The nation's largest, single provider of health care to those infected with HIV (Human Immunodeficiency Virus) is the Department of Veterans Affairs (VA).  Approximately 55,000 veterans with HIV infection and AIDS (Acquired Immune Deficiency Syndrome) have been treated in VA since the disease was first recognized in the United States in 1981.  VA physicians were among the first to report the syndrome.  Regular reporting began in 1983 when 61 patients were treated in VA's health care system. 

In 2003, approximately 20,000 patients with HIV infection were treated at VA facilities across the nation.  Of the total, more than 8,500 received inpatient treatment, a number that has declined steadily in recent years.  Reduction of inpatient care reflects dramatic advances in treatment of HIV/AIDS.  In the outpatient setting, most VA care is provided in infectious disease clinics.

VA’s clinical guidance on management of HIV/AIDS is based upon the Department of Health and Human Services-Kaiser Family Foundation’s "Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents."  These guidelines were developed by a panel of leading international clinical and research experts, including VA’s HIV/AIDS experts.  The guidelines are updated periodically and include the results of most recent research related to anti-HIV drugs and drug combinations, prevention of HIV/AIDS complications, patient adherence to therapy, management of drug side effects and interactions and the use of diagnostic tests including drug resistance assays.

VA guidelines require that all antiretroviral drugs on the national VA formulary be made available at each facility.  Use of currently available Highly Active Anti-Retroviral Therapy (HAART) has resulted in improved survival and fewer complications for people living with HIV/AIDS.  HIV care providers and patients can develop effective regimens from among the many drugs available after consideration of side-effect profiles, patient preferences and information about resistance to individual drugs.

VA's HIV/AIDS care programs take a comprehensive approach with increased emphasis on outpatient services, active case management and tracking of data on HIV-positive veterans through a registry that provides clinical, administrative and management reports.

Training

VA conducts frequent meetings, national training programs and teleconferences on issues related to clinical care and research, testing and counseling, prevention, patient health education and occupational exposure to bloodborne pathogens.  VA also employs newsletters and electronic news service, email groups and web-based training to help HIV care providers keep their knowledge and skills in HIV/AIDS management up to date.

Research

VA conducts wide-ranging research in HIV/AIDS, from basic studies of the mechanisms of AIDS to clinical trials and assessments of health services delivery.  Research is an integral part of VA’s efforts to improve the diagnosis, treatment and prevention of HIV infection.

VA’s large network of medical centers and clinics, and its large patient population, provide a system for multi-center clinical trials investigating new HIV medication regimens or treatment strategy studies.  In seeking better understanding of AIDS, VA also works closely with many other organizations.  These include VA-affiliated academic medical centers, the National Institutes of Health, the Centers for Disease Control and Prevention, the Department of Defense, the NIH-funded Community Program on Clinical Research on AIDS and AIDS Clinical Trials Group, the Food and Drug Administration, the Canadian Institutes of Health Research and the Medical Research Council of the United Kingdom.

Collaboration among these organizations enhances opportunities to discover new and better strategies for veterans and all people with HIV/AIDS.

More information can be found at http://www.publichealth.va.gov/.

# # #