Author Affiliation: Dr Makadon is Vice President, Medical Affairs, Beth Israel Deaconess Medical Center, and Associate Professor of Medicine, Harvard Medical School, Boston, Mass.
Clinical Crossroads at Beth Israel Deaconess Medical Center
is produced and edited by Thomas L. Delbanco, MD, Jennifer Daley, MD,
and Richard A. Parker, MD; Erin E. Hartman, MS, is managing editor.
Clinical Crossroads section editor: Margaret A. Winker, MD, Deputy
DR DELBANCO: Mr K is a
41-year-old man who is clinically well but infected with the human
immunodeficiency virus (HIV). An immigrant to the United States, he
owns a retail business near Boston, Mass. He is covered by a commercial
managed care insurance plan and, since 1994, has received care from a
faculty physician in the primary care practice at the Beth Israel
Deaconess Medical Center.
Mr K is gay and was in a primarily monogamous relationship since the
1980s. Mr K believes he contracted HIV infection from his partner, who
had multiple partners prior to their relationship. In 1990, Mr K had a
short episode of upper respiratory tract viral symptoms, with cough and
fever, and subsequent test results were positive for HIV infection. His
partner was tested and was also found to be HIV positive. Mr K became
extremely depressed for several months and was barely able to work. His
depression improved without psychiatric or pharmacological intervention
and, since that time, he has focused his attention on his work and his
partner's progressive and recently fatal illness.
Makadon HJ. An Asymptomatic 41-Year-Old Man With HIV Infection. JAMA. 1999;281(8):739-744. doi:10.1001/jama.281.8.739