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AIDS
邓子德
中山大学附属第三医院
传染病学教研室
Deng zide
Department of Infectious Diseases
The 3rd Hospital of Sun Yat-sen University
A
Acquired
I
Immuno
D
Deficiency
S
Syndrome
AIDS
• AIDS (acquired immunodeficiency syndrome) was
first reported in the United States in 1981 and has
since become a major worldwide epidemic.
• AIDS is caused by HIV (human immunodeficiency
virus). By killing or damaging cells of the body's
immune system, HIV progressively destroys the
body's ability to fight infections and certain cancers.
• People diagnosed with AIDS may get life-threatening
diseases called opportunistic infections, which are
caused by microbes such as viruses or bacteria that
usually do not make healthy people sick.
AIDS
A
I
D
S
AIDS patient
AIDS patient
Timeline Post-Naming
1982 – First use of term “AIDS”
1983 – Virus isolated and identified
Early to mid 80s – First wave of activism: community based groups
securing visibility.
1985 – HIV Ab testing available
Mid-80s – Border control regulations in more than 50 countries
1987 – First FDA approved drug, AZT. Also, birth of ACT UP and
transition to activism focused on treatment.
Late 80s – WHO produces “world mapping”
Recognizing “New Frontiers”
1990 – Eastern Europe described as the new frontier of the AIDS
epidemic; Signs of infection in China (in fact starting early to mid 80s)
Always “the other”
'AIDS and drug addiction are still seen as consequences of contact
with the West, AIDS being known as aizibing, the "loving capitalism
disease".'
-The Guardian
1993 – concern about underreporting China, mostly reporting IV drug
users
1996 – China’s reported cases: 2/3 in southern province connected to
drug use
Etiology
H
Human
I
Immunodeficiency
V
Virus
Etiology
Pathogen
人免疫缺陷病毒 (HIV)
(human immunodeficiency
virus)∶HIV-1、HIV-2
Etiology
人免疫缺陷病毒
(human immunodeficiency virus,HIV)
HIV-1、HIV-2
Etiology
透膜糖蛋白
包膜蛋白
逆转录酶
核酸蛋白
HIV-Infected T-Cell
HIV
Virus
T-Cell
HIV Infected
T-Cell
New HIV
Virus
HIV病毒破坏人体免疫系统
HIV infected CD4
HIV
生 活
周 期
急性期
HIV RNA
潜伏期
艾滋病期
Anti-Ab
Anti-gp41/120
(anti-gp36)
Anti-Ag
Anti-P24
1周 2周…..1月 2月………………….1年
窗口期
2年 3年…………….10年………..
HIV抗原、抗体变化图
感染
死亡
Epidemiology
1985-2004年9月全国历年报告HIV/AIDS情况
30000
25000
20000
15000
10000
5000
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
AIDS
1
0
2
0
0
2
3
5
23
29
52
38
126
136
230
233
714 1028 6120 9620
HIV(+)
5
1
9
7
171
299
216
261
274
531 1567 2649 3343 3306 4677 5201 8219 9732 21691 29623
年
份
0
*上述数据为当年各省报告数汇总，本次筛查中有所变动，尚需根据筛
查情况不断调整。
中国1985年发现艾滋病的省份
中国1989年发现艾滋病的省份
中国1995年发现艾滋病的省份
中国1998年发现艾滋病的省份
截至2004年底全国累计报告HIV感染者按地理分布
The geographic distribution of cumulative reported HIV cases in China by the
end of 2004
HIV cases
感染者数
1-50
51-100
101-500
501-1000
1001-10000
10001-20000
>20000
HIV prevalence in adults in Asia, 1990−2005
截至2004年底全国累计报告HIV感染者传播途径构成
Modes of transmission among HIV/AIDS cases by the end of 2004
血液/血制品
母婴传播
MTCT
Blood and Blood
products
0.9%
2.8%
Not
clear
不详
17.9%
Commercial blood
采血
and plasma
Donation
26.8%
静注毒品
IDU
43.2%
异性/同性
Heterosexual/MSM
8.3%
截至2004年底全国累计报告HIV感染者按性别分布
Proportions of male and female reported HIV cases in
China by the end of 2004
Male 男
71.6%
不详 Not clear
0.5%
女
Female
27.8%
Distribution of HIV Infections by Age
30-39岁
34.6%
40-49岁
15.6%
20-29岁
34.7%
〈2 0 岁
5.3%
不详
1.9%
>50岁
7.9%
HIV Transmission
Brief Statistics on the HIV/AIDS Epidemic in
China
By the end of September 2004,
• Cumulative reported HIV infections: 89,067
• Cumulative reported AIDS cases: 20,786
• Cumulative reported AIDS deaths: 5,024
China CDC and WHO estimated:
• People Living with HIV/AIDS: 840,000
• AIDS patients: 80,000
Geographic Distribution of Cumulative Reported
HIV Infections in China
(1985-2004.9)
HIV感染者数
1-100
101-500
501-1000
1001-5000
5001-10000
>10000
Features of the HIV/AIDS Epidemic
in China
 The epidemic is characterized by a wide disparity between high
and low prevalence regions
 The epidemic is becoming more severe
 The main HIV transmission route is through injecting drug use.
 The number of AIDS-related deaths is increasing
 HIV is spreading from high risk groups to the general
population
 The proportion of female HIV cases are increasing
Epidemiology
传染源
• 病人
• 无症状HIV携带者
– ☆HIV存在于∶
血液
唾液
精液
眼泪
阴道分泌物
乳汁
Modes of Transmission

