The management of HIV infection has advanced dramatically since its discovery. The HIV Outpatient Study (HOPS) highlighted the statistically significant decrease in HIV-related morbidity and mortality, which was attributed to improved prophylaxis against opportunistic infections and the introduction of a potent combination of antiretroviral therapies (highly active antiretroviral therapy [HAART]) (1). The results from HOPS and other studies began a shift in the delivery of care for persons with HIV infection (2 - 5). The initial Agency for Health Care Policy and Research guidelines for managing HIV infection did not discuss vaccination because vaccinating a population that was unlikely to survive long enough to receive benefit was not cost-effective (6). Not only do the HIV primary guidelines now recommend vaccination, but documentation of hepatitis and pneumococcal vaccination are part of the American Board of Internal Medicine HIV Practice Improvement Module that is required for recertification (7). The physician of choice has also changed. Early in the HIV epidemic, primary care providers referred their HIV-infected patients to HIV experts (usually infectious disease physicians or physicians who provided care to more than 20 HIV-infected patients) to manage HIV-related conditions, oncologists to manage HIV-associated malignant conditions, and palliative care specialists. These HIV experts found themselves in unfamiliar territory as their patients were developing age- or sex-specific non–HIV-related conditions, such as hypertension, cancer, diabetes, and coronary heart disease (CHD). The antiretroviral medications were associated with dyslipidemia, diabetes, and neuropathies (8 - 10). The HIV experts found that they had to either refamiliarize themselves with general primary care or refer their patients to primary care providers. In recognition of the need for a paradigm shift, the Infectious Diseases Society of America and the HIV Medicine Association released primary care guidelines for persons with HIV in 2004 (7).