HIV infection represents the disease caused by a human immunodeficiency virus, which is characterized by acquired immunodeficiency syndrome, promoting developing of secondary infections and malignancies in connection with deep oppression protective property of an organism. HIV infection has diverse options of a current. The disease can only several months last or to stretch up to 20 years. In the main way of diagnosis of HIV infection there is an identification of specific antiviral antibodies, and also virus RNA. Now treatment of patients with HIV is carried out by the anti-retrovirus medicines capable to reduce a virus reproduction.
HIV infection represents the disease caused by a human immunodeficiency virus, which is characterized by acquired immunodeficiency syndrome, promoting developing of secondary infections and malignancies in connection with deep oppression protective property of an organism. Today in the world the HIV infection pandemic, incidence of the population of the planet is noted, in particular countries of Eastern Europe steadily grows.
Characteristic of the activator
Human immunodeficiency virus DNA-containing, belongs to the family Lentivirus of the Retroviridae family. Distinguish two types: VICh-1 is the main causative agent of HIV infection, the reason of a pandemic, development AIDS. VICh-2 – rare type, meets generally in the Western Africa. HIV – an unstable virus, Quickly perishes out of a carrier organism, is sensitive to influence of temperature (reduces infectious properties at a temperature of 56 °C, perishes in 10 minutes when heating to 70-80 °C). Well remains in the blood and its medicines prepared for transfusion. The anti-gene structure of a virus is very changeable.
The tank and source of HIV infection is the person: the suffering AIDS and the carrier. Natural VICh-1 tanks are not revealed, there is an opinion that a natural owner in the nature are wild chimpanzees. VICh-2 is transferred by the African monkeys. The susceptibility to HIV at other animal species is noted. The virus contains in high concentration in blood, sperm, a secret of vaginal glands and menstrual allocations. It can be allocated from women's milk, saliva, a plaintive secret and a likvor, but these biological liquids constitute smaller epidemiological danger.
The probability of transfer of HIV infection increases in the presence of damages of integuments and mucous membranes (injuries, grazes, a uterus neck erosion, stomatitis, periodontosis, etc.) HIV is transmitted through the haemo contact and biocontact mechanism in the natural way (at sexual contacts and vertically: from mother to the child) and artificial (mainly is implemented at the gemoperkutanny mechanism of transfer: at transfusions, parenteral introductions of substances, traumatic medical procedures).
The risk of damage of HIV at single contact with the carrier is low, regular sexual contacts with infected it considerably raise. Vertical transmission of infection from sick mother to the child is possible as in the pre-natal period (through defects of a placentary barrier), and in labor, at contact of the child with mother's blood. Post-natal transfer with breast milk is in rare instances fixed. Incidence among children at the infected mothers reaches 25-30%.
Parenteral infection occurs at injections by means of the needles polluted by blood of HIV-positive persons at hemotransfusions of the infected blood, unsterile medical manipulations (the piercing, tattoos, medical and dental procedures which are made tools without due processing). By a contact and household way of HIV it is not transferred. A susceptibility of the person to HIV infection – high. Development AIDS at persons is more senior than 35 years, as a rule, happens in shorter terms from the moment of infection. Immunity to HIV is in certain cases noted that connect with the specific immunoglobulins A which are present on mucous genitals.
Pathogenesis of HIV infection
The human immunodeficiency virus at hit takes root into blood in macrophages, the microglia and lymphocytes which are important in formation of immune reactions of an organism. The virus destroys ability of immune little bodies to recognition of the anti-genes as alien, occupies a cage and starts a reproduction. After an exit of the bred virus in blood, the cage owner perishes, and viruses take root in healthy macrophages. The syndrome develops slowly (for years), wavy.
At first the organism compensates mass death of immune cages, developing new, over time compensation becomes insufficient, the quantity of lymphocytes and macrophages in blood considerably decreases, the immune system collapses, the organism becomes defenseless both in relation to an exogenous infection, and to the bacteria inhabiting bodies and fabrics it is normal (that leads to development of opportunistic infections). Besides, the mechanism of protection against reproduction of defective blastotsit - malignant cages is broken.
