AIDS pathogenesis scheme. HIV: pathogenesis, etiology, symptoms, diagnostic studies, diagnosis features, treatment methods and constant medical supervision. Where did HIV come from
Etiology, pathogenesis, clinic and diagnosticsHIV infections.
Lisina Ekaterina Mikhailovna,
Teacher-psychologist GBOU SKSH№7.
HIV infection is a disease caused by a retrovirus that infects the cells of the immune, nervous and other systems and organs of a person, with a long chronic progressive course (Rakhmanova A. G., 2005). The infectious nature of this disease and the main ways of its transmission have been proven: horizontal - through the blood, through the mucous membranes during sexual contact and vertical - from mother to fetus. Since mid-1981, this disease has taken on the character of a global epidemic and since 1982 it has been known as “acquired immunodeficiency syndrome” (AIDS) - a combination of infections dangerous for the body, the development of which is caused by the human immunodeficiency virus (Shipitsyna L.M., 2006).
Etiology
The human immunodeficiency virus belongs to the family of retroviruses. A virus particle is a nucleus surrounded by a shell. The nucleus contains RNA and enzymes - reverse transcriptase (revertase), integrase, protease. When HIV enters a cell, RNA is converted into DNA under the influence of reversetase, which is integrated into the DNA of the host cell, producing new viral particles - copies of the virus RNA, remaining in the cell for life. The core is surrounded by a shell, which contains a protein - glycoprotein gp120, which causes the attachment of the virus to the cells of the human body, which has a receptor - the CD4 protein.
2 types of human immunodeficiency virus are known, having some antigenic differences - HIV-1 and HIV-2. HIV-2 is found predominantly in West Africa.
HIV is characterized by high variability; in the human body, as the infection progresses, the virus evolves from a less virulent to a more virulent variant.
Epidemiology
The source of infection is a person infected with HIV in the stage of both asymptomatic virus carriage and advanced clinical manifestations of the disease. HIV has been found in all human biological substrates (blood, cerebrospinal fluid, breast milk, biopsies of various tissues, saliva…).
Ways of transmission of infection - sexual, enteral, vertical. Risk factors may be donor organs and tissues used for transplantation.
Pathogenesis
Having penetrated into the human body, the virus, using the gp 120 envelope glycoprotein, is fixed on the membrane of cells that have a receptor, the CD4 protein. The CD4 receptor is mainly possessed by T-lymphocytes-helpers (T4), which play a central role in the immune response, as well as cells of the nervous system (neuroglia), monocytes, macrophages, vascular endothelium. ... Then the virus enters the cell, its RNA with the help of the enzyme reversetase synthesizes DNA, which is integrated into the genetic apparatus of the cell, where it can remain in an inactive state as a provirus for life. When a provirus is activated in an infected cell, there is an intensive accumulation of new viral particles, which leads to the destruction of cells and the defeat of new ones.
Characterizing the pathogenesis of HIV infection, the following stages are distinguished:
Early dissemination, in which there is an initial "explosion" of viral replication, HIV disseminates to the lymph nodes, where follicular hyperplasia is observed. The center of the lymph nodes captures HIV and becomes the main reservoir of the virus, while HIV is fixed on the follicular dendritic cells. The main target of HIV is CD4 T-lymphocytes.
Viral load - the amount of HIV RNA per ml of blood plasma, reflects the intensity of viral replication.
Macrophages are of paramount importance in the pathogenesis of HIV. They cause damage to all organs and tissues and determine the characteristics of secondary opportunistic infections.
Clinic
The incubation period for HIV is 2-3 weeks, but can be delayed up to 3-8 months, sometimes more. Following it, 30-50% of infected people develop symptoms of acute HIV infection, which is accompanied by various manifestations (fever, lymphadenopathy, erythematous-maculopapular rash on the face, trunk, sometimes on the extremities, myalgia or arthralgia, diarrhea, headache, nausea, vomiting, enlargement of the liver and spleen ...).
Acute HIV infection often goes unrecognized due to its similarity to the symptoms of influenza and other common infections. In some patients, it is asymptomatic.
Acute HIV infection becomes asymptomatic. The next period begins - the virus carrier, lasting several years (from 1 to 8 years, sometimes more), when a person considers himself healthy, leads a normal life, being a source of infection.
After an acute infection, the stage of persistent generalized lymphadenopathy begins, and in exceptional cases the disease progresses immediately to the stage of AIDS.
Following these stages, the total duration of which can vary from 2-3 to 10-15 years, the symptomatic chronic phase of HIV infection begins, which is characterized by various infections of a viral, bacterial, fungal nature, which still proceed quite favorably and are stopped by conventional therapeutic agents. . There are repeated diseases of the upper respiratory tract - otitis media, sinusitis, tracheobronchitis; superficial skin lesions - localized mucocutaneous form of recurrent herpes simplex, recurrent herpes zoster, candidiasis of the mucous membranes, ringworm, seborrhea.
Then these changes become deeper, do not respond to standard methods of treatment, becoming stubborn, protracted. A person loses in his body weight (more than 10%), fever, night sweats, diarrhea appear. Against the background of increasing immunosuppression, severe progressive diseases develop that do not occur in a person with a normally functioning immune system. These are AIDS-marker, AIDS-indicator diseases (as defined by WHO).
Diagnostics
The main method of laboratory diagnosis of HIV infection is the detection of antibodies to the virus using enzyme immunoassay.
When testing for HIV, it is necessary to take into account the epidemiological history. Antibodies to HIV appear in 90-95% of those infected within 3 months after infection, in 5-9% after 6 months and in 0.5-1% at a later date. In the AIDS stage, the number of antibodies can decrease until it disappears completely.
ELISA method (enzymatic immunoassay) is a screening system for detecting antibodies to HIV. This assay is sensitive to all proteins close to HIV proteins. In the case of a positive result, the laboratory analyzes twice (with the same serum) and if at least one more positive result is obtained, the serum is sent for a confirmatory test.
To confirm the specificity of the result obtained by ELISA, the method of immune blotting is used, the principle of which is to detect antibodies to certain proteins of the virus.
To determine the prognosis and severity of HIV infection, it is of great importance to determine the "viral load" - the number of copies of HIV RNA in plasma by the polymer chain reaction method.
