Lecture 2 - Manifestations of Disease[1]

Predicted prevalence of mental ilnesssubstance abuse

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Predicted Prevalence of Mental Ilness/Substance Abuse Diagnoses Brian Pence J Acquir Immune Defic Syndr. 2005;40:434-44 Diagnosis Predicted prevalence (95% CI), UNC-ID Any mood or anxiety disorder 39% (37–41%) Depression 32% (30–35%) PTSD 4% (4–5%) Panic disorder 7% (7–7%) Any substance disorder 21% (19–23%) Alcohol 13% (11–14%) Crack/cocaine 14% (13–16%) Both mood/anxiety and substance disorders 8% (7–9%)
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University of North Carolina 01/10/11 Cost effectiveness of antiretrovirals In patient census Out patient census Average length of stay (days) Inpatient days Antiretroviral drug cost -46% +29% -2.4 -8% +$107,684 Torres et al. 1997 Retrovirus Meeting 1/95-7/95 vs 1/96-7/96, St. Vincents Hospital
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University of North Carolina 01/10/11 Early Clinical Manifestations of HIV Infection Reactivation of TB Shingles Varicella zoster virus aka Chicken Pox More frequent episodes of HSV 1 & 2 Hairy leukoplakia (Epstein Barr Virus) Oral and vaginal candida (yeast infections) Seborrheic dermatitis Molluscum contagiosum
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University of North Carolina 01/10/11 TB
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University of North Carolina 01/10/11 Shingles (Varicella Zoster Virus)
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University of North Carolina 01/10/11 Herpes Simplex Virus
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University of North Carolina 01/10/11 Pathogenesis of HSV Infections Synthesis of infectious virions. Synthesis of infectious virions. Centrifugal migration of infectious virions to epidermis Centrifugal migration of infectious virions to epidermis
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University of North Carolina 01/10/11 Hairy Leukoplakia Epstein Barr Virus
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Candida or Thursh
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University of North Carolina 01/10/11 Seborrheic Dermatitis (? Malassezia Yeasts)
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University of North Carolina 01/10/11 Molluscum contagiosum virus
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University of North Carolina 01/10/11 Opportunistic Infections Over the Course of HIV Infection 0 100 200 300 400 500 600 700 800 0 1 2 3 4 5 6 7 8 9 10 11 CD4 Lymphocyte Count Years Pneumocystis Pneumonia Toxo encephalitis Crypto meningitis MAC Bacteremia CMV Retinitis TB Shingles/Hairy Leukoplakia Thrush/Herpes
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University of North Carolina 01/10/11 Pneumocystis Jirovecci pneumonia
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University of North Carolina 01/10/11 Toxoplasma Encephalitis
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University of North Carolina 01/10/11 Cryptococcal Meningitis
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University of North Carolina 01/10/11 Clinical Appearance of Cytomegalovirus (CMV) Retinitis Courtesy of Baruch D. Kuppermann, MD, PhD. A. Normal Retina A. Normal Retina B. Fluffy Form B. Fluffy Form C. Granular Form C. Granular Form
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University of North Carolina 01/10/11 HIV Encephalitis
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Mycobacterium avium complex (MAC)
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University of North Carolina 01/10/11 Kaposis Sarcoma (Human Herpes Virus 8)
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University of North Carolina 01/10/11 HIV-Related Complications (USA) Selik RM,et al., Ann Intern Med 1995; 123:933 1992 35 35 30 30 25 25 20 20 15 15 10 10 5 0 Deaths (%) Deaths (%) 1987 1988 1989 1989 1990 1991 Criptosporidiosis or Isosproiasis Candidiasis Leucoencephalopathy Bacterial pneumonia Tuberculosis Cryptococcosis Toxoplasmosis Lymphoma Cytomegalovirus Kaposi’s sarcoma Septicaemia Non-TB mycobacteriosis Pneumocystosis Unspecified pneumonia
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