Académique Documents
Professionnel Documents
Culture Documents
1 : 2549
: 800
: ()
. 09/08/49
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1
2
3
3
4
5
8
13
17
18
20
20
21
22
23
26
29
33
33
34
35
4 /
CD4
38
41
44
45
49
52
/
/
55
55
56
62
64
6 /
(..2549)
67
68
71
73
75
77
78
81
82
83
84
85
(HIV CARE)
11
12
27
28
48
57
70
5.2 /
5.3 /
5.4 /
6.1
CD4
6.2 CD4 Count
6.3 :
6.4
5
34
35
50
58
58
59
60
70
70
77
78
HIV
(Dissemination)
70-90%
40-80% (Dissemination)
20-40%
(cavitation) (lower-lobe
infiltration) (miliary infiltrates)
(pleural effusion)
(upper lobe fibrocavitary infiltrates) reactivation
TB
localized alveolar infiltration
bacterial pneumonia
100%
(Disseminated TB)
Disseminated mycobacterium avium complex
|
low-density
necrosis
primary
complex hilar adenopathy, pleural effusion,
lower zone miliary infiltration cavity
tissue damage cavity (
) cell
monocytes
Bronchoscopy tissue Biopsy, Blood culture
/
nocardia
pneumococci, PCP, salmonella, lymphoma, kaposis sarcoma, lymphocytic, interstitial
pneumonitis
caseous necrosis
mediastinum
2 |
Miliary tuberculosis
miliary tuberculosis
miliary noduies
5-10%
tuberculoma
10 1
5 6
10
5 - 10%
1 60
1.
1 7-10%
/ 10% / CD4
PPD
2. TB (Active TB)
|
16
CD4
1.
2.
3. (PPD TST)
5 . CD4
4. CD4
200 5 - 10%
5 .
INH 300 . 9
PPD skin test (Mantoux method)
tuberculin protein
T-lymphocyte PPD skin test
4 |
t-lymphocyte lymphokines
PPD
PPD skin test
10%
5% 2 5%
10%
1. /
2.
Rifabutin Rifampicin
CYP 450 Protease
inhibitor (PI) Non - nucleoside reverse transcriptase inhibitor (NNRTI)
3.
4.
5.
/
Immune recovery syndrome MAC ()
Rifampicin (RIF)
RIF PIs
PIs RIF
80%
35%
92%
82%
RIF NNRITs
37%
13%
NNRTIs RIF
(
/)
1.
(AIDS-de-fining illness)
CD4 250 cell/cu.mm
2. CD4 250 cell/cu.mm
3. CD4 200 cell cu.mm
1. 12
1.1
1.2 CD4 < 25%
2. 12
DOT
HAART
6 |
1. EFV containing regimens
(IRIS)
/ National Tuberculosis
Program
|
(Directly Observed Treatment,
Short - course : DOTS) /
1.
1.1 /
2
1.2
/
2.
2.1 (Voluntary
Counselling and Testing VCT)
2.2
8 |
1.
2.
3.
4.
5.
6.
7.
8.
9.
30
10.
11.
12.
13.
/
2
1.
2
2. /
3.
4.
5.
6.
7.
8.
9. /
/
30
10.
10 |
11. /
12.
11
12 |
37 9 2501
1 2502
1.
2.
3.
4.
13
(...)
2539-2543
1.
2
2.
3.
4.
5.
8-18
14 |
6.
5
(Addiction)
(Pavlov)
Pavlov
4
1. (Introductory stage)
15
2. (Maintenance stage)
3. (Disenchantment phase)
(Limbic system)
4. (Disaster phase)
16 |
1.
1.1
1.2
1.3
2.
2.1
2.2
2.3
3.
3.1
3.2
4. 2
|
17
1.
2.
2.1
18 |
(Abandonment)
(Enmeshment)
2.2
2.3
3.
80
19
1.
2.
1.
2.
3.
3.1
3.2
3.3
3.4
Clorox (Sod Hypochlorite)
20 |
1.
2. (/)
3.
4.
5.
1.
1.1
1.2
1.3
1.4
|
21
2.
2.1
2.2
2.3
2.4
1.
2.
1.
1
(
)
2.
30
2
3.
30
2
4.
30
2
22 |
1.
2.
3.
1.
1.
2.
2.
(/)
23
3.
3.
4. (
4.
)
( )
5.
5.
6.