The diagnosis of HIV infection is established on the basis of epidemiological, clinical, laboratory data, indicating the stage, decoding secondary diseases in detail (Rakhmanova A. G. et al., 2005).
Bibliography:
- Zmushko E.I., Belozerov E.S. HIV infection: a guide for physicians. - St. Petersburg: Publishing house "Piter", 2000 - 320s.
- Pokrovsky V.V., Ermak T.N., Belyaeva V.V., Yurin O.G. HIV infection: clinic, diagnosis and treatment / Ed. V.V. Pokrovsky. - M.: GEOTAR MEDICINE, 2000. - 496s.
- Prevention of HIV / AIDS in minors in the educational environment: Textbook / Ed. L.M. Shipitsyna. St. Petersburg, Rech, 2006. - 208 p. (pp. 5-52).
- Rakhmanova A.G., Vinogradova E.N., Voronin E.E., Yakovlev A.A. HIV infection: clinic and treatment, chemoprevention of HIV transmission from mother to child. Diagnosis and treatment of HIV infection in children. Recommendations for medical and socio-psychological service. Ed. 2, revised and expanded. SPb. 2005. - 112p.
- Rakhmanova A.G., Voronin E.E., Fomin Yu.A. HIV infection in children. St. Petersburg: Peter, 2003. - 448s.
- Rakhmanova A.G. HIV infection. Clinic and treatment. St. Petersburg, publishing house SSZ, 2000. - 370s.
- Epidemiology and infectious diseases. Scientific and practical journal. No. 1, 2001
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epidemioloHygiene and prevention of HIV infection
Completed: students of group 4a-14
Sergeeva Lyubov, Sorokina Elnara,
Slatimova Tatiana
Penza, 2014
HIV infection- an anthroponotic viral disease, the pathogenesis of which is based on progressive immunodeficiency and the development of secondary opportunistic infections and tumor processes as a result.
Brief historical information
The disease was singled out as a separate nosological form in 1981, after a large number of young homosexual men suffering from immunodeficiency with manifestations of pneumocystis pneumonia and Kaposi's sarcoma were identified in the United States. The symptom complex that developed was called "acquired immunodeficiency syndrome" (AIDS). The causative agent - the human immunodeficiency virus (HIV) - was isolated by L. Montagnier with the staff of the Paris Institute. Pasteur in 1984. In subsequent years, it was found that the development of AIDS is preceded by a long-term low-symptom period of HIV infection, which slowly destroys the immune system of an infected person. Further epidemiological studies have shown that by the time AIDS was first discovered in the United States, HIV had already spread widely in Africa and the Caribbean, with individual infected individuals found in many countries. By the beginning of the 21st century, the spread of HIV had become a pandemic, with more than 20 million deaths from AIDS and 50 million infected with HIV.
The first case of HIV infection in the USSR was discovered in 1986. From this moment begins the so-called period of the emergence of the epidemic. The first cases of HIV infection among citizens of the USSR, as a rule, occurred as a result of unprotected sexual contacts with African students in the late 70s of the XX century. Further epidemiological measures to study the prevalence of HIV infection in various groups living on the territory of the USSR showed that the highest percentage of infection at that time was among students from African countries, in particular from Ethiopia. The collapse of the USSR led to the collapse of the unified epidemiological service of the USSR, but not the unified epidemiological space. A brief outbreak of HIV infection in the early 1990s among men who have sex with men did not spread further. In general, this period of the epidemic was distinguished by an extremely low level of infection of the population, short epidemic chains from infecting to infected, sporadic introductions of HIV infection and, as a result, a wide genetic diversity of detected viruses. At that time, in Western countries, the epidemic was already a significant cause of death in the age group from 20 to 40 years.
This prosperous epidemic situation led to complacency in some now independent countries of the former USSR, which was expressed, among other things, in the curtailment of some broad anti-epidemic programs, as inappropriate for the moment and extremely expensive. All this led to the fact that in 1993-95 the epidemiological service of Ukraine was unable to localize in time two outbreaks of HIV infection that occurred among injecting drug users in Nikolaev and Odessa. As it turned out later, these outbreaks were independently caused by different viruses belonging to different subtypes of HIV-1. Moreover, the transfer of HIV-positive prisoners from Odessa to Donetsk, where they were released, only contributed to the spread of HIV infection. The marginalization of IDUs and the unwillingness of the authorities to carry out any effective preventive measures among them greatly contributed to the spread of HIV infection. In just two years, several thousand HIV-infected people were identified in Odessa and Nikolaev, in 90% of cases IDUs. From this moment on the territory of the former USSR, the next stage of the HIV epidemic begins, the so-called concentrated stage, which continues to the present. This stage is characterized by the level of HIV infection of 5 percent or more in a certain risk group. In 1995, there was an outbreak of HIV infection among IDUs in Kaliningrad, then successively in Moscow and St. Petersburg, then outbreaks among IDUs followed one after another throughout Russia in the direction from west to east. The direction of the concentrated epidemic and molecular epidemiological analysis have shown that 95% of all studied cases of HIV infection in Russia have their origin in the initial outbreaks in Nikolaev and Odessa. In general, this stage of HIV infection is characterized by the concentration of HIV infection among IDUs, the low genetic diversity of the virus, and the gradual transition of the epidemic from the risk group to other populations.
By the end of 2006, about 370,000 HIV-infected people were officially registered in the Russian Federation. However, the actual number of carriers is estimated at the end of 2005 to be ~940,000. Adult HIV prevalence has reached ~1.1%. From diseases associated with HIV and AIDS, approx. 16,000 people, including 208 children.
About 60% of HIV infections among Russians occur in 11 out of 86 Russian regions.
Virus transmission
HIV can be found in almost all body fluids. However, a sufficient amount of the virus for infection is present only in the blood, semen, vaginal secretions, pre-semen fluid, lymph and breast milk. Infection can occur when hazardous biological fluids enter directly into the blood or lymph flow of a person, as well as onto damaged mucous membranes. If the blood of an HIV-infected person comes into contact with an open wound of another person, from which blood flows, infection usually does not occur.
