Book Review

AIDS — Politics, Policies, and Patients

AIDS and Other Manifestations of HIV Infection

N Engl J Med 1993; 328:451February 11, 1993

Article

AIDS and Other Manifestations of HIV Infection
Second edition. Edited by Gary P. Wormser. 715 pp., illustrated. New York, Raven Press, 1992. $130. ISBN: 0-88167-881-3

In keeping with the rapid changes in our knowledge of the biology of HIV, its pathophysiology, and the treatment and prevention of AIDS, the second edition of this book contains several new chapters. A few chapters from the first edition (for example, those on the history of AIDS and ultrastructural changes in AIDS) have been appropriately deleted. The new chapters include a review of viral cofactors in the pathogenesis of HIV, biological features of HIV type 2 (HIV-2), simian retroviruses, gastrointestinal, oral, and ophthalmologic manifestations of AIDS, vaccination and immunization, occupational issues related to AIDS, and ethical issues for research.

The book is divided into seven sections. The epidemiology of HIV infection and AIDS in adults and children both within and outside the United States is well covered in the first section. The second, on etiologic agents, contains comprehensive discussions of retroviruses, simian retroviruses, and animal models of HIV infection. Also included in this section are discussions of the virologic and biologic features of HIV-2, the pathogenesis of HIV type 1 infection, including viral cofactors, and the laboratory detection of human retroviral infection. Ideally, a separate chapter focused on the laboratory detection of retroviral infection in infants and children (including the role of IgA anti-HIV antibodies) would have been included as well. In addition, a discussion of the role of mycoplasma as a cofactor is missing.

The immunology of HIV infection is reviewed in the third section. Although the immunopathogenesis of AIDS is discussed extensively, the immunologic defects in infants and children are not covered in any detail. Furthermore, immunologic defects in antigen-presenting cells (monocyte-macrophages, Langerhans' cells, and dendritic cells) and natural killer cells are discussed very superficially. The interleukin-1 inhibitors should have been included. Section IV deals with the clinical manifestations of HIV infection, including bacterial, viral, fungal, and protozoal infections, neoplasms associated with HIV infection, and neuropsychiatric, ophthalmologic, and oral manifestations of HIV infection. All these chapters are very well written; however, a separate chapter on the hepatobiliary manifestations of HIV infection would have been welcome.

The general pathology and neuropathology of HIV infection are covered in section V. Infection control and occupational issues related to the HIV epidemic are discussed in section VI. Section VII comprises review chapters dealing with various therapeutic and preventive methods and includes nursing perspectives and ethical considerations in prevention, research, and the care of patients with AIDS. Antiretroviral therapy in children and women is covered only superficially. The chapter on immunotherapy could have been more extensive.

In general, this edition is comprehensive and up to date, and it contains an extensive bibliography for each chapter. The basic, clinical, laboratory, social, and public health aspects of HIV infection are covered. This book should be of interest to academic and practicing internists, pediatricians, immunologists, virologists, nurses, and public health workers.

Another excellent book on HIV infection that is currently available is Pediatric AIDS: The Challenges of HIV Infection in Infants, Children, and Adolescents, edited by P.A. Pizzo and C.M. Wilfert (Baltimore: Williams and Wilkins, 1991).

Sudhir Gupta, M.D., Ph.D.
University of California, Irvine, Irvine, CA 92717