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Paul Volberding, M.D.
Director, AIDS Program
San Francisco General Hospital

Our mission in launching HIV Newsline is a simple one: to provide clinicians with pertinent, practical, up-to-the-minute information on the diagnosis and longterm management of one of the most complex disease entities ever confronted by health-care providers.

When my colleagues and I first began seeing cases of HIV infection, in 1981, we recognized that we were dealing with a serious defect in immune function -- but at that time this new and frightening syndrome had no known etiology and no certain prognosis. It did not even have a name, and the opportunistic diseases that were its principal manifestation were so uncommon that even experts in the fields of infectious disease and oncology had rarely encountered them.

Fourteen years later, HIV infection and AIDS are no longer reportably rare. They are, regrettably, all too common -- not just in large cities of the Northeast and West Coast but in rural areas as well, notably in the Deep South and Southwest. The exponential growth of the HIV caseload -- an ascending curve predicted with uncanny accuracy, during the first years of the pandemic, by epidemiologists at the Centers for Disease Control in Atlanta -- has made HIV infection, inevitably and inescapably, a primary care problem.

Most of my colleagues in infectious disease now see patients with HIV infection, and we are, by now, all too familiar with opportunistic infections we once thought we would encounter only in profoundly immunosuppressed patients receiving chemotherapy, in transplant recipients, and in the back pages of our textbooks. Oncologists encounter the malignancies of HIV disease and pulmonologists see patients infected (and re-infected) with Pneumocystis carinii pneumonia. Dermatologists see Kaposi's sarcoma lesions and countless other manifestations of the hydra that is HIV; gynecologists see a range of disorders now attributed to the human immunodeficiency virus. And primary care practitioners in small, office-based practices in small towns across America are increasingly likely to be seeing early manifestations of HIV in their patients.

HIV Newsline has been developed to help all of these clinicians, specialists and non-specialists alike, recognize HIV infection in their patientsand provide those patients with continuing care that is clinically sound, cost-effective, and compassionate. Our objective is to offer the readers of HIV Newsline articles, editorials, literature surveys, and patient information materials that are consistently readable, relevant, and reliable. In selecting, soliciting, editing and reviewing the editorial content of HIV Newsline I will be assisted by an advisory board made up of clinicians with a broad range of experience in diagnosing and treating HIV infection and frank AIDS. Their names are listed on the masthead page of this issue.

Prolonging life and improving quality of life

It might fairly be said that our mandate comes directly from the federal government -- specifically from the Agency for Health Care Policy and Research. A recent issue of The Journal of the American Medical Association reports that the AIDS experts at AHCPR agree that overt disease can be delayed, life prolonged, and quality of life improved in HIV-positive individuals -- but only if well-educated primary care physicians and other medical care providers become involved in caring for patients with HIV infection.

Progress is being made in treating HIV disease -- progress that does delay the onset of overt disease, alleviate symptoms, prolong life, and enhance the quality of that life. At times this progress is frustratingly slow; at other times, surprisingly rapid. When therapeutic advances are made, they are announced in one of the dozens of scholarly journals that publish papers on HIV infection. This multiplicity of sources suggests how intensely researchers are pursuing the pathogen that causes HIV infection, but it also poses a problem for practitioners who want to keep abreast of the latest developments. To assist these busy clinicians, HIV Newsline will survey the vast literature on HIV and AIDS, and report therapeutic breakthroughs when they occur -- in clear, concise articles that not only describe recent advances in the treatment of HIV-infected individuals but assess the impact those advances are likely to have on current clinical practice.

In its first year, HIV Newsline will appear on a bimonthly basis, and it will be mailed free of charge to clinicians across the country. This vitally important educational effort is made possible by unrestricted educational grants from pharmaceutical companies. Without the support of these charter sponsors of HIV Newsline, we would not have been able to send our publication, without charge, to concerned clinicians and other health-care providers nationwide.

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