Book Review

The AIDS Knowledge Base: A textbook on HIV disease from the University of California, San Francisco, and the San Francisco General Hospital

N Engl J Med 1995; 332:617March 2, 1995

Article

The AIDS Knowledge Base: A textbook on HIV disease from the University of California, San Francisco, and the San Francisco General Hospital
Edited by P.T. Cohen, Merle A. Sande, and Paul A. Volberding, with six others. 1552 pp., illustrated. Boston, Little, Brown, 1994. $125. ISBN: 0-316-77067-1

This book, the work of 102 contributing authors, is the result of an ambitious attempt to provide timely and comprehensive information about disease caused by the human immunodeficiency virus (HIV); it is intended to be relevant to all geographic regions for a wide range of health care professionals and motivated nonprofessionals. The editors have been moderately successful in meeting these goals.

The book's 11 sections address not only the molecular biology, pathogenesis, epidemiology, clinical manifestations, and management of HIV infection, but also legal and economic issues, prevention and education, and ethical issues. Although this is a medical textbook, it also offers material for those in other disciplines who are interested or involved in the care of persons with HIV infection. Most of the information is relatively up to date.

The chief focus of the book is on HIV disease as it presents and is managed in the United States. That a large proportion of the authors are from San Francisco gives the book a tendency to base general statements on experience with middle-class men. For example, the authors state that persons with advanced HIV disease are usually covered by a managed-care insurance plan. There is also an absence of information on or reference to issues of confidentiality and discrimination in the brief chapter on how to tell patients that they have HIV disease; this omission implies that the patient has already been counseled and tested before becoming ill, which is often not true for women, injection-drug users, and persons of color. Nonetheless, information on HIV disease that is relevant to all affected persons is usually included.

There are some excellent chapters. Those on the methods of testing for HIV antibody or antigen and on rochalimaea and the section on the pulmonary aspects of HIV disease are particularly clear and comprehensive. Many others are also outstanding. However, the chapters vary considerably in length and quality. Their length ranges from less than 2 to more than 28 pages, and the number of references varies from none to more than 300. The amount of space allotted to topics is sometimes puzzling. The chapter on tuberculosis, for instance, referred to as “a frequent and treatable cause of morbidity and mortality,” is the same length as that on aspergillosis, of which “there are remarkably few cases.” There is considerable redundancy, both because of the multiple authors and because both organ-system and pathogen-specific approaches to clinical disease are represented. Occasionally, identical or very similar tables appear in two or more chapters. Improved cross-referencing could eliminate much duplication.

The book is not without a number of errors. Most are typographic or otherwise minor, but a few are more substantial. In the chapter on diarrhea, a table lists vancomycin as an alternative treatment for shigellosis, and fluconazole is omitted as an option for the long-term suppressive treatment of cryptococcus; both the table and the text state that histoplasmosis must be managed with long-term amphotericin B treatment, and itraconazole is neglected as a possible alternative. Hence, caution is necessary in assessing the value of some of the authors' suggestions.

This comprehensive textbook will be a useful addition to the libraries of those who care for or are concerned about persons with HIV infection. Some scholarly sections will probably remain relevant for years. As with most textbooks, however, this one should not be used as the sole source of information for important clinical decisions.

Robert S. Klein, M.D.
Montefiore Medical Center, Bronx, NY 10467