AIDS Therapy, Third Edition

In the preface to the third edition of this comprehensive reference on AIDS therapy, the editors proclaim that their book is a “one-stop resource for busy clinicians in busy practice settings.” And this textbook serves that purpose well. But first, you will need to lift it. This hardcover edition weighs in at a hefty 7 pounds!

That said, in its 10 sections and 81 chapters, the book covers everything related to treating HIV/AIDS, starting with diagnosis of HIV infection through to drug-drug interactions. The chapter authors are all well-known US and international figures in HIV and allied medicine.

The chapter on primary care of patients with HIV infection is divided into 2 sections: primary care in industrialized countries and primary care in resource-limited settings. Included appropriately in this chapter is the current hot-button issue of the acute retroviral syndrome and its recognition, in addition to identification of persons with HIV infection using a more aggressive approach to HIV testing, and a summary of the 2006 CDC guidance on “routinizing” HIV testing in primary care settings. The discussion of diagnostic testing is there also, and the chapter author sorts through the differences in various technologies available for HIV screening and monitoring.

The lengthy section on antiretroviral agents consists of discussions of individual drugs and resistance testing.

There is a fairly comprehensive discussion of cervical cytology in women, but the discussion of anal screening in men and women is limited, and the authors take a soft approach to the topic. In other words, the authors don’t take many risks or push the envelope too hard with this one. In the case of anal Pap smears for men, the 2002 US Public Health Service/Infection Disease Society of America (USPHS/IDSA) Guidelines for the Prevention of Opportunistic Infections is cited as the source for lack of consensus on the matter.

If the authors are behind the curve in their approach to anal cytology, the book certainly gains traction with the chapter on pharmacogenetics of antiretroviral agents. In addition to the important discussion of the influence of genetic variation on drug metabolism, the authors introduce the topic of “toxigenetics,” the genetic susceptibility to adverse reactions. The third section in this chapter discusses our emerging understanding of the genetic influences on disease progression. Also ahead of the curve is a discussion of the CCR5 and CCR4 coreceptor inhibitors as tools to prevent HIV-1 transmission.

The rest of the book’s chapters discuss antiretroviral agents, immune-based therapies, alternative therapies, metabolic issues, and therapies directed at opportunistic diseases and specific syndromes in detail. New in this edition are comprehensive discussions of cardiovascular and metabolic diseases. The final section contains a list of Internet resources.

The big question with any textbook approach to HIV medicine is the problem of the material becoming outdated quickly. The way around this is the concept of the “Multimedia Edition,” which is available for this book. Purchase of the book entitles you to free access to the book’s Web site “until the next edition is published or until the book is no longer offered for sale, whichever occurs first,” according to information in the book.

The Web site requires online registration with the publisher. Within the first few pages of the book, there is a scratch-off label that contains the code to access the Web site. Once I got into the site with the proper pass code, the entire text was displayed, organized by the same table of contents as the print edition.

The Web edition also includes the book’s extensive index, and it has an impressive search engine, which gets very high marks. Enter a phrase such as “anal cytology,” and the results show excerpts from each of the chapters in which it is discussed. Click on a heading, and it takes you directly to the text that discusses the topic, making it easier to research one topic completely rather than thumbing back and forth between the index and the text in the hard-copy edition.

Where are the updates? According to someone in the publisher’s customer support department, updates are added to the Web site at the discretion of the authors and editors. I was told that when updates are added, this would be indicated in the menu bar on the Web page.

The chapter on the antiretroviral agent abacavir, which is well written by Victoria Johnson from the University of Alabama at Birmingham, was used as my test case. For obvious reasons, more recent data on the role of HLA-B*5701 testing to assess the risk of abacavir hypersensitivity are not included in the book; those data were published after this book went to press. However, these new data are not included on the Web site either, at least not yet.

Should you buy this book? If you have $189 to spend, it’s a good investment. The real value of the book is that everything is in one place. The access to online updates notwithstanding, there is more information in this textbook than the most experienced HIV care providers could ever hope to know. If you are looking for information on a specific topic, you are likely to find it here. Another way of using the online edition is to merely type in a topic and start reading. Also, the plethora of tables and figures, which break up the text, allow for quick access to information. The numbered reference citations in text are enabled; click on the reference number and you jump to the complete reference in the chapter’s reference list. In addition, the title of each reference is hyperlinked; click on the title and you are taken to the citation abstract on the National Library of Medicine’s Web site.

The last chapter in the book, “Internet-Related Resources,” makes the most sense in the book’s electronic format. All that’s required is a click on the link, and a new window opens the site in question. However, in order for this format to work maximally, the hyperlinks will also need to be updated periodically, since some of the links are already outdated and clicking to navigate to a Web site produced error messages, such as “Page Not Found.”

Probably the best reason to buy this book, however, is the Internet access to its entire text, because the Web site extends the book’s shelf life and allows for a different way of reading and learning. The Web site’s commendable search engine is also a bonus for busy practitioners who need information in a hurry.

One last suggestion: the publisher might want to consider breaking the next edition of this book into 2 volumes.

William M. Valenti, MD
University of Rochester School of
Medicine and Dentistry
Rochester, NY