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Re: Another HIV questionFrom: DoctorJoe@aol.comFri Sep 27 08:29:51 1996
<<Like many physicians, the ones in our area (South Texas/Mexico border) seem reluctant to care for HIV positive clients. However, it seems unethical to me send this girl 350 miles away for AZT. Am I missing something? Is there some complicated trick to managing AZT therapy in pregnancy? My clinical site would have been glad to manage this area of her pregnancy, perhaps it is a matter of mis-information. What do you think?>> The AMA (I think) has put out an informational monograph on HIV disease for the primary care doc (in which number ob's certainly include themselve). Look for it (presumably gotten from the AMA): American Medical Association Advisory Group on HIV early intervention: Physician guidelines. 2nd ed. Chicago, AMA, 1994. One of the thrusts of that document is that primary care (entry level) practitioners must know how to diagnose and initially evaluate the HIV+ patient, and how to care for them in the early stages of the disease. As I read it, there is NO EXCUSE for sending an otherwise normal HIV+ gravida into a 'high risk' center... You see what you think it implies. I don't recall that it specifically mentions AZT in pregnancy, but I would think that is a lame excuse to get rid of a patient. The protocol for AZT in pregnancy is extremely easy. Joe P.
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