6.
24 |
7.
7.
8.
8.
9.
9.
10.
10.
25
1.
2.
3.
4.
5.
6.
7.
1.
2.
3.
4.
5.
6. (Water - based Lubricants)
(Oil - based Lubricants)
7.
26 |
27
28 |
29
1
(denial)
(decompensation) (projection)
2
(guilt) (shame)
(acting out)
(low self-esteem) (suicidal
ideation)
3
(recognition of stigma)
30 |
5
5 . (Coming Out
to Significant Others)
(model) Kubler-Ross
Cass (1979)
(stages of homosexual identity
formation)
(bargaining)
(stress displacement)
(rejection)
(confrontation)
5 . (Looking for Others)
(loss of autonomy)
5 . (Special Status)
(reaction formation)
(a sense of guilt or self-blame)
(us and
them dichotomy)
|
31
5 . (Altruistic Behavior)
5 5
(overreaction) (overcompensation)
(burn out)
6
(preparatory grief) (final grief)
7
(self-identity)
(altruism) (self)
(unfinished business)
(resuscitation method)
32 |
(Voluntary Counseling and Testing : VCT)
(Voluntary Counseling and Testing : VCT)
(motivation)
1. (Compassionate)
(nonjudgmental)
2.
3.
(Pre-test Counseling)
(prevalence)
Mood Disorders Substance-Use
Disorders
1.
2.
3.
4.
3.1
33
8. (social status)
(positive) ( )
9. (high-risk behaviors)
10.
11.
(stress)
3.2
34 |
35
Delirium
Delirium (cognitive functions)
(consciousness) (orientation)
(attention) (learning) (memory) Delirium
(physical diseases) (neurological
disorders)
Depressive Disorders
(mild depression)
(Depressive Disorders)
2
(suicide behavior)
36 |
2-3
1-2 (viremia) (antigenemia)
2-6 (anti-HIV)
1-2
3-12 ( 8 6 )
window period
37
2
1. Indirect method
2. Direct method
p24
3-12 6
IgM IgG
2
1. (Screening test)
2. (Confirmatory test)
ELISA
paticla agglutination (rapid/simple test)
western blot
1. (Screening test)
1.1 (ELISA)
ELISA 99
0.3-0.5%
IgM IgG window period
1.2 (Simple Test)
(Gelatin particle agglutination ; GPA)
1.3 (Rapid Test)
1.4
38 |
(technical error)
(clerical error)
(reactive)
(false-negative)
(false-positive)
(biological false-positive)
anti-HIV
1. Auto antibodies SLE (systemic lupus erythematosus)
2. HIV Vaccine
3.
4.
anti-HIV
1. Window period anti-HIV
3 - 3
10-14
2. anti-HIV (Seroreversion)
3.
4. gamma
globulin (Agammaglobulinemia)
5. HIV-1 type (type N
type O) HIV-2
anti-HIV-1
(Screening
Test)
39
2. (confirmatory tests)
anti-HIV-1/2
2.1 (Western blot, WB)
gold standard
WB
(profile)
2.2 (Immunofluorescent
assay, IFA)
licensed US FDA
fix slide
anti-human lgG conjugate
Fluorescein
1.
2.
3.
2.3
(Line immunoasay)
envelope / gag
40 |
HIV
viral load
41
2.
/
HIV-1 RNA
HIV viral load 5
HIV viral load 5
viral load
(caesarean section)
viral load
2. viral load
10
1
3. viral load 20,000 copies/
ml
42 |
.
.
CD4+ T cells
. viral load
.
4. viral load 20,000 copies/ml
viral load (<50 copies/ml)
viral load 60,000 copies/ml (
32.6%) 3 viral load
18,000 copies/ml ( 5.9%) 3
5. viral load 2-8
7. viral load
3-4
8.
viral load
5
viral load
500 copies/ml 4-6
50 copies/ml 6-8
viral load
CD4+ T cells
43
1. HIV antigen HIV
p24
HIV-1 HIV-2
p24 HIV antigen ELISA
p24 antigen
2-4 HIV
antigen
15
anti-HIV
HIV antigen
2.
probe HIV RNA proviral DNA
Anti-HIV Anti-HIV
18
7.
8.