SEXUAL ACTIVITY
BLOOD-TO-BLOOD
CONTACT


VERTICAL TRANSMISSION
Routes of Transmission of HIV
Sexual Contact:
Male-to-male
Male-to-female or vice versa
Female-to-female
Blood Exposure:
Injecting drug use/needle sharing
Occupational exposure
Transfusion of blood products
Perinatal:
Transmission from mom to baby
Breastfeeding
HIV Transmission
• HIV enters the bloodstream through:
– Open Cuts
– Breaks in the skin
– Mucous membranes
– Direct injection
HIV Transmission
• Common fluids that are a means of transmission:
– Blood
– Semen
– Vaginal Secretions
– Breast Milk
HIV in Body Fluids
Blood
18,000
Semen
11,000
Vaginal
Fluid
7,000
Amniotic
Fluid
4,000
Saliva
1
Average number of HIV particles in 1 ml of these body fluids
Epidemiology
传播途径
• 性接触
–同性恋
–异性恋
• 注射
–不洁注射
•输血及血制品
•母--婴
•其他
HIV Transmission:
Sexual Transmission

Highest risk activities
Unprotected anal intercourse
Unprotected vaginal intercourse


Oral sex ?
Condom efficacy:
Consistent and correct use
HIV and Sexually Transmitted
Diseases
HIV and Sexually
Transmitted Diseases
STDs increase infectivity of HIV
– A person co-infected with an STD and HIV may be more
likely to transmit HIV due to an increase in HIV viral
shedding
– More white blood cells, some carrying HIV, may be
present in the mucosa of the genital area due to a sexually
transmitted infection
HIV and Sexually
Transmitted Diseases
• STDs increase the susceptibility to HIV
– Ulcerative and inflammatory STDs compromise the
mucosal or cutaneous surfaces of the genital tract that
normally act as a barrier against HIV
– Ulcerative STDs include: syphilis, chancroid, and
genital herpes
– Inflammatory STDs include: chlamydia, gonorrhea,
and trichomoniasis
HIV and Sexually
Transmitted Diseases
• The effect of HIV infection on the immune
system increases the the risk of STDs
A suppressed immune response due to HIV can:
• Increase
the reactivation of genital ulcers
• Increase the rate of abnormal cell growth
• Increase the difficulty in curing reactivated or newly
acquired genital ulcers
• Increase the risk of becoming infected with additional
STDs
艾滋病与性病相伴
HIV Transmission:
Blood-to-Blood Contact

