Prognosis And The Role Of The Surgeon

The prognosis of this most potent 20th century epidemic has changed from a disease with an almost 100% fatality rate to a manageable syndrome within 20 years. This represents a change that is unprecedented in the history of medicine. Reports from around the developed world have documented the efficacy and safety of potent antiretroviral therapy and the huge impact (Fig. 22) this has had to the disease prognosis and survival. Unfortunately, as of 2006, the epidemic continues to be rampant in the poorest areas of the planet, although programs to deploy effective drugs may be under way.

The surgeon in 2006 is expected to encounter more and more survival success cases or new cases with a potential for control and long-term survival. Hence, philosophies that once discouraged certain therapies should be reevaluated. Effective treatment and collaborative work are the keys to the continuation of the survival benefits for HIV-infected persons.

FIGURE 21 Lateral cervical fat pads in HIV-related lipodystrophy. Source: Courtesy of the Massachusetts Medical Society. From Ref. 30.

CD4~adjusted Survival after Clinic Entry, by Time Period

Owen Clinic (n=5054 at risk, 1376 deaths, median follow-up 2 years)

Time after Clinic Entry (years)

- period = 2001-2003

Adjusted to CDJ=2O0

FIGURE 22 AIDS-related death proportions, UCSD Owen Clinic, by era. Source: Courtesy of Mathews WC, MD.

SUMMARY

As described in this chapter, HIV disease can present with many different head and neck manifestations. Both in the chronic latent stage and in the acute primary infection, any suspicious symptom should prompt testing for the presence of HIV infection. Since some of those symptoms have broad differential, require prompt diagnosis for improved outcomes, and have significant prognostic value, aggressive diagnostic workup and treatment are warranted.

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