best care at the same time as minimizing the risk they might pose to other immunocompromised individuals. These, however, are minor points. This book should have a place in every medical library, and at A45 represents very good value-for-money compared with other larger textbooks on AIDS.
D. Churchill
Department
Imperial
of Genitourinary Medicine and Communicable Diseases, College School of Medicine at St. Mary’s, Praed Street, London W2 lPG, UK