Hospitalists Should Expect More HIV Patients
Advances in treatment and ever-growing life expectancies for patients diagnosed with human immunodeficiency virus (HIV) are likely to push more HIV-positive patients into the censuses of HM groups, according to a specialist at Mount Sinai School of Medicine in New York City.
“Hospitalists … are going to be doing more and more of the HIV care because we have a growing population of aging patients who are in care or identify as being HIV-positive, and they’re not coming in with exotic or unusual opportunistic infections,” says Rich MacKay, MD, director of the inpatient HIV service at Mount Sinai Medial Center in New York. “They are coming in with the things that other 50-, 60-, 70-year-olds are coming in with, though they may have more of those.”
Dr. MacKay, who is an assistant professor and splits his time between admitted patients and an outpatient clinic, spoke to more than 100 attendees at the fifth annual Mid-Atlantic Hospital Medicine Symposium last weekend in New York. He says hospitalists who familiarize themselves with HIV indicators could press for earlier identification of HIV in patients.
“If you screen people and you’re testing them on the day of their hospitalization, I think that’s huge,” Dr. MacKay says. “Finding somebody who is early in the disease and linking them in to care, so that they don’t fall off the cliff, so that they don’t come in five years later with PCP [pneumocystis pneumonia] and die from it—I think that’s a huge part for the hospitalist.”
Dr. MacKay further notes that just being aware of HIV symptoms can provide the cognizance necessary to consider alternative diagnoses. That can be particularly relevant for cases in which standard treatments might be effective for a few days (e.g. a steroid regimen) but not actually resolve the underlying problem, he adds.
“Maybe [a patient] is coming in with what looks like an exacerbation of COPD, but they’ve only got 50 T-cells and in fact what you’re seeing is PCP,” he says. “It’s not always clear.”