Injecting drug users (IDUs) who share
needles

Recipients of contaminated blood
products

Healthcare workers with
occupational exposure
静脉
注射毒品
Health Care Worker Risks
Exposure By Health Care Categories
Nurse 63%
Housekeeping 3%
Resp. Therapist 2%
Phlebotomist 8%
Lab Technician 10%
Physician 14%
Health Care Worker Risks
Exposure by Type
Needlesticks
79%
Open Wound 6%
Mucous Membranes 6%
Cuts with Sharps 9%
HIV Transmission:
Vertical Transmission
Transplacental transmission


Intrapartum transmission

Transmission through breast milk
HIV Transmission:
Perinatal transmission
(mother-to-child transmission )
• Many children are infected perinatally; About
30-40 percent of babies born to infected
mothers will be infected
• They receive the infection from their mothers
– during pregnancy,
– at the time of birth
– through breastfeeding.
Perinatal transmission
HIV-Infected T-Cell
HIV
Virus
T-Cell
HIV Infected
T-Cell
New HIV
Virus
Window Period
• This is the period of time after becoming infected
when an HIV test is negative
• 90 percent of cases test positive within three months
of exposure
• 10 percent of cases test positive within three to six
months of exposure
HIV Infection and Antibody Response
---Initial Stage---- ---------------Intermediate or Latent Stage-------------Flu-like Symptoms
Or
No Symptoms
Symptom-free
---Illness Stage---
AIDS Symptoms
----
Virus
Antibody
Infection
Occurs
---< 6 month
~ Years
~ Years
~ Years
~ Years
Symptoms and signs
EARLY SYMPTOMS OF HIV INFECTION
• a flu-like illness within a month or two after exposure to the
virus. This illness may include
–
–
–
–
Fever
Headache
Tiredness
Enlarged lymph nodes (glands of the immune system easily felt in
the neck and groin)
• These symptoms usually disappear within a week to a month and
are often mistaken for those of another viral infection. During
this period, people are very infectious, and HIV is present in
large quantities in genital fluids.
临床表现
潜伏期∶2-10年
1期 急性HIV感染
2期 无症状HIV感染
3期 持续性全身性
淋巴结肿大综合征
4期 艾滋病
—— CDC关于HIV感染的分
类
AIDS
3期 持续性全身性
淋巴结肿大综合征
persistent
generalized
lymphadenopathy
(PGL)
2期 无症状HIV感染
1期 急性HIV感染
临床表现
• 艾滋病
– 全身性症状∶发热、乏力、不适、盗汗、厌食、
消瘦、腹泻
– 神经症状∶+头痛、癫痫、痴呆、瘫痪
– 机会性感染∶结核杆菌、病毒等感染、寄生虫、
真菌、
– 恶性肿瘤∶卡波济肉瘤、淋巴瘤
– 其他∶慢性淋巴性间质性肺炎
Symptoms of opportunistic infections
•
•
•
•
•
•
•
•
•
•
•
Coughing and shortness of breath
Seizures and lack of coordination
Difficult or painful swallowing
Mental symptoms such as confusion and forgetfulness
Severe and persistent diarrhea
Fever
Vision loss
Nausea, abdominal cramps, and vomiting
Weight loss and extreme fatigue
Severe headaches
Coma
临床表现
• 消瘦综合征
• 卡氏肉瘤
临床表现
• 病毒感染∶
– 带状疱疹
• Herpes Zoster
临床表现
• Human Papiloma Virus感染∶疣
临床表现
• 寄生虫----隐孢子虫感染
Cryptosporidiosis
• 真菌----孢子丝菌病
各系统临床表现 [一]
1.呼吸系统
• 卡氏肺孢子虫(肺囊虫)肺炎
• 肺结核
• 巨细胞病毒感染
• 真菌性肺炎
• 卡氏肉瘤
Pneumocystis carinii grossly in lung
卡氏肺囊虫肺炎
CMV inclusions in lung
巨细胞病毒肺炎
肺部弓形虫感染
Toxoplasmosis
各系统临床表现 [二]
2.消化系统
• 口腔与食道炎
• 口腔毛状白斑
• 感染性腹泻
• 肛周、直肠疱疹病毒感染
• 肝损害
小肠隐孢子虫感染
Cryptosporidiosis
肝脏组织浆胞菌感染(Histoplasmosis )
各系统临床表现 [三]
3.神经系统
• 机会性感染∶
隐球菌脑膜炎等
• 机会性肿瘤∶原发性淋巴瘤等
• HIV直接感染∶痴呆综合征等
弓形虫脑脓肿
各系统临床表现 [四]
4.皮肤粘膜
• 卡氏肉瘤
• 念珠菌感染
• 外阴疱疹、
尖锐湿疣
(genital warts)
皮肤卡氏（Kaposi’s）肉瘤
各系统临床表现 [五]
5.眼部
•
•
•
•
视网膜炎(CMV感染)
眼底棉絮状白斑(CMV感染)
弓形虫脉络膜炎
卡氏肉瘤
Opportunistic Infections
("OIs").
Opportunistic Infections ("OIs").
Bacterial and Mycobacterial