HIV is unstable - outside the body when the blood dries, it dies. Domestic infection does not occur. HIV almost instantly dies at temperatures above 56 degrees Celsius.
However, with intravenous injections, the probability of transmitting the virus is very high - up to 95%. To reduce the chance of HIV transmission in such cases, doctors are prescribed a four-week course of highly active antiretroviral therapy. Chemoprophylaxis may also be given to other individuals at risk of infection. Chemotherapy is prescribed no later than 72 hours after the probable entry of the virus.
The repeated use of syringes and needles by drug users is highly likely to lead to HIV transmission. To prevent this, special charitable points are being set up where drug users can get clean syringes for free in exchange for used ones. In addition, young drug users are almost always sexually active and prone to unprotected sex, which creates additional prerequisites for the spread of the virus.
Data on HIV transmission through unprotected sexual contact vary greatly from source to source. The risk of transmission largely depends on the type of contact and the role of the partner.
Protected intercourse, in which the condom broke or its integrity was violated, is considered unprotected. To minimize such cases, it is necessary to follow the rules for the use of condoms, as well as use reliable condoms.
A vertical route of transmission from mother to child is also possible. With HAART prophylaxis, the risk of vertical transmission of the virus can be reduced to 1.2%.
Prevention of HIV infection
Organization of counteraction against the developing pandemic and the fight against its devastating consequences are is currently the most important task of international and national health policy.
WHO in a number of documents identifies 4 main areas of activity aimed at combating the HIV epidemic and its consequences:
1) prevention of sexual transmission of HIV, including such elements as teaching safe sexual behavior, distribution of condoms; treatment of (other) sexually transmitted diseases, training in behavior aimed at the conscious treatment of these diseases;
2) prevention of HIV transmission through the blood by supplying safe blood products, ensuring aseptic conditions during invasive surgical and dental practices that violate skin integrity;
3) prevention of perinatal transmission of HIV by disseminating information on the prevention of HIV transmission, perinatal transmission and family planning, providing medical care, including counseling, to women who are infected with HIV; viral immunodeficiency hiv infection
4) organization of medical care and social support for HIV-infected patients, their families and others.
Implementing HIV prevention activities is far more complex than many health policy makers realize in Russia, and on this path so far failures are much more common than noticeable successes.
"Isolation" of the source of infection in HIV infection (a very effective method for other infections) is rather difficult, since, apparently, the majority of those infected remain potential sources until the end of life, i.e. for at least a few years. However, the possibility of using this approach is still being discussed.
The real experience of isolation of HIV-infected people is available only in Cuba. Initially, all identified HIV-infected persons were placed there in a "sanatorium" such as a leper colony, where they were provided with treatment, the opportunity to perform certain types of work, etc. The patients of this sanatorium were given the opportunity to go on excursions, various kinds of performances, and even visits from relatives under the supervision of medical workers. The moderate pace of the epidemic in Cuba may be related to the implementation of this project.
Although not doubt that isolation HIV infected people can reduce the level of HIV transmission in fairly isolated areas, however However, there are a number of significant objections to the use of this method, except, of course, the most basic one: objections to the direct infringement of the rights of the infected.
The pragmatic objections to this are as follows:
1) it is impossible to organize a sufficiently fast and for a certain period regular survey of the entire population in a territory that is not completely isolated;
2) it will not be possible to organize an examination for antibodies to HIV just for those contingents that are affected by HIV due to the fact that that they will no doubt actively avoid the examination, knowing its consequences;
3) the isolation of “identified” infected will lead to the fact that the rest of the population will not apply precautionary measures due to the false belief that all HIV-infected people have been detected and isolated.
Undoubtedly, active resistance to isolation on the part of HIV-infected people is also possible. There was a case when a citizen of Cuba, who was diagnosed with HIV infection in Russia, instead of returning to his homeland to a “sanatorium”, departed in a direction unknown to us (probably in the west). With a large number of HIV-infected people, it is quite difficult to control such cases.
The objections of the economic plan are as follows: 1) it would be too expensive to quickly and re-survey the entire population; 2) long-term isolation of HIV-infected people, who undoubtedly need to create more acceptable living conditions than punished criminals, will cost society too much. Cuba's experience shows that these costs are quite high even for a country with a small population and low numbers of people infected with HIV.
The idea is sometimes expressed that it is necessary to isolate only those infected who became infected as a result of immoral behavior. But one can object: is it right to isolate them so that those who remain can calmly do what HIV-infected people are twice punished for?
Another measure of the isolation plan is to prevent HIV-infected people from entering general hospitals, for the sake of which in Russia a total examination of all persons entering hospitals is being carried out in a number of places. It is assumed that in this way it is possible to prevent the transmission of HIV due to violations of the rules for the use of medical instruments from HIV-infected people to other patients or medical personnel. Obviously, it is assumed that HIV-infected people should always receive medical care in specialized hospitals. The doubtfulness of this program, in addition to discrimination against HIV-infected people and limiting their rights to access to medical care, lies in the fact that in many cases hospitalization is carried out for emergency reasons, when the results of the examination become known at best a few days after hospitalization, and, consequently, the program does not reach the target. Experience shows that in most cases, patients are hospitalized after donating blood for an AIDS test, and not after receiving a response. Thus, the examination of patients for the presence of antibodies to HIV in Russia has become a purely formal procedure.
Close to the isolation of the infected, the idea lies in the introduction in a number of countries of severe criminal penalties for infection or even an attempt to become infected with HIV. We call it close because, in this case, it is supposed to prohibit sexual contact with the infected or isolate him not immediately upon detection, but in the event that he begins to lead a lifestyle that threatens to infect others.
The threat of criminal punishment for the spread of HIV seems no more, but rather less effective than the threat of criminal punishment for theft and other crimes.
As an isolation measure, the removal of HIV-infected people from donation can also be considered.
In a number of countries of the world, a method of self-exclusion from direct donation of persons who had a risk of HIV infection is practiced. Donors are asked to indicate on the questionnaire that their blood is intended for technical use only, in case they had risk factors.
An issue in its own right, which has been widely discussed in the United States since the discovery of a case of a fairly likely infection of patients from a dentist, is the issue of suspension of HIV-infected persons performing parenteral interventions in medical institutions. The anti-epidemic effectiveness of this measure has not been studied anywhere and by anyone. The main difficulty is that the removal from surgery means a sharp drop in earnings, so surgeons are quite interested in strongly opposing this event.