44 |
CD4
CD4
(Flow cytometer)
CD 4 cell (CD4+
T-lymphocyte) CD4 cell
anti-HIV CD4 cell
CD4 <
200 cell/ml
CD4 cells
CD4 cell
monoclonal Ab CD4 marker
%
lymphocyte
complete blood count (CBS) CD4
cell cells/ml
|
45
CD4
EDTA
(ethylenediamine tetraacetic acid) K3EDTA
EDTA 0.15 1
3 ( ()
EDTA )
EDTA
( 1 )
1.
2. colt
3. 24
46 |
anti-HIV
1.
anti-HIV
(unit)
2. (epidemiological surveillance)
(Unlinked anonymous)
3. anti-HIV (screening assay) anti-HIV negative (non reactive)
(reactive)
western
blot (immunoblot)
(indeterminate)
.. 2537 .. 2540
( .. 2540
.. 2545) 2
/
3
anti-HIV positive
3
(indeterminate)
1-6 1
( 1)
47
48 |
3 ( 4.1)
1. (primary infection) 2-6
anti-HIV window period (pre-serocoversion) CD4+ T
lymphocytes HIV-RNA (viral load)
105-106 copies/ml HIV-1 DNA HIV
p24 Ag 89 HIV RNA HIV p24 Ag
10-12 16-17
20-25 HIV RNA HIV p24 Ag 10
5
2. (clinical latency) 3-10
anti-HIV HIV-1 DNA
HIV-1 p24 Ag HIV RNA
(viral load)
antiretroviral
viral load CD4+ T lymphocyte
viral load 105 copies/ml 3
5 3-10 5
CD4+ > 500 cells/ml 10-15 (long term
survivor) CD4+ < 200 cells/ml
3. (advanced disease)
CD4+ <
200 cells/ml
49
4.1
CD4+ T cells
(Cells/ul)
99.3-99.7
200-500
<200
200-500
<200
10-20
37-95
30-70
75-85
p24 immune
complex
(acid treatment)
(heat denature)
PBMC/
(co culture)
<500
95-100
97-98
proviral DNA
(indeterminate)
>200
<200
90
98-100
RNA
(viral load)
reall time PCR
()
Anti-HIV /
(immunoassay)
50 |
HIV
HIV
(clotted blood) EDTA (sterile EDTA
blood) (Peripheral blood mononuclear cell, PBMC)
(whole blood) EDTA blood
Anti-HIV
HIV Ag
Viral load
HIV DNA
HIV RNA
HIV culture
CD4+ T lymphocyte
: , 5
(whole blood )
: , 5
: ( EDTA 5 )
: PBMC
: ( EDTA 5 )
: PBMC,
: EDTA blood 3-5
(p24 antigen)
p24 antigen (Core
protein)
p24 antigen
p24
(fluctuation)
51
RNA
proviral DNA
proviral DNA
(polymerase chain reaction, PCR)
PCR 1993
p24
18
PCR 2-3
100% 6
Universal Precautions
pathogenic organisms
1.
2.
52 |
3.
4.
5.
6.
7.
8.
( 110%)
9.
10.
53
1.
2.
3.
4.
1. 3 4
2.
3.
0.5% 2% 30
54 |
/
/
/
1. /
2. /
3. /
4. /
/
1.
2. /
/
/
/
55
3.
4.
/
/
1.
/
/
2.
3.
4.
56 |
57
5.1 /
67
8
-
-
5.2 /
66 9
1
2
(/)
- /
-
1
- /
- /
- /
-
67
-
-
- -
9
58 |
5.3 /
1
1.1
1.2
1.3
1.4
1.
.
2.
3. 25
-
-
1.
.
2.
3.
-
-
1.
.
2.
5
2 . 0 2246 0359
|
59
5.4 /
1.
1.
2.
2.
(
)
1,000
3,000
1
2,000 /
1
3,000 /
1
1.
(
)
2.
3.
4.
5.
2,000
3 /
/
1.
2.
3.
(
)
()
1 . 10100
0-2282-5869, 0-2659-6170-71
* .. 2539 0514/227
5 2537
60 |
3.
1. - - - 500 /
6,000 /
2.
1.
2.
3.
4.
5.
( 3x5
2
60 . . 10400
0-2247-9480, 0-2246-8651, 0-2247-9484
4.
1.
...
.. 5,000
2539
2.
3.
4.
5.
5,000
. 0526.7/
3/140 29
2539
1.
2.
3.
8
( 118)
|
61
/
67
1.