•
•
•
•
•
Mycobacterium Avium Complex (MAC, MAI)
Salmonellosis
Syphilis and Neuroshyphilis
Turberculosis (TB)
Bacillary angiomatosis (cat scratch disease)
Opportunistic Infections ("OIs").
Fungal Infections
•
•
•
•
•
Aspergillosis
Candidiasis (thrush, yeast infection)
Coccidioidomycosis
Cryptococcal Meningitis
Histoplasmosis
Opportunistic Infections ("OIs").
Protozoal Infections
•
•
•
•
•
Cryptosporidiosis
Isosporiasis
Microsporidiosis
Pneumocystis Carinii Pneumonia (PCP)
Toxoplasmosis
Opportunistic Infections ("OIs").
Viral Infections
•
•
•
•
•
•
•
•
Cytomegalovirus (CMV)
Hepatitis
Herpes Simplex (HSV, genital herpes)
Herpes Zoster (HZV, shingles)
Human Papiloma Virus (HPV, genital warts, cervical cancer)
Molluscum Contagiosum
Oral Hairy Leukoplakia (OHL)
Progressive Multifocal Leukoencephalopathy (PML)
Malignancies
• Kaposi's Sarcoma
• Lymphoma -– Systemic Non-Hodgkin's Lymphoma (NHL)
– Primary CNS Lymphoma
DIAGNOSIS
• By testing your blood for the presence of
antibodies to HIV.
• HIV antibodies generally do not reach
noticeable levels in the blood for 1 to 3 months
following infection.
HIV Testing
• Requires a blood or oral fluid sample
• HIV test detects the body’s antibody response to
HIV infection
• The test does NOT detect the HIV virus
HIV Testing
• Those recently exposed should be retested at least six
months after their last exposure
• Screening test (EIA/ELISA) vs. confirmatory test (IFA)
EIA/ELISA (Reactive)
Repeat EIA/ELISA (Reactive)
IFA (Reactive)
Positive for HIV
HIV Testing
EIA/ELISA
Test
Positive
Negative
No HIV Exposure
Low Risk
Repeat
Positive
HIV Exposure
High Risk
Negative
Repeat ELISA
Every 3 months
for 1 year
Repeat every
6 months for continued
High risk behavior
End Testing
Negative
Positive
Indeterminate
Repeat at
3 weeks
Run IFA
Confirmation
Negative
Repeat at
2-4 months
Positive
HIV
+
全国艾滋病筛查实验室分布图（截至2003年12月）
56
检疫系统 164
军队系统
201
81
59
54
28
59
37
62
9
40
106
9
1
32
Lanzhou
Tianjin
39
263
51
80
30
截至2003年12月，全国已经通
过验收的艾滋病筛查实验室
总数为2382个，其中CDC系统
700个，医院系统966个，检疫
系统164个，军队系统201个，
性防系统87个，计生5个，妇
幼系统92个，其它系统167个。
80
25
86
147
92
18
85
72
34
273
10
全国艾滋病确认实验室分布图(截止2004年10月)
Haerbin
Changchun
Urumchi
Shenyan
g
Huhehaote
Beijing
Tianjin
baoding
Taiyuan
Yinchuan
Xining
Jinan
Lanzhou
Lanzhou
Tianjin
Xian
Nanjing
Zhengzhou
Lhasa
Shanghai
Hefei
Wuhan
Chengdu
Hangzhou
Chongqing
Changsha
图例 防疫站 35
检疫局 11
医院 3
医科院 2
Nanchang
Guiyang
Fuzhou
Kunming
Nanning
Guangzhou
军科院 1
参比室 1
Haikou
Treatment of AIDS
关于抗HIV
– 至今无特效药
现有药物只能抑制病毒复制,停药后病毒可恢复复制。
– 新的HIV/AIDS治疗方案
早期联合用多个逆转录酶和蛋白酶抑制剂,使血中HIV病毒含量降至
最低,可使患者得以长期存活。(改良治疗方法)
– 联合用药----cocktail（鸡尾酒）疗法
两种或两种以上药物合用,可选两种逆转录酶抑制剂如AZT, DDI,
DDC,3TC和D4T中的两种(AZT不能和D4T合用--有拮抗作用),再加一
种蛋白酶抑制剂。
Treatment of AIDS
• 药物治疗
–抗HIV药物的应用:highly active antiretroviral
therapy, or HAART.
–免疫治疗
–治疗各种机会感染和肿瘤
highly active antiretroviral therapy
( HAART)
• Researchers have credited HAART as being a major factor in
significantly reducing the number of deaths from AIDS.
• HAART is not a cure for AIDS, it has greatly improved the
health of many people with AIDS and it reduces the amount of
virus circulating in the blood to nearly undetectable levels.
• Researchers, however, have shown that HIV remains present in
hiding places, such as the lymph nodes, brain, testes, and retina
of the eye, even in people who have been treated.