Finally, in European countries where prostitution is licensed (it is officially recognized as a professional activity), there have been attempts to transfer infected prostitutes to other work: strippers, sellers in porn shops, etc. The problem, however, is that a worker who is removed from his usual source of income does not engage in prostitution "in his spare time from his main job."
For this reason, the "legalization" of prostitution, accompanied by regular testing for antibodies to HIV, should not be considered a sufficiently effective preventive measure. Along with officially registered, there is always illegal prostitution.
Apparently, the problem lies in the peculiarities of the teaching methods, in their correspondence to the characteristics of the group to which the HIV-infected student belongs, and his individual characteristics and personal circumstances.
An undoubted achievement in preventing the spread of HIV has been a set of measures aimed at preventing the transmission of HIV through blood transfusion and organ and tissue transplantation.
Among the most effective measures is the destruction or disposal of HIV-contaminated donated blood and other donated materials after they have been tested for the presence of HIV antibodies.
Of great importance is the desire to comply with the principle of "one donor - one recipient", which was preferable in Russia. However, this method is at odds with current blood drug production technologies, which often become cheaper the more "portions" of donated blood are used in the production of a given batch of drug.
Finally, undoubtedly, the most affordable method to reduce the risk of transmission of HIV-contaminated blood, in which, for one reason or another, markers of HIV infection could be detected, is to reduce the number of blood transfusions to the required minimum. As we noted earlier, HIV infection often occurs in cases where blood transfusion was not at all a necessary method of treatment.
A more complex issue is the prevention of HIV transmission from infected patients to personnel performing parenteral interventions and from infected personnel to patients.
Our society has become skeptical about the possibility of changing people's behavior through training. However, there are many examples of recent years, when the media and individual propagandists managed in a short time to instill in the majority of the Russian population completely ridiculous ideas, for example, that diseases can be treated on TV, not to mention political ideas. The problem, then, is that information be disseminated in adequate and diverse ways, be sufficient in volume, duration, repetition, and the results must be constantly evaluated and corrected. If the issues of HIV prevention in With as much attention paid to the media as to psychics, the problem would have been solved long ago.
However, education on safe sexual behavior plays a leading role in preventing the spread of HIV.
The main directions of education in individual methods of HIV infection prevention, of course, do not include the requirement to change sexual behavior, but the explanation that there are alternative options for it.
In a "pure" form, i.e. theoretically, there are two models of safe behavior: either limiting the number of sexual partners to a minimum, or using condoms and other techniques that reduce the risk of infection regardless of the number of partners. In reality, of course, it is necessary to achieve that individuals are able to use both approaches depending on their personal circumstances: upbringing, cultural traditions, age, sexual needs, marital status, personal attachments, religious beliefs, etc.
This does not exclude the well-known contradictions that arise, for example, between religious tradition and the need to provide the population with such information. Thus, the Catholic and Orthodox churches do not approve of extramarital sex or the use of a condom. Of course, if this tradition is strictly followed, there is no need to learn how to use condoms or other ways of "less dangerous sex." At the same time, already in early Christian literature, in the Gospel, it is not difficult to find indications that prostitution (with subsequent repentance, of course) can be forgiven, i.e. allowed. Muslim tradition, in a number of interpretations, allows the use of a condom, but only in marriage. At the same time, Muslim tradition allows for polygamy and divorce. In some countries, short-term, for several days or hours, marriage is allowed, which is, in fact, a cover for prostitution.
One cannot but reckon with the opinion of those “conservative” figures who express fears that by telling young people about condom use and other types of “less dangerous sex”, teachers thereby lead listeners to think about the very possibility of relatively safe premarital and extramarital sex, etc. .p., i.e. corrupt them. Moreover, some tend to think that the threat of STDs and HIV and unwanted pregnancies should in fact deter people from misbehaving.
Obviously, the solution to this contradiction lies in the very form of teaching methods to prevent infection, which must, to the necessary extent, correspond to local traditions and accepted religious principles. Apparently, in all communities there is a group of people who, for one reason or another, do not adhere to traditional restrictions, no matter how reasonable they may be. It is to this part of the population that training in "less risky sexual behavior" should be directed.
However, despite the obvious correspondence of religious recommendations to the goals of preventing HIV infection, achieving practical results in this direction seems to be very difficult. Such recommendations, with the exception of the use of condoms and other methods of less dangerous sex, have been implemented in the form of rigid guidelines for centuries by the main churches and religious movements of the world, and, unfortunately, without much success. Sometimes the appearance of HIV infection is interpreted as another proof that "wrong" behavior is punished already in this life.
Currently, strict regulation of sexual relations by society or the state is preserved only in some Muslim countries, in other countries it is supported by religious tradition. For example, in Iran, adultery can lead to severe punishment, up to the death penalty, if both parties to the relationship are married, and corporal punishment and imprisonment if only one of the parties to the crime is married. Pre-marital sexual relations are less severely pursued, but they, of course, are suppressed.
The effectiveness of such measures in terms of AIDS prevention has not been studied, but it is certain that they play a certain role in preventing the spread of HIV due to the reduction in the number of sexual partners, as evidenced by the low incidence of HIV infection in Iran.
Such restrictions are likely to have a certain impact on the course of the epidemic process of HIV infection in China as well. In addition, in China, the state policy of birth control, which includes as an element the spread of the practice of using condoms, cannot but have an impact on the spread of HIV.
The low prevalence of HIV in Russia was to a certain extent due to the fact that until the 1990s in the USSR, society was focused on monogamous relationships, condemnation of premarital and extramarital sex, sexual relations with foreigners, active prosecution of prostitution, homosexuality, and drug use. . These elements of public policy, while they may not have been able to eradicate these phenomena, have certainly limited their impact on the spread of HIV. Thus, the persecution of homosexuals made it more difficult for them to find new and part with old partners, so even in Moscow, where a fairly large population of homosexuals lived, the average number of partners they had even in the 80s was significantly lower than in the United States and Western Europe. The same applies to the underground practice of drug use, which led to the limitation and stability of the circle of partners for their use.