Settling by a virus of immune cages often provokes various autoimmune states, in particular neurologic frustration as a result of autoimmune defeat of neyrotsit which can develop even earlier are characteristic, than the clinic of an immunodeficiency will be shown.
Classification of HIV
In the clinical course of HIV infection distinguish 5 stages: incubations, primary manifestations, latent, stage of secondary diseases and terminal. The stage of primary manifestations can proceed asymptomatically, in the form of primary HIV infection, and also be combined with secondary diseases. The fourth stage depending on weight is subdivided into the periods: 4A, 4B, 4B. The periods pass the phases of progressing and remission differing depending on the antiretrovirus therapy taking place or its absence.
HIV infection symptoms
1. The incubation stage – can make from 3 weeks to 3 months, is in rare instances extended about one year. At this time there is an active reproduction of a virus, but the immune answer to it is absent so far. The incubatory period of HIV comes to an end with either clinic of sharp HIV infection, or emergence in blood of HIV antibodies. At this stage the basis for diagnosis of HIV infection is detection of a virus (anti-genes or particles of DNA) in blood serum.
2. The stage of primary manifestations is characterized by manifestation of reaction of an organism to active replication of a virus in the form of clinic of a sharp infection and immune reaction (development of specific antibodies). The second stage can proceed asymptomatically, positive serological diagnostics on antibodies to a virus will be the only symptom of the developing HIV infection.
Clinical manifestations of the second stage proceed as sharp HIV infection. The beginning is sharp, it is noted at 50-90% of patients three months later after the infection moment, often preceding formation of HIV antibodies. The sharp infection without secondary pathologies has quite various current: fever, various polymorphic rashes on integuments and visible mucous membranes, polylymphadenitis, pharyngitis, a liyenalny syndrome, diarrhea can be noted.
At 10-15% of patients sharp HIV infection proceeds with accession of secondary diseases that is connected with decrease in immunity. It can be quinsies, pneumonia of various genesis, fungal infections, herpes, etc.
Sharp HIV infection usually lasts from several days to several months, on average 2-3 weeks then in most cases passes into a latent stage.
3. The latent stage is characterized by gradual increase of an immunodeficiency. Death of immune cages at this stage is compensated by their increased production. At this time it is possible to diagnose HIV by means of serological reactions (at blood there are antibodies to HIV). Increase in several lymph nodes from the different, not connected among themselves groups, excepting inguinal lymph nodes can be a clinical sign. At the same time other pathological changes from the increased lymph nodes (morbidity, changes of surrounding fabrics) are not noted. The latent stage can proceed of 2-3 years, to 20 and more. On average it to last 6-7 years.
4. The stage of secondary diseases is characterized by developing of the accompanying (opportunistic) infections of virus, bacterial, fungal, protozoan genesis, malignancies against the background of the expressed immunodeficiency. Depending on expressiveness of secondary diseases distinguish 3 periods of a current.
- 4A – loss of body weight does not exceed 10%, defeats of integumentary fabrics are noted infectious (bacterial, virus and fungal) (skin and mucous membranes). Working capacity is reduced.
- 4B – losses in the weight more than 10% of lump of a body, long temperature reaction, is possible the long diarrhea which does not have the organic reason, tuberculosis of lungs can join, infectious diseases recur and progress, the localized Kaposha's sarcoma, a hairy leukoplakia comes to light.
- 4B – the general kakheksiya is noted, secondary infections get generalized forms, candidiasis of a gullet, airways, pnevmotsistny pneumonia, tuberculosis of extra pulmonary forms, disseminirovanny sarcoma of Kaposha, neurologic frustration is noted.
Substages of secondary diseases pass the phases of progressing and remission differing depending on the antiretrovirus therapy taking place or its absence. In a terminal stage of HIV infection the secondary diseases which developed at the patient gain irreversible character, measures of treatment lose the efficiency, the lethal outcome comes several months later.
The course of HIV infection is quite diverse, all stages not always take place, these or those clinical signs can be absent. Depending on an individual clinical current duration of a disease can make as several months, and 15-20 years.