Goals of Antiretroviral Therapy
(ART)
• Eradication of HIV?
Not possible with currently available
antiretroviral medications
ART Goals & Tools to Achieve Them
• Improvement of quality of life
• Reduction of HIV-related
morbidity and mortality
• Restoration and/or preservation
of immunologic function
• Maximal and durable
suppression of viral load
• Selection of ARV regimen
• Preservation of future treatment
options
• Rational sequencing of therapy
• Maximizing adherence
• Use of resistance testing in
selected clinical settings
nucleoside reverse transcriptase inhibitors
(NRTI)
nucleoside analogs:
–
–
–
–
–
–
–
–
AZT (Azidothymidine)
ddC (zalcitabine)
ddI (dideoxyinosine)
d4T (stavudine)
3TC (lamivudine)
Abacavir (ziagen)
Tenofovir (viread)
Emtriva (emtricitabine)
non-nucleoside reverse transcriptase
inhibitors (NNRTIs)
• Delavridine (Rescriptor)
• Nevirapine (Viramune)
• Efravirenz (Sustiva) (in combination with other
antiretroviral drugs)
protease inhibitors (PI)
interrupt the virus from making copies of itself at a later step in its
life cycle. They include
• Ritonavir (Norvir)
• Saquinivir (Invirase)
• Indinavir (Crixivan)
• Amprenivir (Agenerase)
• Nelfinavir (Viracept)
• Lopinavir (Kaletra)
• Atazanavir (Reyataz)
• Fosamprenavir (Lexiva)
PIs interrupt the virus from making copies of itself at a later step in
its life cycle.
fusion inhibitors
• Fuzeon (enfuvirtide or T-20),
the first approved fusion inhibitor, works
by interfering with HIV-1's ability to enter into
cells by blocking the merging of the virus with
the cell membranes.
Current Antiretroviral Medications
PI
NRTI
•
•
•
•
•
•
•
•
Abacavir
Didanosine
Emtricitabine
Lamivudine
Stavudine
Zidovudine
Zalcitabine
Tenofovir
ABC
DDI
FTC
3TC
D4T
ZDV
DDC
TDF
NNRTI
• Delavirdine
• Efavirenz
• Nevirapine
DLV
EFV
NVP
•
•
•
•
•
•
•
•
Amprenavir
Atazanavir
Fosamprenavir
Indinavir
Lopinavir
Nelfinavir
Ritonavir
Saquinavir
APV
ATV
FPV
IDV
LPV
NFV
RTV
SQV
– soft gel
– hard gel
– tablet
SGC
HGC
INV
• Tipranavir
TPV
Fusion Inhibitor
• Enfuvirtide
T-20
Initial Treatment for Previously
Untreated Patients: Choosing
Regimens
• Three categories:
– 1 NNRTI + 2 NRTIs
– 1 PI + 2 NRTIs
– 3 NRTIs
• Few clinical endpoints to guide choices
• Advantages and disadvantages to each type of regimen
• Individualize regimen choice
Initial Treatment:
Preferred Regimens
NNRTI-Based
# pills
/day
2-5
Efavirenz*
+ (lamivudine or emtricitabine)
+ (zidovudine or tenofovir)
PI-Based
Lopinavir/ritonavir (Kaletra)
+ (lamivudine or emtricitabine)
+ zidovudine
8-10
*Avoid in pregnant women and women with high pregnancy potential.
Side effects
• The most common side effects associated with
protease inhibitors include nausea, diarrhea, and other
gastrointestinal symptoms.
• In addition, protease inhibitors can interact with other
drugs resulting in serious side effects.
• Fuzeon may also cause severe allergic reactions such
as pneumonia, trouble breathing, chills and fever, skin
rash, blood in urine, vomiting, and low blood pressure.
Local skin reactions are also possible since it is given
as an injection underneath the skin.
Control of HIV
Transmission
Prevention
Body Fluids to which Universal
Precautions Apply
BLOOD
 SEMEN
 VAGINAL SECRETIONS
 AMNIOTIC FLUID
 PLEURAL FLUID
 PERITONEAL FLUID
 PERICARDIAL FLUID
 CEREBROSPINAL FLUID
 SYNOVIAL FLUID