There is no doubt that various social, age, etc. Population groups need different levels of knowledge and skills to prevent the spread of HIV and to protect themselves from infection. It is clear, for example, that such information should be differentiated according to the age principle.
In addition, many groups can be identified among the population that need additional information or special ways of disseminating information. Thus, medical workers need to acquire skills to prevent parenteral transmission of HIV, migrants, due to language and cultural barriers, need to develop programs adapted for them, blind and deaf people need specific information.
Educational work is usually built on three levels: training through the media, group training, often aimed at the "target" population groups, and, finally, individual - counseling.
The distribution of videos, brochures and other literature acquaints the population with the problem in more detail.
A certain problem of television and radio information lies in the fact that many listeners cannot immediately remember by ear or correctly interpret what they see and hear. Therefore, repetitions of such transmissions are of great importance. Some advantage of printed products is that it can Read it over and over until you fully understand. However, newspapers and magazines are now regularly read by far fewer people than watch TV .
A completely different problem with television and radio is that a certain part of the population watches only a rather limited number of programs, such as music or detective stories, so in order to bring information about HIV infection to this part of the population, it should be evenly dispersed over the airtime, which is usually not done.
In many European countries for prevention of HIV infection, posters containing information about AIDS were used.
Finally, condom use skills are important.
The World Health Organization considers condoms should be distributed through three main channels: through the public health system, through non-governmental public organizations and through the commercial network.
In Russia, non-governmental organizations dealing only with the health of the population and not pursuing some other, most often commercial or political, goals have not yet received sufficient development.
The activities of such organizations are usually associated with educational work with the "target" groups of the population, which, in our terminology, are more correctly called threatened contingents. As a rule, group and individual training is of great importance for this part of the population.
Education for people who use drugs can be carried out in special clinics designed for their treatment, shelters created for the same purpose, with the help of voluntary organizations involved in helping drug addicts, in prisons, where they quite often end up.
Young people everywhere are also considered a threatened contingent, because they are characterized by inexperience, a tendency to experiment in the field of sexual behavior.
In developed countries, youth education programs are focused on school education. Clubs, associations connecting young people with interest in music, etc. are also used to teach safe sexual behavior. In many countries, there are government or community-based institutions that provide counseling and treatment to adolescents, teaching them how to prevent HIV infection.
The development and implementation of such programs at the state level, subject to their qualitative compliance with the tasks set, can lead to a significant improvement in the epidemiological situation.
The main problems associated with teaching safe sexual behavior in schools arise from the ambiguous attitudes of adults.
Another problem with teenagers is that in many parts of the world a fairly large proportion of children are not getting education. A similar fate is now in store for many Russian children. The "street" youth is therefore an independent, threatened contingent, tending to dangerous sexual behavior in all respects, drug use, etc. Working with this part of the youth is an independent problem, which is solved by attempts to train through a special police service, non-governmental public organizations whose representatives conduct training directly on the streets or using the usual means of attracting such an audience: popular music concerts, etc.
The homeless and the poor are also becoming a target group and are a problem not only in civilized countries, but also in Russia. Studies in New York and Berlin have shown that this group is exposed to multiple risk factors, including a variety of risky sexual behaviors and drug use. Education of representatives of this group, which has lost social ties, can be carried out through rooming houses, charitable food centers, etc.
Prisoners are a specific group for education because sexual intercourse between men, including violent intercourse, and drug use are often practiced in prisons.
In our opinion, prisons are a convenient place for educating those groups of the population that are difficult to educate in freedom.
The training is also designed to solve such an important issue as correcting misconceptions about the spread of HIV infection, which for one reason or another (most often due to a misinterpretation of information disseminated by the media) may arise among the population. The most typical misconceptions relate to the formation of an associative connection among the population between certain social or ethnic groups and AIDS.
The most well-known misconception that AIDS is a disease of only homosexuals has been ubiquitous. In the US and South Africa, the misconception of AIDS by blacks as a disease of white homosexuals has had negative consequences. On the contrary, in Russia, many associated AIDS exclusively with blacks, since the first cases of HIV infection were found in Russia among African students.
Sometimes you have to make a choice between the objectivity of information and the possible negative reaction of the press and the public to it.
A very common phenomenon is attempts to link HIV infection with environmental problems and weakened immunity of the population, for example, as a result of the Chernobyl disaster, etc. They are usually carried out purposefully by medical professionals in order to obtain additional funds or for other reasons. For example, attempts to link the outbreak of HIV infection in Kalmykia with reduced immunity of the population, which allegedly developed as a result of the deportation of Kalmyks to Siberia in the 1940s, etc., were clearly inspired by persons responsible for nosocomial infection, and possibly nationalist circles.
It is quite a tenacious notion that HIV is not the causative agent of AIDS at all, and AIDS develops as a result of exposure only to some other factors leading to a decrease in immunity. The undoubted harm of such publications is calling into question the need to avoid contracting HIV.
In many communities, phenomena are common that should be attributed to factors that negatively affect the effectiveness of teaching safe sexual behavior. Among them, the first place is occupied by the use of alcohol.
Alcohol reduces the ability to self-control, as a result of which people are more likely to enter into have sex with people they wouldn't have sex with while sober, and are less likely to use "less dangerous sex" methods. Alcohol makes many people more insistent on sexual harassment and the like. It is clear that limiting the influence of this factor is an independent problem, the complexity of which is well known. The use of drugs and stimulant substances has a very negative impact on the fight against HIV infection.
Money is a similar factor. Many people are convinced that a man should have so much women, as many as his purse allows. And moreover, since money is mined for this very purpose, then with their help it is simply it is necessary to get as many pleasures as possible, including changing partners, having a mistress, experiencing dangerous types of sex, and even with the help of money to achieve sex without using a condom. We don't speak already that acquisitiveness is the main "driver" in the spread of drug addiction. Mitigation of the influence of these factors is possible only with the social reorganization of society.
Prospects for Specific Prevention
We are on the verge of developing a catastrophic pandemic. Humanity, although it already has reliable methods for diagnosing a dangerous pandemic, has not yet found either effective treatment or reliable vaccination. Under these conditions, the level of sanitary and educational work is of particular importance.
