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Doody's Review ServiceReviewer: John A. Robinson, MD (Loyola University Stritch School of Medicine)
Description: The number of books on HIV-AIDS, already a surfeit, continues to increase. Some are very good, many are less than pedestrian, and this book falls somewhere in between.
Purpose: The major drawback of encyclopedic texts, especially in the continually evolving HIV arena, is the unavoidable publication delay. This inevitable knowledge gap poses a serious problem for publishers, writers, and readers. Unfortunately, 1996 was a banner year for exciting revelations, not only in the treatment of HIV-AIDS, but for getting off the CD4 dime and moving on to implicating coreceptor(s) for infection. In turn, the latter revelation shed light on genetically dictated resistance to infection. The fact that none of these advances could be adequately addressed in a macrotext revision leads one to question the usefulness of such frequent updating of HIV textbooks. Infectious disease historians might draw a parallel to the syphilis saga at the turn of the century, and one hopes that neurologists will do so with Alzheimer's disease in 2025! After all, most of the clinical fundamentals of HIV-AIDS are now well described and available at multiple levels of reader sophistication. How much more historical and descriptive clinical information could be in the wings? What is needed and now available is rapid access to new HIV understandings by electronic transfer and monthly publications. To the editors' and publisher's credit, an insert detailing the newest strategies of retroviral polytherapy was added, apparently in the terminal stages of publication, but nonetheless, significant scientific discussion on additional subjects ranging from viral load, chemokines, infection resistance, HIV superantigen functions to the depressing evidence that safe sex practices of gay males are being abandoned, the unexpected clash between AIDS activists and animal rights groups, and two straight years of reported AIDS decreases in the U.S. could not be adequately addressed.
Audience: The primary audience for this text is clinicians.
Features: There are many excellent chapters in this book; almost all the clinical and epidemiologic ones are well written. Others, depending on the eyes of the beholder, may have less luster. The book insists on being multidimensional and, in an apparent attempt to mirror the intermingled sociological, political, public health, and psychosocial ramifications of this epidemic, chapters on the latter are scattered throughout. More than a few readers, but certainly not all, will find the placement in the section on psychosocial aspects of the history of community-based responses to HIV-AIDS from the perspective of an activist somewhat curious. The demons of ideology and political correctness, a distraction in many AIDS works, have been almost completely exorcised, but a few vestiges survive. For example, intravenous drug abuse (IVDA) at one point becomes injection of illicit psychoactive drugs (IIPD) and the mantra drumbeat of increasing heterosexual transmission in the U.S. still appears more often than one would expect.
Assessment: This book is recommended to readers who need a fundamental text in HIV biology, transmission, and clinical outcomes. Infectious disease subspecialists and their allies may benefit more from rapid information transfer sources or annual HIV-AIDS reviews.