“I wasn’t supposed to be here,” [the patient said] to the nurse as he watched the last few drops of his chemotherapy drug infuse into the port implanted in his chest… The nurse caring for him smiled while preparing to disconnect his IV tubing and flush the port….   What distinguished [this patient] from the nurse’s other patients was that he had been living with HIV for 32 years.”

At the very beginning of the HIV epidemic, a friend of mine worked on one of the first HIV units in New York City. The nursing staff followed Standard Precautions in their work with these patients, as we do today. They weren’t particularly concerned about risk to themselves, because it was already clear that this disease—as little as we knew about it then—was not easily transmitted to caregivers.

Remembering fear.

Yet many who worked in other parts of the hospital were not convinced of this. One of my friend’s stories always stayed with me: She relayed how dietary staff would take the elevator to the HIV unit, shove the meal cart out of the elevators into the elevator lobby, and quickly step back into the elevator and close the doors. Many times the nursing staff didn’t even know the food had arrived.

Current epidemiologic trends, treatments, comorbidities, and prevention.

We’ve come a long way since then in our understanding of HIV. Amazingly, in just a few decades, an infection that was once virtually a death sentence is now managed as a chronic disease. In “HIV Update: An Epidemic Transformed,” Jeffrey Kwong updates us on HIV epidemiologic trends, current treatments, common comorbidities, and options for prophylaxis.

Kwong’s thorough and succinct summary of “where we’re at” in our knowledge of HIV and of the care we can provide will be useful for any nurse who comes into contact with people who are HIV positive or at risk for the infection. Read more in this month’s issue of AJN.