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Drugs in HIV and AIDS
  1. MARTIN WISELKA
  1. Department of Infectious Diseases, Leicester Royal Infirmary, Leicester, UK

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    Drugs in HIV and AIDS, 2nd edn, A Palfreeman, M Youle, C Farthing. J Wiley and Sons, 1998. £16.99, paperback

    The last 2 years have seen a revolution in the treatment of HIV and this pocket-sized book provides up-to-date information on all commonly used drugs. Patients with HIV are often extremely well read about current treatment strategies and may ask difficult questions in the clinic. This book will ensure that the clinician seeing the patient is well informed and has the information required to encourage compliance with often difficult drug regimens.

    The book has a UK perspective and the authors come from a range of backgrounds in the UK and USA. Its value in the developing world is far more limited due to the lack of availability of most of the drugs described.

    Overall, the sections on opportunistic infections and their treatment are up-to-date, well described and comprehensive, although there are some important omissions such as the use of second-line agents to treat mycobacterial infections. It would also be helpful if further details were provided of the methodologies currently in use for testing viral load and their limitations and drawbacks.

    The question of HIV testing still taxes many clinicians, particularly those working outside genito-urinary clinics and it would be useful to state the GMC Guidelines on HIV testing. The mystique attached to HIV counselling is one of the factors contributing to the late presentation of many patients. The real benefits of early testing including access to antiviral therapy, prophylaxis, and reduction in maternal transmission should be emphasised.

    The greatest changes between the first and second editions are in the section on anti-retroviral treatment with the introduction of many new agents over the past few years. This is a very rapidly developing field and, as predicted by the authors, the book is already out of date as it was completed before the 1998 BHIVA Guidelines in the UK and NIH Guidelines in the USA were published. Nevertheless, the issues involved in deciding when to start treatment and which regimen to use are well reviewed, including the current fashion for initiating therapy with non-nucleoside reverse transcriptase inhibitors.

    Drugs which are not yet licensed but will soon enter the UK market including abacavir, efavirenz, and delavirdine are also mentioned. This is very helpful as patients will frequently ask questions about these unlicensed drugs. The authors recommended combination therapies are somewhat idiosyncratic, however, it would be hard to find any two clinicians who could agree on which combinations to choose at which stages of infection.

    A summary chart of anti-retroviral drugs would be helpful for future editions and a copy of the excellent drug interaction tables which are now available, as there is clearly great potential for significant interactions. A list of useful Internet sites could also be considered.

    Overall I think this is an excellent book which is clinically relevant, and is a convenient size to fill the pockets of all doctors and other healthcare professionals seeing patients with HIV.

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