Physician Experience in the Care of HIV-Infected Persons is Associated with Earlier Adoption of New Antiretroviral Therapy [Kitahata MM, et al. JAIDS 2000; 24: 106]: The authors reviewed charts of patients receiving HIV medical care in the state of Washington between December 1995 and May 1997 to determine patterns of antiretroviral use. The analysis concerned utilization of treatments recommended by IAS and DHHS correlated with physician experience as measured by total number of HIV-infected persons cared for according to ADAP records. The results showed that, after controlling for CD4 cell counts and the calendar period of treatment, patients cared for by physicians with the greatest HIV experience were significantly more likely to receive "triple-therapy" as recommended by guidelines. Comment: Dr. Kitahata, the lead author on this paper, was also the lead author on the 1996 publication that showed that care by a physician with HIV experience was associated with a significant increase in longevity [NEJM 1996; 334: 701]. A frequent concern about this paper was that experience was defined by a history of care of at least five patients with HIV infection. This seemed low, but the results were striking in showing a one-year increase in survival. These results predated the HAART era. Subsequently, HIV care has become more complicated and multiple authorities have defined experience that qualifies a provider for HIV care as a panel of at least 25 - 50 HIV-infected patients and there is often a CME requirement as well. This mandate for experience is perhaps better defended for HIV care than for almost any other medical condition based on results of multiple studies, which show that provider experience is associated with prolonged patient survival, better use of OI prophylaxis according to current guidelines, reduced hospital costs and knowledge of HIV-related topics [CID 1999; 28: 14]. This study shows that utilization of triple-therapy according to consensus guidelines also reflects HIV care experience. These results are not surprising, but can now be added to the ammunition regarding the need for experience and qualifications for HIV care. posted 8/11/2000