1.1
(..3)
1.2
(..3)
(..3)
62 |
2.
(..3)
()
(Zoning)
()
/
/
/
63
( )
.. 2533
CD4 200 cell/cu.mm
CD4 250 cell/cu.mm
14
15% 3
64 |
1
2
2 2
NVP 1
2 2.1
d4T 1
2 2.2
NVP d4T 1
2 2.3
NVP EFV 1
2 2.4
HIV/AIDS
1 2
1 2
5,000
1.
2.
3.
65
1.
2. 1 2
2 HIV/AIDS
3.
4.
66 |
/
/
/ 2
(Comprehensive care)
/
(1) (Medical care)
(2) (Psychological care)
(Counselling) (Emotional support)
/ (Self-help group)
/
67
(Continum care)
/
/
2
(1) (Place)
/
/
(Health care provider)
68 |
(2) (Time)
/
/
(Bio-medical care) (Psychological care)
(Socio-economical care)
(Evidence based)
/
/
69
6.1
CD4
CD4 (/..)
CD4 200
CD4 200-350
CD4 350
CD4 < 200
OI/ARV
3
6
PCP
Toxoplasmosis
Cryptococosis
Mycobacterium Avium
Complex
70 |
Cotrimoxazole
2
Fluconazole
(200) 2
Azithromycin
(250) 4-5
: 3
( )
(collective financing)
(third party payer principle)
.
|
71
/
30 /
1 2548
()
2549
2549
2,796.2
82,000
2550
72 |
MAC CMV
/
4 250
4 200
:
1. (CD4)
4 6
( )
(
)
d4T+3TC+NVP
AZT+3TC+NVP
d4T+3TC+EFV
ddl NFV
AZT+3TC+EFV
d4T+3TC+IDV/r
AZT+3TC+IDV/r
NRTI : AZT 3TC d4T ddl
PI : IDV/r, SQV/r LPV/r
|
73
2.
CD4 6
() 6
() 1
CD4 30 %
1,000
(adherence)
1,000
3.
/
(CD4)
...
74 |
(..2549)
CD4
3
(.. 2549)
1.
2.
3.
3.1 AZT 28 300
75
4. CD4
CD4<200
3
4.1 14 AZT
100 + 3TC 150 .+ NVP
200 . 2 -
4.2 AZT 100
+3TC 150 . + NVP 200 .
2 -
5.
5.1 6 1 (
2,500 2 1 )
5.2 AZT 2
1 6 1
4
5.3 AZT 2
1 6 6
4
6.
12
7.
12
18
8. (
)
9.
76 |
1.
2.
3.
/
4.
5.
6.
7.
6.3 :
< 60 kg
> 60 kg
40 mg 12
3. 3TC
4. NVP
200 mg
1.GPO-VIR
2. d4T
200 mg 1 200 mg 1 x 14
x 14 days
200 mg 12
600 mg
600 mg 600 mg
5. EFV
6. IDV+RTV
(Boosted PI)
7. AZT
100 mg
77
6.4
1.
(NRTI)
(AZT)
(d4T)
( )
( )
()
Steven-Johnson Syndrome
()
()
(3TC)
(ddI)
2.
(NVP)
(NNRTI)
(EFV)
3. (PI)
-
-
-
(IDV)
(SQV)
(RTV)
/
(LPV/RTV)
(NFV)
( )
()
.. 2527
1 6
78 |
1.
1 d4T + 3TC+NVP (GPO-VIR)
2 2.1 d4T+3TC+EFV NVP
2.2 AZT+3TC+NVP d4T
d4T
<50 copies/ml
d4T GPO-VIR S40 GPO-VIR S30 d4T, 3TC
NVP d4T 15 20 mg. 12
2.3 AZT + 3TC + EFV NVP d4T
3 3.1 d4T + 3TC + IDV/RTV
3.2 AZT + 3TC + IDV/RTV
2.
1 d4T + 3TC ( AZT + 3TC) + NVP >20
GPO-VIR ()
2 d4T + 3TC ( AZT + 3TC) + EFV
3 d4T + 3TC + IDV/RTV AZT + 3TC + IDV/RTV NVP
EFV
NVP, EFV IDV/RTV CD4 > 15%
d4T + 3TC AZT + 3TC
NEW
1
2.1
2.2
2.3
3.1
3.2
4
5
6
7
8
9
10
..
..
..
..
..
..
( ..)