The issue of developing specific vaccines and drugs for the prevention of HIV infection deserves special attention.
The development of such drugs is actively underway, but no clear positive results have been published at the time of this writing.
The following theoretical variants of the "structural" approach to the design of vaccines are being developed: live attenuated vaccines; whole inactivated; vaccines from individual viral proteins obtained in different ways (virus destruction, chemical synthesis, genetic engineering); live recombinant viral or bacterial vectors (carriers) containing immunogenic HIV proteins or DNA; anti-idiotypic vaccines.
The preparations obtained in this way should, in particular, overcome such a problem as the antigenic variability of HIV, and at the same time have sufficient immunogenicity.
The requirements for such drugs are quite high: they must cause a strong immunogenic response without causing an immunosuppressive effect specific to the prototype (HIV), not to mention a variety of side effects.
When discussing the prospects for the development and use of prophylactic drugs for AIDS, one should keep in mind the extreme variability of the immunodeficiency virus. American scientists have shown that this virus is very unstable: the frequency of spontaneous mutations in it per year averages about a thousand for each gene. This circumstance seriously complicates the work on the creation of an effective vaccine against a new disease.
Before a drug can be called a vaccine, it must undergo many tests. Among them are tests of immunogenicity and toxicity, tests of protective activity on animals.
The question of whether it is possible to immediately proceed to human testing without animal testing is determined by the laws of individual states, but, apparently, in the case of HIV infection, “exceptions to the rules” are possible. Human trials should be conducted in at least 3 phases:
1) determination of immunogenicity and safety in a small group of volunteers;
2) study of immunogenicity and safety with determination of the effect of dose and route of administration on a large group of volunteers;
3) large-scale "field" trials to assess the activity of the "vaccine candidate" in vivo.
The long-term consequences of immunization with drugs that have the structure of HIV, which themselves can cause the development of immunodeficiency in the long term, can be very ambiguous, so the observation period should be long-term. At the same time, special attention should be paid to the study of the effect of such drugs on people with various diseases, especially those with impaired immunity, which makes it necessary to expand experimental teams or even conduct special tests on this group of people. In the third phase of the study, the immunized population must be sufficiently affected by HIV so that a difference in seroconversion rates between the vaccinated and unvaccinated groups can be detected fairly quickly.
Since HIV infection develops over 10 years or more, the effects of immunization will need to be observed for an even longer time.
With positive results from a vaccine trial, new Problems. The production of a sufficient amount of vaccine will be largely limited by the technical complexity of its production and the resulting future cost, which may be too high.
The next problem is the definition of contingents to be vaccinated. The expediency of mass vaccination of the population against pathogens that are not transmitted by airborne or transmissible means is constantly questioned, since there are always other ways to protect against infection.
It can be assumed that the advent of a vaccine will only provide a new choice in the practice of protection against infection, which will not change the social and psychological essence of the problem. You can be vaccinated, but you can protect yourself by well-known methods. One can even foresee the emergence of the opinion that a person vaccinated against HIV infection did so for the sole purpose of leading an inappropriate lifestyle. Moreover, the availability of a vaccine would, as it were, remove another argument in favor of observing the traditional rules of sexual behavior, which may have uncertain social consequences.
Apparently, voluntary vaccination of persons from groups at increased risk of infection can be most realistically carried out: homosexual men, prostitutes , drug addicts; the temptation will not resist this temptation and medical professionals who believe that they are at serious risk of infection from their patients. In other cases, the problem of choosing methods for preventing infection will be quite obvious. .
Another anticipated complication associated with vaccination is the possible emergence of a layer of immunized but uninfected individuals who have markers that indicate possible HIV infection. In this regard, there will be a problem of differentiation of infected and immunized HIV, which will require improvement and cost of the procedure for establishing the diagnosis of HIV infection.
Thus, those who expect that all the problems associated with the prevention of HIV infection will be automatically solved when preventive vaccines appear soon are seriously mistaken.
Moreover, spreading the opinion about the inevitable appearance of drugs and prophylactic drugs is a certain danger, as it inspires the population with unjustified optimism, which reduces the effectiveness of educational programs.
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Acquired immunodeficiency syndrome (AIDS) is a particularly dangerous viral infection with a long incubation period. It is characterized by suppression of cellular immunity, the development of secondary infections (viral, bacterial, protozoal) and tumor lesions, resulting in the death of patients.
Etiology. The causative agent of AIDS is the human T-lymphotropic virus of the retrovirus family. The virus was isolated in 1983, initially referred to as LAV and also as HTLV-111. Since 1986 it has been called "human immunodeficiency virus" (HIV). Retroviruses have an enzyme that reverses transcriptase. Viruses are cultivated in cell culture. Heating at 56°C kills viruses. Two types of human immunodeficiency virus have been identified. Many of their properties are not well understood.
Pathogenesis. The entrance gates of AIDS are skin microtraumas (contact with blood) and mucous membranes of the reproductive system or rectum. From the moment of infection to the appearance of the first symptoms of the disease (latent (incubation) period), it can take from 1 month to 4-6 years. The persistence and reproduction of the virus occurs in the lymphoid tissue. However, already at this moment, the virus periodically penetrates into the blood and can be detected in the secretions. Such individuals without severe symptoms of AIDS may be sources of infection. The intensity of viremia determines the clinical manifestations. The basis of the pathogenesis of AIDS is the T-lymphotropism of the virus. AIDS viruses, replicating in T4 cells (helpers), inhibit their proliferation and disrupt the structure of T-helper plasmolemma proteins. A change in their structure prevents the recognition of infected T4 cells and their destruction by cytotoxic T8 lymphocytes. There is an inhibition of proliferation and a decrease in the absolute number of T4 cells. A defect in the mechanism of recognition of antigens of the AIDS virus is manifested by an increased synthesis of antibodies of classes A and G, which, however, do not have the ability to neutralize the pathogen. Immunity deficiency leads to the development of latent infections or the addition of an opportunistic (accidental) disease caused by opportunistic microbes. It is these diseases that predetermine the outcome and lead to the death of patients in the next 1-2 years after the onset of the first clinical symptoms of AIDS. A decrease in cellular immunity also leads to the emergence of some malignant tumors (Kaposi's sarcoma, brain lymphoma). Pneumocystis pneumonia, gastrointestinal and pulmonary forms of cryptosporoidosis, generalized toxoplasmosis, which occurs more often in the form of encephalitis, generalized manifestations of herpetic and cytomegalovirus infections, fungal infections, and bacterial infections are most often noted as associated infections.
