Download HIV-infection/AIDS.

“For knowledge of AIDS, its necessary to know
all medicine”
HІV-Infection
HIV-Infection viral disease of human, which is passed mainly
by sexual and parenteral ways and
characterized by long-term persistence. Defeat
of the thymus gland’s system of immunity,
causes clinically expressed form – syndrome
of acquired immune deficiency (AIDS) with
lymphadenopathy, intoxication, spreading of
infectious diseases and oncological processes
Globally, an estimated 33.2 million people lived with HIV in
2007, including 2.5 million children. An estimated 2.5 million
(range 1.8–4.1 million) people were newly infected in 2007,
including 420,000 children
Sub-Saharan Africa remains by far the worst affected region.
In 2007 it contained an estimated 68 % of all people living with
AIDS and 76 % of all AIDS deaths, with 1.7 million new
infections bringing the number of people living with HIV to
22.5 million, and with 11.4 million AIDS orphans living in the
region. Unlike other regions, most people living with HIV in subSaharan Africa in 2007 (61 %) were women. AIDS continued to
be the single largest cause of mortality in this region
South Africa has the largest population of HIV patients in the
world, followed by Nigeria and India.
South & South East Asia are second worst affected; in 2007
this region contained an estimated 18 % of all people living with
AIDS, and an estimated 300,000 deaths from AIDS
India has an estimated 2.5 million infections and an estimated
adult prevalence of 0.36 %.
Life expectancy has fallen dramatically in the worst-affected
countries; for example, in 2006 it was estimated that it had
dropped from 65 to 35 years in Botswana.
HIV and AIDS affects economic growth by reducing the availability of
human capital. Without proper nutrition, health care and medicine that is
available in developed countries, large numbers of people suffer and die
from AIDS-related complications. They will not only be unable to work,
but will also require significant medical care. The forecast is that this
will likely cause a collapse of economies and societies in countries with a
significant AIDS population.
.The increased mortality will result in a smaller skilled population and
labor force. This smaller labor force will be predominantly young people,
with reduced knowledge and work experience leading to reduced
productivity. An increase in workers’ time off to look after sick family
members or for sick leave will also lower productivity. Increased
mortality will also weaken the mechanisms that generate human capital
and investment in people, through loss of income and the death of
parents.
By killing off mainly young adults, AIDS seriously weakens
the taxable population, reducing the resources available for
public expenditures such as education and health services
not related to AIDS resulting in increasing pressure for the
state’s finances and slower growth of the economy. This
results in a slower growth of the tax base, an effect that will
be reinforced if there are growing expenditures on treating
the sick, training (to replace sick workers), sick pay and
caring for AIDS orphans. This is especially true if the sharp
increase in adult mortality shifts the responsibility and
blame from the family to the government in caring for these
orphans.
On the level of the household, AIDS results in both the loss
of income and increased spending on healthcare by the
household. The income effects of this lead to spending
reduction as well as a substitution effect away from
education and towards healthcare and funeral spending.
L. Montonae
R. Gallo
Electronogram of HIV
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Etiology
HIV - Т- lymphotropic retrovirus of ІІІ type
RNA-containing, cells-targets – DNAсоntaining (helpers T-lymphocytes)
Ferments: reverse transcriptase (revertase),
protease
Specific markers – p24, gp41, gp120, gp160
Genom of the virus include 3 structure genes
(as all retroviruses) and 6 regulatory genes
(increase replication, activate of virus protein
structure synthesis)
Types of Agent:
Human immunodeficiency virus -1 (HIV -1),
widespread in the entire countries of world
Human immunodeficiency virus -2 (HIV -2),
widespread mainly in Western Africa, but
already turns out in different countries of
Europe and America
Sensitive to heating, 70 alcohol, desinfection
agents, stainable to ionize radiation, UVR, dryness
African Green Monkey
Epidemiology
Source – sick and carrier (contagious during all life)
(Disease of «4 Н» - homosexuality, heroin (drug
addicts), hemophilia, Haiti island)
Mеchanism of transmission – contact (wound),
vertical
Ways of transmission :
natural: sexual (homosexualists – 1-3 %, females – 0,6
%, males – 0,09 %)
vertical (transplacentar – 15-20 %, childbirth – 5070 %, during breast feeding – 20-30 %)
artificial: parenteral manipulations and drug using – 30
%, blood recipients – 100 %, transplantation of
organs and tissues, artificial ingravidation – 100 %
professional: infection of medical personal – 0,1-0,4 %
Intrahospital outbreaks (Elista, 1988)
HIV High Risk Groups :
Homo- and bisexuals
Intravenous drugs addicts
Recipients of blood, blood preparations and organs
Prostitutes and other persons who conduct the
disorderly sexual life
Patients with venereal diseases and viral hepatitis B,
C, D
Children infected by HIV mothers
Pandemic zones of HIV-infection at
present time :
Central Africa and Caribbean Sea area, transmission of
virus mainly through heterosexual contacts
North America, Western Europe, Australia and New
Zeeland, virus circulates mainly among homosexuals
and narcotic users
East Europe and Asia, including Ukraine (Russia,
Estonia)
Pathogenesis
Cells-targets for HIV (all cells with CD4 receptors)
- Т-lymphocytes (helpers), macrophagocytes, Вcytes, microglia, Langerhanse cells.