Features of clinic of HIV infection at children
HIV at early children's age promotes a delay of physical and psychomotor development. Retsidivirovaniye of bacterial infections at children is marked out more often than at adults, lymphoid pneumonites, increase in pulmonary lymph nodes, various encephalopathies, anemia are frequent. The hemorrhagic syndrome which is a consequence of the expressed thrombocytopenia is the frequent reason of child mortality at HIV infections.
The most frequent clinical display of HIV infection at children is the delay of rates of psychomotor and physical development. The HIV infection got by children from mothers anti-also perinatalno proceeds much heavier and quicker progresses, unlike that at the children infected after a year.
Diagnosis of HIV infection
Now the main diagnostic method at HIV infection is the identification of antibodies to a virus which is made mainly with application of a technique of IFA. In case of positive result investigate blood serum by means of a technique of an immune blotting. It allows to identify antibodies to specific HIV anti-genes that is sufficient criterion for final diagnosing. Not identification by means of a blotting of antibodies of characteristic molecular weight, however, does not exclude HIV. During the incubatory period the immune response to introduction of a virus is not created yet, and in a terminal stage as a result of the expressed immunodeficiency of an antibody cease to be developed.
At suspicion of HIV and lack of positive results of an immune blotting an effective method of identification of particles of RNA of a virus is PTsR. Diagnosed by the serological and virologic HIV infection methods is the indication to dynamic observation of a condition of the immune status.
Treatment of HIV infection
Therapy of HIV-positive persons means constant control of the immune status of an organism, prevention and treatment of the arising secondary infections, control over development of new growths. Often the HIV-infected persons need psychological assistance and social adaptation. Now in connection with considerable spread and the high social importance of a disease in the state and world scales support and rehabilitation of patients is carried out, access to the social programs providing to patients the medical care facilitating a current and improving quality of life of patients extends.
Today primary etiotropny treatment is purpose of the medicines reducing reproductive abilities of a virus. Treat anti-retrovirus medicines:
- NIOT (nukleozidny inhibitors of a transkriptaza) of various groups: a zidovudine, , , , , the combined medicines;
- (nucleotide inhibitors of the return transkriptaza): , ;
- protease inhibitors: , , , and others;
- merge inhibitors.
At making decision on the beginning of antiviral therapy patients should remember that use of medicines is carried out many years, almost for life. Success of therapy directly depends on strict observance of recommendations: timely regular reception of medicines in necessary dosages, observance of the ordered diet and strict following to the mode.
The arising opportunistic infections treat according to rules effective against the therapy activator (antibacterial, antifungal, antiviral means) which caused them. The immunostimulating therapy at HIV infection is not applied as promotes its progressing, the cytostatics appointed at malignancies oppress immunity.
Treatment of HIV-positive people includes the means (vitamins and biologically active agents) and techniques of physiotherapeutic prevention of secondary diseases all-strengthening and supporting an organism. Treatment in the corresponding clinics is recommended to the patients having drug addiction. In connection with considerable psychological discomfort, many patients undergo long psychological adaptation.
The forecast at HIV infection
HIV infection is completely incurable, in many cases antiviral therapy yields insignificant result. Today on average HIV-positive people live 11-12 years, however careful therapy and modern medical medicines will allow to extend the term of life of patients considerably. Developing AIDS plays the main role in control the psychological state of the patient and his effort directed to observance of the registered mode.
Prevention of HIV infection
Now the World Health Organization holds the general preventive events for decrease in incidence of HIV infection for four main directions:
- education in safety issues of the sexual relations, distribution of condoms, treatment of diseases, sexually transmitted, promotion of culture of sexual relationship;
- control over production of medicines from donor blood;
- conducting pregnancy of HIV-positive women, ensuring their medical care and granting means of chemoprophylaxis to them (in the last trimester of pregnancy and in families of the woman receive anti-retrovirus medicines which are also appointed to the first three months of life to newborn children);
- organization of the psychological and social assistance and support of HIV-positive citizens, consultation.
Now in world practice special attention is paid to such factors, epidemiologically important concerning incidence of HIV infection, as drug addiction, chaotic sex life. As a preventive measure in many countries free distribution of disposable syringes, methadone replacement therapy is made. As the measure promoting decrease in sexual illiteracy the courses training to sexual hygiene are entered into training programs.