Body Fluids to which Universal
Precautions need not Apply *
SALIVA
 BREAST MILK (?)
 FECES
 URINE
 NASAL SECRETIONS
 SPUTUM
 SWEAT
 TEARS
 VOMITUS

(*) UNLESS THEY CONTAIN VISIBLE
BLOOD
HIV Infection Control
HOSPITAL-BASED
MEASURES

Heat sterilization
(autoclaving)
Various antiseptic products

HIV Infection Control

HOUSEHOLD AVAILABLE PRODUCTS
Clorox bleach (undiluted)
Hydrogen peroxide (undiluted)
Alcohol (various types)
Thorough use of soap and water

Can I get HIV from casual contact
(shaking hands, hugging, using a
toilet, drinking from the same glass,
or the sneezing and coughing of an
infected person)?
• Answer:
No.
• HIV is not transmitted by day-to-day contact in
the workplace, schools, or social settings.
以预防为主。
——毛主席语录
PREVENTION --- FIRST!
HIV Risk Reduction
• Avoid unprotected sexual contact
• Use barriers such as condoms and dental
dams
• Limit multiple partners by maintaining a
long-term relationship with one person
• Talk to your partner about being tested
before you begin a sexual relationship
HIV Risk Reduction
• Avoid drug and alcohol use to maintain good
judgment
• Don’t share needles used by others for:
Drugs
Tattoos
Body piercing
• Avoid exposure to blood products
Condoms
Using condoms is not 100 percent
effective in preventing transmission of
sexually transmitted infections including
HIV
Condoms = Safer sex
Condoms ≠ Safe sex
Condom Use
• Should be used consistently and correctly
• Should be either latex or polyurethane
• Should be discussed with your partner before the
sexual act begins
• Should be the responsibility of both partners for
the protection of both partners
• Male and female condoms are available
“When you have sex with someone,
you are having sex with everyone they
have had sex with for the last ten
years.”
Former Surgeon General
C. Everett Koop
预 防(1)
•广泛宣传和普及HIV/AIDS的常识
•切断各种传播途径,包括严禁毒品,卖淫嫖娼等
预 防(2)
• 控制医源性感染,重点是献血员的管理
• 暴露后预防∶建议用AZT次/d;DDC 0.75次/d(或3TC次/d)
加上一种蛋白酶抑制剂如indinavir, 三种药联合应用4～6周。
• 疫苗？
HIV Post Exposure Prophylaxis
HIV Occupational Exposure
• Review facility policy and report the incident
• Medical follow-up is necessary to determine the
exposure risk and course of treatment
• Baseline and follow-up HIV testing
• Four week course of medication initiated one to two
hours after exposure
• Liver function tests to monitor medication tolerance
• Exposure precautions practiced
Chinese President Hu Jintao shakes hands with an AIDS patient in a
Beijing hospital on Nov. 30, 2004.
On December 1st 2003, Premier Wen Jiabao and Vice Premier Wu
Yi went to Beijing Ditan Hospital to meet AIDS patients and
health workers
“Four Frees and Care”