Connection gp120 of virus with CD4 of cells-targets
Transformation of virus RNA into DNA (reverse transcriptase)
Infragmentation of DNA-copy into cell genome (integrase) - provirus
Viruses replication – synthesis of viral proteins, assembly on cell`s
membrane, «ripen» of virus (protease)
Direct pathogenic action of HIV (cytopatic effect)
Formation of sincitium («coffin» for lymphocytes)
Destroing of immunity material basis - cell
(development of opportunistic infections, decreasing of
immune control against atypical cells) and humoral
Direct оncogenic action of HIV on certain tissues
Periods of Clinical Course
Incubation period– from 7 days till 5-6 years and more
(in 90 % infected persons seroconversion observe during first
3 months)
Acute retroviral syndrome (mononucleosis similar
state)
Latent period which can proceed long, sometimes
years (increasing of more than one lymph nodes in
more than one anatomic region, except for inguinal,
which is last over 1,5 months)
AIDS-associated with complex symptoms, or preAIDS. Which proceeds more frequent from 1 to 6
months, rarely for few years
Last period – actually AIDS
Clinical classification of HIV stages
(WHO, 2002)
I clinical stage:
Asymptomatic
Persistent generalized lymphadenopathy.
Level of functional ability 1: Asymptomatic
course, normal level of everyday activity
II clinical stage
Loss of weight less 10 % from initial
Minimum defeats of skin and mucous (seborrhea
dermatitis, mycotic defeats of nails, recurrent
ulcers of mucous of mouth cavity, angular
heylitis)
Episode of herpes zoster during the last five years
Recurrent infections of upper respiratory tract
(bacterial sinusitis)
Or/and level of functional ability 2: symptomatic
course, normal level of everyday activity
Lymphadenopathy in HIV-infection
III clinical stage
Loss of weight more than 10 % from initial
Hyperthermia more than 1 month
Pneumocyst pneumonia
Cerebral toxoplasmosis
Cryptosporidiosis with diarrhea by duration more
than 1 month
Extrapulmonary criptococosis
Cytomegalovirus infection with the defect of any
organs, except liver, spleen or lymph nodеs etc.
Level of functional ability 3: during 1 month
before patient's testing he (she) lay in bed less
than 50% of daily time
IY clinical stage
Severe loss of weight
Pneumocystis carinii pneumonia
Cerebral toxoplasmosis
Criptosporidiosis with diarrhea
Cytomegalovirus infection with involving of all
organs except liver, spleen and lymph nodes
Last level of functional ability (full bed rest)
Decreasing of T-helpers (<0,5109/l)
Progressive weight loss in
patient with AIDS
Kaposhi sarcoma in patients with AIDS
Kaposhi sarcoma in patients with
AIDS
Properties of Kaposhi sarcoma in
patients with AIDS:
- strike the persons of age young and middle
- primary elements appear on a head and trunk
- become purulent and varicosity
- metastasizes in internal organs, has a malignant
course
- is marked by high lethality, patients more frequent
does not exceed 1,5 year
According to effected organs &
systems the disease is divided
into :
cerebral
pulmonary
intestinal
disseminated
neoplastic forms of AIDS
Classification of the HIV-infection with
counting CD4 Т-lymphocytes in patient’s
blood [Diseases Control Center (USA) 1993
A.D.]:
Clinical categories
Level CD4 Tcells, in
1 mcl
>500
200 - 499
<200
A. Asymptomatic,
acute HIV-infection
or generalized
lymphoadenopathy
B. Manifesting,
but not A also not
C
С. AIDS-indicator
state
А1
А2
А3
В1
В2
В3
С1
С2
С3
Criteria of diagnosis:
Epidemiologic data;
Clinical data;
Prolong fever;
Diarrhea;
Generalized lymphadenopathy;
Loss of weight (10 % and more);
Opportunistic infections;
Kaposhi’s sarcoma;
Laboratory data’s: IFA, Immunobloting.
