Cooke M, Libman H, Smith M D, Cooney T G, Hollander H, Makadon H J, Volberding P A
Department of Medicine, University of California, San Francisco.
J Gen Intern Med. 1991 Jan-Feb;6(1 Suppl):S46-55. doi: 10.1007/BF02599258.
The care of patients who have HIV infection requires technical competence, skill in clinical decision making, a commitment to continuing self-education, the ability to collaborate with medical and community-based service providers, and attention to the psychological and ethical aspects of patient care. General internists bring these attributes to their work and will be increasingly involved in meeting the challenges presented by the AIDS epidemic. Controversial issues in the management of HIV illness include: assessment and management of latent syphilis in patients with intercurrent HIV infection; risk assessment and postexposure zidovudine prophylaxis of health care workers after occupational accidents; determination of the risk of reactivation tuberculosis in HIV-infected individuals; and treatment or nontreatment of infections with the Mycobacterium avium complex in symptomatic patients. Patients illustrating these management problems are presented by progressive disclosure; the points made in discussion by a panel of general internists and AIDS specialists are presented.
对感染艾滋病毒患者的护理需要专业技能、临床决策能力、持续自我教育的决心、与医疗及社区服务提供者协作的能力，以及对患者护理心理和伦理方面的关注。普通内科医生具备这些特质，并将越来越多地参与应对艾滋病流行带来的挑战。艾滋病毒疾病管理中的争议性问题包括：并发艾滋病毒感染患者潜伏梅毒的评估与管理；医护人员职业事故后齐多夫定暴露后预防的风险评估；艾滋病毒感染者结核复发风险的判定；有症状患者鸟分枝杆菌复合体感染的治疗或不治疗。通过逐步披露呈现说明这些管理问题的患者；展示普通内科医生和艾滋病专家小组在讨论中提出的观点。