Russian classification of HIV infection (V. I. Pokrovsky, 2001)
1. Stage of incubation.
2. Stage of primary manifestations, course options:
1) asymptomatic;
2) acute HIV infection without secondary diseases;
3) acute infection with secondary diseases.
3. Latent stage.
4. Stage of secondary diseases, course options:
1) weight loss less than 10%; fungal, viral, bacterial lesions of the skin and mucous membranes, shingles; repeated pharyngitis, sinusitis;
2) weight loss of more than 10%, unexplained diarrhea or fever for more than 1 month, hairy leukoplakia, pulmonary tuberculosis, recurrent or persistent viral, bacterial, fungal, protozoal lesions of internal organs, recurrent or disseminated herpes zoster, localized Kaposi's sarcoma;
Phases: progression (against the background of the absence of antiretroviral therapy, against the background of antiretroviral therapy), remission (spontaneous, after previous or against the background of antiretroviral therapy).
5. Terminal stage.
Clinic. The incubation period usually lasts about 6 months. The onset of the disease is gradual. The initial (prodromal, non-specific) period is characterized by an increase in body temperature (above 38 ° C) with profuse sweating and symptoms of general intoxication (lethargy, depression, decreased performance). There is also a lesion of the digestive system, esophagitis (pain when swallowing, ulcers of the esophagus) of candidal etiology, less often viral (herpetic, cytomegalovirus) can develop. Enteritis is characterized by pain in the abdomen, diarrhea, with sigmoidoscopy there are no changes. Enteritis is more often caused by protozoa (giardia, cryptosporids, isospores) and helminths (strongyloidiasis), less often by cytomegaloviruses. Colitis is more often caused by salmonella, campylobacter, sometimes dysenteric amoebae and chlamydia. Homosexuals may first of all show signs of proctitis of gonococcal origin, syphilitic, less often lesions with cytomegaloviruses and herpes viruses. Characteristic of the initial period of AIDS is the presence of generalized lymphadenopathy. The process begins mainly with the cervical, axillary and occipital lymph nodes. AIDS is characterized by damage to the lymph nodes in at least two places for 3 months or more. They can grow up to 5 cm in diameter and be painless. During the development of the disease, the lymph nodes may merge. Splenomegaly is detected in 20% of patients with lymphadenopathy. More than half of the patients develop skin changes - maculopapular elements, seborrheic dermatitis. Steroid-resistant fever appears, etc. The presence of AIDS can be confirmed on the basis of the simultaneous detection of two or more clinical signs that make up this complex, and two or more laboratory diagnostic signs. Further, it is necessary to conduct a complex of special studies, which will confirm the final diagnosis.
Symptom complex related to AIDS.
1. Clinical signs (for 3 months or more):
1) unmotivated lymphadenopathy;
2) unmotivated loss of body weight (more than 7 kg or 10% of body weight);
3) unmotivated fever (constant or intermittent);
4) unmotivated diarrhea;
5) unmotivated night sweats.
2. Laboratory and diagnostic signs:
1) reduced number of T-helpers;
2) change in the ratio of T-helpers and T-suppressors;
3) anemia, leukopenia, thrombocytopenia or lymphopenia;
4) an increase in the amount of immunoglobulins A and G in the blood serum;
5) decrease in the reaction of blast transformation of lymphocytes into mitogens;
6) the absence of a delayed-type hypersensitivity skin reaction to several antigens;
7) increase in the level of circulating immune complexes.
The manifest period of AIDS (the period of the peak of the disease) is characterized by the predominance of clinical manifestations of a secondary (opportunistic) infection. Almost half of the patients develop lung lesions (pulmonary type of AIDS), most often caused by pneumocystis. Pneumocystis pneumonia is severe, mortality is 90-100%. There are pains in the chest, aggravated by inhalation, shortness of breath, cough, cyanosis. The radiograph shows multiple infiltrates in the lung tissue. Lung diseases caused by legionella and various bacterial pathogens are also severe. The lungs are also affected in generalized cytomegalovirus infection. When lung abscesses form, a fungal infection can develop in their cavities. In 30% of patients, CNS lesions in the form of encephalitis caused by generalized toxoplasmosis infection, less often cytomegalovirus and herpetic, come to the fore. Signs of encephalitis may be combined with a picture of serous meningitis. Primary or secondary brain lymphoma may also develop. In some cases, AIDS patients are dominated by prolonged fever and general intoxication. Fever is often of the wrong (septic) type. This is usually a rare disease in older people with a primary lesion of the skin of the lower extremities. The disease is steadily progressing. Patients with manifest forms of AIDS die within the next 1-2 years.
Diagnostics. Examination of the contingent, as well as the stages and scope of clinical and laboratory studies, are regulated by the Decree of the Presidium of the Supreme Soviet of the USSR of August 25, 1987, and the rules for medical examination for the detection of infection with the AIDS virus, established by the USSR Ministry of Health in accordance with the provisions of this Decree. Research is carried out in specially designated laboratories.
Treatment. Effective etiotropic agents currently do not exist. Antiviral drugs (azidothymidine, virazole) are prescribed. With the development of a secondary infection, drugs are used to treat it. Treatment also includes the use of immunomodulators. At best, the improvement is only temporary, then a new infectious factor joins, and the disease recurs.
Prevention. General preventive measures are carried out in accordance with the Decree of the Presidium of the Supreme Soviet of the USSR of August 25, 1987 "On measures to prevent infection with the AIDS virus." Patients are placed in separate boxes, they are cared for by specially assigned instructed personnel. The sampling of blood and other materials, as well as their processing, is carried out in rubber gloves. If infectious material gets on the skin, it must be treated with medical alcohol with a strength of 70% or a 1% solution of chloramine. Laboratory glassware containing blood and other materials must be specially marked. Work is underway to create specific immunoprophylaxis.