Factors of distribution of HIVinfection
Promote
Brake
Presence of harmful habits
(alcohol and drugs)
Believing in treatment
Fatalism
Sense of unharmed or
immunity
Ignorance
Difficulties of control of
sexual impulses
Knowledge about ways and
factors of HIV infection
Fear from the infection
Warning of risk and
sensitivity
Reduction or waiver of
alcohol, drugs
Increasing of control of the
impulses
Diagnosis
Epidemic anamnesis (risk group)
Main clinical criteria of AIDS ( loss of weight, long
hypertermia, diarrhea, lymphadenopathy, dementia)
Laboratory dates – leukopenia, lymphopenia, decreasing
of T-helpers, decreasing of correlation Th/Ts,
insensibility of lymphocytes to mitogens, increasing of
IgA, IgG, IgE, CircIC, decreasing of interferon's
production
Determination of specific HIV markers (p24,
gp41, gp120, gp160) in IFA, immune bloating,
RNA (load with virus) in PLR
Laboratory investigation after the patients
agreement only
DIFFERENTIAL DIAGNOSIS
Congenital immunodeficiency
Secondary immune insufficiency after
serious inflammatory and
oncohematologic diseases, bleeding,
radiation, poisoning by chemical
substances, medicaments
Infectious mononucleosis
ARVI
Diphtheria
Lymphadenitis
Idiopathic form of sarcoma Kaposhi
TREATMENT (HААRТ)
1-st group - nucleosid inhibitors of opposite
transcriptaze (NIOТ)
azidotimidin (AZT, zinovudin) , didanozin, stavudin
2-nd group – nonnucleosid inhibitors of
opposite transcriptaze (NNIOТ)
nevirapin (viramun), ifavirenc
3-d group – inhibitors of proteases (IP)
indiravir (cricsivan), sacvinavir (fortovase),
lopinavir/ritonavir (kaletra)
Recommended combinations
1. 2 specimens NIOТ + 1 specimen IP
2. 2 specimens NIOТ + 1 specimens NNIOТ
3. 3 specimens NIOТ
DEPOSITIONS FOR HААRТ
1. CD4<200 cells/mcl
2. Viral loading (number of virus DNAcopies) >55000/ml
3. Number of lymphocytes <1200
cells/mcl
4. III and IV clinical stages of HIVinfection
TREATMENT
Immune correction – interleukin-2 (roncoleukin), tactivin,
timalin, inerferones, immunofan, splenin, galavit, specific
(monoclonal) antibodies, transplantation of thymus gland аnd
osteal brain
Treatment of opportunistic infections (protozoa –
bactrim, pirimethamin-sulfamеtоxаzоl, metronidazol, pentamedin;
mycosis – amphotericin В, kеtоkоnаzоl, flukonazol;
herpetic infection –acyklovir, valtrex , zovirax, interferon, laferon;
CMV-infection – gancyklovir, foskarnet;
bacterial – antibiotics – macrolids, ftorohinolons, karbopemens,
cephalosporins, aminoglicosids)
Ant tumors remedies
Pathogenetic and symptomatic
Prophylaxis
HIV/AIDS in blood transfusions
Selection and investigation of donors
(obligatory 6-months quarantine of all plasma
donors)
Contaminated by HIV plasma recipients (Chernigiv,
2003; Mariupol, 2005)
Blood transfusions in vital disorders only
(consilium conclusion)
Patients agreement (or relatives)
Obligatory investigation of recipient
during 3 months after the transfusion
Medical personal prophylaxis
In case of medical accident –
Pretreatment of dirty skin with 70 % ethyl
alkohol, washing by water with soap, mucous
membranes – with clean water
To register of case in special journal
Investigation of suffer person concerning of
HIV antibodies presence (in first 5 days, then
– after 1, 3 and 6 months)
Post contact prophylaxis (scheme № 2)
during 72 hours (better 24-36) after accident
In case of positive reaction – conclusion of
special commission about the professional
contamination
Prophylaxis of perinatal
contamination
Treatment of HIV from 28 weeks of
pregnancy
Cesarean section in 38 weeks term
Treatment of mother and newborn
Prohibition of breast feeding
Groups for HIV investigation
Donors – blood, plasma, others biological tissues and
fluids
Recipients (during 3 months after transfusions and
transplantation)
Pregnant
Professional contamination in case of medical
accident
According clinical features – infectious
mononucleosis, hepatitis В, С, D, recidives of herpes
zoster, pneumonia, tuberculosis, candidoses, CMVinfection etc.
Foreign citizens
Risk groups
Prophylaxis
Educational work– propaganda of safety sex
Observance of hygiene and moral norms
Anonymous testing for antibodies to HIV
Utilization of using instruments (syringes,
needles, systems)
Processing (desinfection, sterilization) of
multiusing instruments
Individual defense of medical personal (gloves,
masks, special dress)
Observe ant epidemic regimen of laboratories
and specialized clinical departments
HIV- infected child’s
Childs of HIV-infected mothers observed 1,5 years
They may stay in organized collectives (kitchen
gardens, schools)
Provisional isolation till the recovering (in case of
moist ulcers of skin)
Plan inoculations according to schedule – except
alive vaccines (change to artificial polyvalent
vaccines)
Vaccination don’t perform for child’s with AIDS,
passive immune prophylaxis with immune
globulins only
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