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Global HIV/AIDS Medicine

Farley, John MD, MPH

JAIDS Journal of Acquired Immune Deficiency Syndromes: 1 June 2008 - Volume 48 - Issue 2 - p 235
doi: 10.1097/QAI.0b013e31817432fc
Book Review

Institute of Human Virology, University of Maryland School of Medicine

ACTION Project, Institute of Human Virology-Nigeria, Nigeria

Global HIV/AIDS Medicine. Edited by Paul A. Volberding, MD, Merle A. Sande, MD, Joep Lange, MD, Warner C. Greene, MD, PhD, and Joel E. Gallant, MD, MPH. WB Saunders. ISBN: 978-1-4160-2882-6, 846 pages, 100 illustrations, Copyright: 2008, Price: US $99.00.

The Medical Management of AIDS,1 well known to many readers and published in the sixth edition in 1999, has been reborn as Global HIV/AIDS Medicine2 and is now available as a soft-cover textbook (available at:; list price for Africa GBP £57.99). In their preface, the editors note that “Antiretroviral regimens have become more convenient, less toxic, and, in resource-limited settings, often much less expensive. Although huge challenges remain, hope is now possible for those areas most in need of confronting the scourge of HIV…” The editors' goal is that Global HIV/AIDS Medicine “can play a valuable role in extending the incredible advances of HIV/AIDS therapy to the many millions still in desperate need.”

Edited by Paul Volberding, Merle Sande, Warner Greene, Joep Lange, and Joel Gallant, the 800-page textbook includes chapters from 35 contributors. Many of the contributors are undisputed leaders in their area of expertise, and a number of notable contributors working primarily in resource-limited settings have been included. The textbook is organized in 6 sections: Epidemiology and Biology of HIV Infection; Prevention, Diagnosis, and Treatment of HIV Infection; Diseases Associated with HIV Infection; Prevention, and Management in Resource-Rich Settings; Prevention and Management in Resource-Poor Settings; and Economic and Social Consequences of the HIV Epidemic. In general, the organization is logical and reader-friendly.

The chapters in section 1 focusing on HIV origin and diversification, molecular biology, immune response, and viral and host determinants of disease progression are particularly well done. They are presented clearly, with excellent illustrations, and should be quite helpful in ensuring that clinicians new to HIV care develop expertise based on important scientific principles that can stand the test of time.

Section 2, focusing on prevention, diagnosis, and treatment, includes excellent chapters on laboratory testing and antiretroviral therapy (ART) drug pharmacology, which should also help to ground clinicians in important principles. For those working in resource-limited settings, the chapters focusing on ART would be strengthened by a greater and more practical emphasis on nevirapine pharmacokinetics and implications for the use of fixed-dose combinations.

Management of tuberculosis coinfection is well treated in a chapter focused on this disease in section 3 but could be emphasized more strongly as principles of ART are introduced. In general, including some case illustrations would enhance interest for clinicians and highlight important concepts. Although the chapter on adherence includes an excellent review and critique of the literature, it does not include an emphasis on emerging data concerning loss to follow-up or strategies that may improve the likelihood of adherence. Strengthening an understanding of behavioral principles having an impact on retention in care and adherence and an enhanced appreciation of a multidisciplinary team approach and community support linkage remain important training needs for health care workers in resource-limited settings.

The rest of section 3, focusing on diseases associated with HIV infection, is well done. With the exception of the dermatology chapter, the chapters in this section are particularly well illustrated and inclusive of challenges in the resource-limited setting. For example, the chapter on Pneumocystis pneumonia includes a nice literature review with a clinical algorithm specifically for resource-limited settings.

Sections 4 and 5 attempt to separate prevention and management issues in resource-rich settings from those in resource-poor settings. The chapters are generally quite excellent. The chapter on pediatric care in resource-limited settings does an outstanding job of blending practical care guidelines with a solid literature review and presentation of clinical principles of care. Organizing the final sections of the textbook in this way leads to some redundancy, however. For a number of topics, such as prevention of mother-to-child transmission, the clinical issues are now more alike than different regardless of setting. There are a number of chapters in section 4, focusing on resource-rich settings, that present valuable data from Africa and may be missed by the selective reader. A number of chapters in section 5, focusing on resource-limited settings, address policy and public health planning issues rather than clinical ones and are interwoven with clinically focused chapters. This observation, and the inclusion of the final section 6 focusing on economic and social consequences of the epidemic, caused me to wonder if 2 books might be in order. Conversely, facilitating a solid understanding of ART principles among policy planners and decision makers, and an appreciation of public health planning issues among care providers, could only strengthen the global response.

In the past few years, we have witnessed unprecedented expansion in access to ART throughout the world. This scale-up has created ever-growing needs for capacity development, particularly among health care providers in resource-limited settings. The project headed by my own organization, the Institute of Human Virology-Nigeria, has trained nearly 3000 health care workers in ART in the past 3 years in Nigeria. Although there are some minor limitations, this textbook presents important principles of virology, immunology, and pharmacokinetics in a clear and clinically relevant manner. The textbook goes a long way toward meeting the need for an affordable reference book to help move capacity development beyond instruction relying on clinical guidelines and case scenarios to development of a critical mass of local experts well grounded in the science of HIV care. For donors supporting scale-up, the textbook is an affordable investment in promoting sustainable high-quality care.

John Farley, MD, MPH

Institute of Human Virology University of Maryland School of Medicine

Baltimore, MD

ACTION Project Institute of Human Virology-Nigeria Ajuba, Nigeria

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1. Sande MA, Volberding PA. The Medical Management of AIDS. 6th ed. Philadelphia, PA: WB Saunders; 1999.
2. Volberding PA, Sande MA, Lange J, et al, eds. Global HIV/AIDS Medicine. Philadelphia, PA: WB Saunders; 2008.
© 2008 Lippincott Williams & Wilkins, Inc.