HIV Management Specialist Recommendation
HIV-infected patients should be managed by a clinician with documented HIV expertise—defined by experience and continuing education—rather than by specialty designation alone, as expertise (not specialty training) is what determines better health outcomes. 1
Defining an HIV Expert
The HIV Medicine Association of the Infectious Diseases Society of America establishes clear criteria for identifying qualified HIV physicians 1:
Minimum Qualifications for HIV Expertise
- Managed at least 25 HIV patients during the previous 36 months 1
- Completed at least 40 hours of Category 1 HIV-related continuing medical education during the same 36-month period 1
- Alternatively: Infectious disease physicians certified or recertified within the previous 12 months are considered qualified 1
Specialty Training Is Not the Determining Factor
HIV disease does not fall under the purview of any one medical specialty—physicians trained in internal medicine, family medicine, and other medical subspecialties can be HIV experts alongside infectious disease specialists 1. Critically, many HIV experts are infectious disease physicians, but not all infectious disease physicians are HIV experts 1. The key distinction is ongoing patient management and continuing education, regardless of specialty training 1.
Evidence Supporting Expertise Over Specialty
Patients managed by clinicians with greater HIV experience and expertise have better health outcomes and receive more appropriate and cost-effective care, regardless of the clinician's specialty training 1. Research confirms that expert generalists deliver quality of care equivalent to infectious disease specialists, while nonexpert generalists show inferior performance 2. Specifically:
- Over 80% of appropriate patients received highly active antiretroviral therapy when cared for by infectious disease physicians or expert generalists, compared to only 73% with nonexpert generalists 2
- Physicians managing fewer than 20 active HIV patients had lower rates of appropriate antiretroviral therapy use (73% vs 82%) and saw patients less frequently 2
Care Models Based on Resource Availability
The HIV Medicine Association recognizes that HIV expert shortages necessitate flexible care models 1:
Direct Management Model
- HIV expert directly manages both HIV treatment and primary care 1
- Most appropriate for complex patients with intensive medical and social service needs 1
Co-Management Model
- Primary care provider maintains ongoing consultative relationship with HIV expert 1
- HIV expert manages HIV treatment through regular visits at 3-6 month intervals 1
- Effective for healthier patients with less intensive needs, particularly when established at diagnosis 1
Consultation Model
- Primary care provider manages ongoing care with HIV expert serving as consultant via teleconference or telemedicine 1
- Used in settings with limited access to HIV experts 1
Credentialing and Certification
Multiple organizations provide formal credentialing for HIV providers 1:
- American Academy of HIV Medicine (AAHIVM): Credentialing process for physicians, nurse practitioners, physician assistants, and pharmacists 1
- Association of Nurses in AIDS Care: HIV/AIDS Nursing Certification Board for registered nurses and nurse practitioners 1
- State adoption: California and Arizona have adopted these recommendations for identifying HIV experts 1
Critical Caveat
Primary care physicians with little HIV experience should link with an HIV specialist when caring for HIV-infected patients to optimize access to best therapies 3. The most important reasons for consultation or comanagement with an HIV expert include management of antiretroviral drug resistance, drug toxicities, viral hepatitis coinfection, or pregnancy 4.