To the Editor,

This letter is an appeal to the editor to consider publishing more articles that are relevant to nurses in acute care who take care of people living with HIV (PLWH). The first author, an emergency department (ED) nurse working in a city with high HIV prevalence, feels that this journal and the nurses who conduct HIV research are not meeting the education and information needs of nurses who care for PLWH who require acute care. The most recent issues of JANAC have no shortage of articles on HIV primary care, testing, and prevention, but there is very little about acute care for the patient with chronic HIV infection. A crude tally of JANAC articles published between January 2016 and October 2018 found only four articles, or approximately 5%, that pertained to acute care of PLWH. The paucity of literature about acute care nursing for patients living with HIV has a detrimental effect on the patients we serve.

PLWH who experience frequent hospitalizations usually have a history of fragmented care from multiple EDs, resulting in inadequately managed comorbidities (Feller, Akiyama, Gordon, & Agins, 2016). The nursing care needs of PLWH who are either lost to care, lack access to antiretroviral therapy (ART), or are receiving episodic care in EDs or during hospital admissions are knowledge gaps that acute care nurses experience and that provide an opportunity for nurse scientists to address. The first author recently cared for a patient in just such a situation twice in a 6-week period. On the first occasion, the patient had not received ART for a long time; during that hospitalization, she began to take ART. On the second occasion, she was sicker than on the first occasion. It dawned on the first author that the patient was likely experiencing immune reconstitution inflammatory syndrome, a condition that the first author only learned about during a course in the HIV specialization tract of her Doctor of Nursing Practice program. The first author told this story to one of her colleagues who became a nurse in 1991, and the colleague recalled that ED nurses were proficient at taking care of patients living with HIV "back in the day," and now, most nurses would not know what they were looking at if one of those "1990s-sick" patients was admitted to the ED. In 2018, we see 1990s-sick patients frequently in urban EDs that treat a population experiencing numerous health disparities and limited access to care.

We have reached a point where nurses who became HIV care experts in the early days of the epidemic have left acute care practice to go into academia, administration, policy, research, or retirement. There is a discrepancy between what scholars of HIV nursing recognize as the education needs of prelicensure and professional nurses (Bradley-Springer, Stevens, & Webb, 2010; Frain, 2017) and the education support we actually receive in nursing programs and professional practice. Today's typical acute care nurse does not know how to take care of sick PLWH who need acute care, and, as a result, patients are suffering. What little the first author learned about HIV in nursing school is outdated, and a graduate-level pharmacology course the first author took within the past 2 years did not even broach the topic of HIV medications. If the first author was not in the HIV specialization of her Doctor of Nursing Practice program, the extent of her HIV education would have been a 3-hr lecture. In addition, none of the hospitals where the first author has worked offered ongoing continuing education about caring for PLWH experiencing acute exacerbations of chronic HIV infection. HIV care has changed tremendously since the most recent publication of ANAC's Core Curriculum for HIV/AIDS Nursing in 2010 (Swanson, 2010), which makes articles in JANAC critically important to the professional development of acute care nurses.

As of 2014, the majority (62%) of PLWH have been linked to HIV primary care, but fewer than half have been retained in care (Centers for Disease Control and Prevention, 2017). In the first author's experience, PLWH who come to the ED and are admitted to a critical care unit are patients who have not been retained in care. Hospital nurses are HIV nurses, too, but the articles in JANAC do not prepare us to meet the needs of our patients living with HIV. We need JANAC and the researchers who contribute to this journal to address our education needs and to include our patients-who are often lost to care-in their studies. JANAC could remedy this problem by publishing a supplement about opportunistic infections in acute care, continuing to include articles about caring for PLWH in acute care settings, and soliciting the voices of bedside nurses caring for PLWH in hospitals and other acute care settings.

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