The risk of HIV infection during unprotected sex in women is about 8 times higher than in men. In women in the early phase of HIV infection, immune activation is more pronounced, which leads to less pronounced virus replication, but later, with a chronic process, this mechanism ensures a higher rate of disease progression. On the background of ART, women experience a less pronounced decrease in the level of inflammatory markers than men. Women are more likely than men to interrupt ART, including on their own. At the same time, married women with an older partner have the highest adherence to treatment. Women are more likely than men to experience side effects of ART.
HIV infection and pregnancy planning
Pregnancy with HIV infection is possible because the risk of transmitting HIV infection to your sexual partner, as well as to your child, can today be significantly reduced, and in some cases even completely eliminated. HIV-infected persons do not transmit HIV through sexual contact under the following conditions:
- An HIV-infected patient receives ART under the supervision of a doctor;
- viral load remains at an undetectable level for at least 6 months;
- no other sexually transmitted infections.
HIV infection in children
In the vast majority of cases, children are infected from the mother in a vertical way. The horizontal route of infection transmission: blood transfusions, sexual contacts, drug use is practically excluded for children. Typical adult signs of acute HIV infection, such as fever, sore throat, and lymphadenopathy, are not observed in children. At the same time, the presence of antibodies to HIV in the blood does not always confirm the presence of infection. Because the risk of death from AIDS is extremely high in infancy, ART should be initiated within the first 12 months of life, regardless of virological, immunological, or clinical criteria.
HIV/AIDS Therapy
HIV infection is currently treatable with ART. Although a complete cure is not yet possible, it is possible to control the disease. The goal of ART is to prolong life and improve its quality in patients with HIV infection, and to prevent the development of AIDS.
Tasks of ART:
- clinical: prevention of the development of opportunistic infections and HIV-associated non-communicable diseases;
- virological: maximum and long-term suppression of HIV replication;
- immunological: restoration and maintenance of the function of the immune system;
- epidemiological: reduction in the number of HIV transmissions.
Starting ART as early as possible can not only have long-term immunological and virological benefits for the infected person, but also prevent the development of resistance in undetected infections during pre-exposure prophylaxis.
ART is prescribed:
- all patients with a CD4+ lymphocyte count< 500 мкл -1 независимо от стадии заболевания. Пациентам с количеством лимфоцитов CD4+ >500 µl -1 ART may be given if willing to take lifelong therapy. It is recommended to prescribe ART regardless of the number of CD4+ lymphocytes with their rapid decline (> 100 μl -1 per year);
- all patients, regardless of the number of CD4+ lymphocytes, in the presence of clinical manifestations of secondary diseases, especially in the development of AIDS-defining diseases, and in some cases, ART may be delayed to prevent the development of an inflammatory syndrome of immune system recovery;
- in acute HIV infection for life;
- all patients, regardless of the number of CD4+ lymphocytes and the stage of the disease in the following situations:
- patients with active tuberculosis;
- hepatitis B, if treatment is indicated, or if there are signs of severe chronic liver damage;
- patients with concomitant chronic hepatitis C (with a CD4+ lymphocyte count > 500 μl -1 ART may be delayed until the completion of its course of treatment;
- patients with HIV-associated nephropathy;
- patients with diseases requiring prolonged use of immunosuppressive therapy (radiation therapy, corticosteroid hormones, cytostatics);
- pregnant women;
- thrombocytopenia;
- patients over 60 years of age with HIV-associated neurocognitive disorders;
- with a viral load> 100,000 copies / ml of plasma;
- according to epidemiological indications: to an HIV-infected partner in a discordant couple, when preparing an HIV-infected patient for the use of assisted reproductive technologies.
When conducting ART, it is not allowed to interrupt it, otherwise the infection recurs and the pathogen develops resistance.
Prevention of HIV infection
HIV prevention includes:
- exclusion of promiscuity;
- sexual relationship with a reliable partner;
- the use of contraceptives during casual sexual contact;
- exclusion of the use of any form of narcotic drugs;
- carrying out procedures for piercing, tattooing, ear piercing in special institutions;
- use of individual personal hygiene items.
Post-exposure prophylaxis of HIV infection
Post-exposure prophylaxis is a short-term course of ART to reduce the likelihood of developing the disease after exposure to HIV-infected biological substances. Biological substances, upon contact with which HIV infection is likely:
- blood;
- sperm;
- vaginal discharge;
- synovial fluid;
- cerebrospinal fluid;
- pleural fluid;
- pericardial fluid;
- amniotic fluid;
- any liquids with an admixture of blood;
- containing HIV cultures and culture media.
In addition, there are a number of unforeseen (emergency) situations that can lead to HIV infection:
- contact with blood or biological substances contaminated with HIV in the performance of professional duties by medical personnel;
- unprotected sexual contact with an HIV-infected person, use of non-sterile syringes, accidental needle sticks, etc.).
In the event of an emergency at the workplace, a medical worker is obliged to immediately take a set of measures to prevent HIV infection:
- in case of cuts and injections, immediately remove gloves, wash hands with soap and water under running water, treat hands with 70% ethyl alcohol solution, lubricate the wound with 5% iodine alcohol solution;
- if blood or other biological fluids of the patient get on the skin, this place is treated with a 70% solution of ethyl alcohol, washed with soap and water and re-treated with a 70% solution of ethyl alcohol;
- if blood and other biological fluids of the patient get on the mucous membrane of the eyes, nose and mouth, the oral cavity is washed with plenty of water and rinsed with a 70% solution of ethyl alcohol, the mucous membrane of the nose and eyes is washed with plenty of water (do not rub);
- if blood and other biological fluids of the patient get on the dressing gown, clothes, work clothes are removed and immersed in a disinfectant solution or in a bix for autoclaving.
ART should be started within the first two hours after the accident, but no later than 72 hours. Drug prophylaxis should be carried out under the supervision of specialists from regional centers for the prevention and control of AIDS, who assess the degree of risk of HIV infection and prescribe the necessary ART regimen.
Life expectancy of patients with HIV infection
The known minimum life expectancy is about 3 months. Average - every second patient dies within 13 years. The known maximum lifespan is over 20 years.
Consultation of a specialist of the regional Center for Prevention and Control of AIDS.