 Free ARV drugs to AIDS patients who are rural
residents or people with financial difficulties living in
urban areas;
 Free Voluntary Counseling and Testing (VCT);
 Free drugs to HIV infected pregnant women to
prevent mother-to-child transmission, and HIV
testing of newborn babies;
 Free schooling for children orphaned by AIDS;
 Care and economic assistance to the households of
people living with HIV/AIDS.
政策－－“四免一关怀”
Policy – Four Frees and One Care
• 在全国范围内为自愿接受艾滋病咨询检测的人员免费提供咨询
和初筛检测；
Free Voluntary Counseling and Testing (VCT)
• 对农村居民和城镇未参加基本医疗保险等医疗保障制度的经济
困难人员中的艾滋病病人免费提供抗病毒治疗药物；
Free ARV drugs to AIDS patients who are rural residents or
people with financial difficulties living in urban areas
• 为感染艾滋病病毒的孕妇提供免费母婴阻断药物及婴儿检测试
剂；
Free ARV drugs to HIV infected pregnant women to prevent
mother-to-child transmission, and HIV testing of newborn
babies
政策－－“四免一关怀”
Policy – Four Frees and One Care
• 对艾滋病病人的孤儿免收上学费用；
Free schooling for children orphaned by AIDS
• 将生活困难的艾滋病病人纳入政府救助范围，按照国家有关规定
给予必要的生活救济。积极扶持有生产能力的艾滋病病人开展生
产活动，增加其收入。
Care and economic assistance to the households of people living
with HIV/AIDS
World AIDS Day
What is World AIDS Day?
• World AIDS Day is observed annually on December 1
to strengthen global efforts to address the challenges
of the AIDS pandemic that continues to spread
throughout every region of the world.
• The World Health Organization (WHO), supported by
the United Nations General Assembly, declared
December 1 as World AIDS Day in 1988. With the
creation of UNAIDS in 1996, World AIDS Day was
remodeled as a campaign to build on the momentum
created by the international day, and to encourage
more concerted and sustained responses to the
epidemic.
12月1日
世界艾滋病日
妇联“面对面”
宣传
全面宣传
Comprehensive
AIDS Campaign
“Face-to-face”
Education by Women
Federation
• 多部门参与预防艾滋病宣传，如教委
、妇联等
Multi-sector participation of AIDS
Campaign
学生知识竞赛
Knowledge test
上街宣传
Street campaign
by students
全面宣传
Comprehensive
AIDS Campaign
多种形式并用（电视、报纸、海报、
标语等）
Multiple formats (TV, newspapers,
posters, banners)
400万套宣传海报发到每村、校
、社区。
4 million copies of AIDS posters
for each village, school and
community in the country.
文艺和体育界名人
Celebrities in Sports,
Literary and Art Circles
文艺和体育界名人通过他们的名人
效应在艾滋病宣传和动员方面起到
了很大的作用。
Celebrities in literary and art circles
have played an important role in
publicizing HIV/AIDS knowledge and
mobilizing HIV/AIDS-related activities.
Thank you !
The End
(or is it The Beginning?)
FDA-approved Drugs
• Entry and Fusion Inhibitors
• Non-nucleoside Reverse Transcriptase
Inhibitors
• Nucleoside Reverse Transcriptase Inhibitors
• Opportunistic Infection and Other Drugs
Protease Inhibitors