79
1.
2.
1. EFV containing regimens
2. NVP containing regimens EFV
3. unboosted PI regimen EFV boosted PI
IDV / RTV ( 800:200 BID ) PI booted
RTV 200 mg BID RTV 100 mg BID
80 |
( )
0.3%
0.09 %
0.09%
81
2
1
2
3
3
3
(less sevsere) (solid needle) (superficeal injury)
(more severe) (lasge bore hollow needle)
(deep injury) (visvble blood in device)
(needle in patient artery or vein )
12
3
82 |
1.
2.
3.
4.
5.
6.
7.
8.
9.
1. 2
2.
3.
4.
5.
6. 3
7.
8.
9. 2
10. 1
1.
11.
2.
12.
3. (HIV-NAT)
13. .
4.
14.
5.
15. 2
6.
16.
7.
17.
8.
18.
9.
19.
10.
20.
11.
21. 2
12.
22.
23.
13.
24. 1
14.
25.
15.
26.
16.
27. 9
17.
[ 2549 ]
83
, . .. 2540
().
, . / 1 :
, 2548.
, .
. 1. : ,
2549 .
, . .
3. : , 2549.
, . 1 . :
, 2547.
, . /. 1. :
, 2548.
, . /. 1.
: , 2547.
, . . 1.
: , 2547.
, . .
1. : , 2547.
, , , 2542.
Atkinson JH, Grant l. Natural history of neuropsychiatric manifestations of HIV disease. Psychiatr Clin North Am
1994 : 17 : 17-33.
Cass VC. Homosexual identity formation : a theoretical model. J Homosex 1979:4:219-35
Catalan J. Psychological interventions in infection with the human immunodeficiency virus. Br J Psychiatry
1995:167:104-11.
Fernandez F,Levy JK. Psychopharmaology in HIV spectrum disorders. Psychiatr Clin North Am 1994:17:135-47.
Grant I, Atkinson Jr. JH. Psychiatric aspects of acquirde immune deficiency syndrome. In:Kaplan HI, Sadock BJ,
editors. Comprehensive textbook of psychiatry/VI. 6th ed. Baltimore (MD) : Williams & Wikins : 1994.
p.1644-69.
Hinkin CH, van Gorp WG, Satz P. Neuropsychological and neuropsychiatric sapects of HIV infection in Adults.
In : Kaplan HI, Sadock BJ, editors. Comprehensive textbook of psychiatry/VI.6th ed. Baltimore (MD) :
Williams & Wilkins : 1994.p. 1669-80.
Kelly JA. Behavior and acquired immunodeficiency syndrome. In : Wedding D, editor. Behavior and medicine.2nd
ed. St. Louis (MO) : Mosby : 1995. p. 367-75.
Oakley A, Fullerton D, Holland J. Behavioural interventions for HIV/AIDS prevention. AIDS 1995:9:479-86.
Rosse RB, Giese AA, Deutsch SE, Morihisa JM. Laboratory and diagnostic testing in psychiatry. Washington (DC)
: American Psychiatric Press; 1989.
www.aisdthai.org,
84 |
1. 66
.1
.2
.3
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.7
.8
.9
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.11
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.13
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10200
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. 10800
.
10400
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10400
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10330
.
10330
663 .
10120
119 . 103
10260
.
10200
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10110
.
10400
40 .
10120
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10100
389/1 . 42 .
10120
41 () .
10900
0-2226-5897
0-2222-7874
0-2251-7735-38
0-2245-9144
0-2587-0618
0-2587-7307
0-2587-0873
0-2586-9512
0-2246-1553
0-2245-0640
0-2246-1554
0-2248-6086
0-2216-1297
0-2214-1057
0-2282-8493
0-2282-0048
16
0-2294-9444
0-2294-3306
0-2294-9444 100
0-2361-6760-2
0-2393-0628
0-2281-7861
0-2282-8494
0-2258-4892
0-2259-2523
0-2271-1122
0-2278-5535
0-2291-7637-9
./
. 0-2222-7875
0-2224-5436
./ 0-2211-2353
0-2221-9154
. 0-2939-9538
0-2541-8380
0-2541-8382
85
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.17
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.19
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181/62 . . 4
10330
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10900
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10120
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10230
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45
10900
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10310
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10600
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124/16 .
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27/21 . 49 .
10150
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164/79 .-
10700
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10700
86 |
/
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