AIDS

Description:

This state which is developing against the background of HIV infection and characterized by falling of number of CD4+ of lymphocytes, multiple opportunistic infections, noninfectious and tumoral diseases. HIV is transmitted in direct contact of mucous membranes or blood with biological liquids, viruliferous, for example, with blood, sperm, a secret of a vagina or with breast milk. HIV infection is not transmitted through saliva and tears, and also a household way. Transfer of HIV can happen at proctal, vaginal or oral sex, hemotransfusion, use of the infected needles and syringes; between mother and the child during pregnancy, childbirth or when breastfeeding through the biological liquids stated above. AIDS is the HIV infection end-stage.

AIDS symptoms:

Pulmonary infections. The pneumocystic pneumonia (caused by Pneumocystis jirovecii) is rather rare disease at immunocompetent persons, but is considerably widespread among HIV-positive persons. Before development of effective diagnostic methods, treatment and prevention of HIV infection in the western countries pneumocystic pneumonia was one of proximate causes of death of HIV-positive people. In developing countries pneumocystic pneumonia remains to one of the first signs AIDS at not diagnosed faces though, as a rule, does not develop at number of CD4 lymphocytes less than 200 in мкл blood.
It is separately possible to distinguish tuberculosis as the last is given to immunocompetent persons in the airborne way from other diseases associated with HIV infection and will difficult respond to treatment. According to WHO, coinfection of tuberculosis and HIV is one of the main problems of world health care: in 2007 more than 456000 HIV-positive TB patients died that makes a third of total number of death of tuberculosis and about a quarter of two million death of HIV infection this year.
Incidence of tuberculosis is considerably reduced in the countries of the West, however in developing countries the epidemiological situation both on HIV infection, and on tuberculosis remains heavy. At early stages of HIV infection (the number of CD4 lymphocytes exceeds 300 cells in 1 мкл), tuberculosis develops as a disease of lungs. At late stages of HIV infection clinical implication of tuberculosis often atypical, the extra pulmonary general disease develops. Symptoms, as a rule, of a konstitutsionalna also affect marrow, bones, urinogenital system, digestive tract, a liver, peripheral lymph nodes and the central nervous system.
Gastrointestinal infections.
Esophagitis — an inflammation of a mucous membrane of the lower part of a gullet. At HIV-positive people the esophagitis, as a rule, happens fungal (candidiasis) or virus (a virus of a herpes simplex of the first type, a cytomegalovirus) etiologies, is in rare instances caused by mycobacteria.
Chronic diarrhea at HIV infection can be caused bacterial (Salmonella, Shigella, Listeria or Campylobacter) and parasitic infections, and also rare opportunistic infections, for example, kriptosporoidozy, mikrosporoidozy, Mycobacterium avium and viruses (such as astrovirus, adenovirus, rotavirus and cytomegalovirus; the last is the reason of colitis).

In some cases diarrhea can be side effect of some antiviral drugs, and also antibiotics which use at treatment of the bacterial infections causing diarrhea, for example Clostridium difficile. At late stages HIV infectionof diarrhea can reduce nutritive absorption in intestines and is one of the reasons of weakness and breakdown.
Neurologic and psychiatric symptoms.
HIV infection leads to various neuropsychiatric complications which or result from direct defeat of a nervous system of HIV, or are a consequence of opportunistic infections.

Toxoplasmosis is caused by a one-celled parasite of Toxoplasma gondii who can infect a brain and cause encephalitis, or eyes and lungs. Cryptococcal meningitis — a meninx infection, Cryptococcus neoformans caused by a mushroom. Symptoms of infection are fever, a headache, fatigue, nausea, vomiting, attacks.

The progressive multifocal leukoencephalopathy — a demyelinating disease at which the myelin covering axons of neurons gradually collapses and is broken carrying out nervous impulses. Is an etiology полиомавирус which in a latent form infected about 70% of human population. In an active form полиомавирус causes death within several months after emergence of symptoms.
At HIV-positive people development of the metabolic encephalopathy called by a weak-mindedness complex AIDS (English AIDS dementia complex, ADC) which develops in the infected brain with the participation of macrophages and a microglia is possible. These cells easily catch HIV and develop a neurotoxin. Specific neurologic deviations are shown in the form of cognitive, behavioural, motive disturbances. Such disturbances are shown in several years after infection of HIV and are connected with decrease in number of CD4+ of T lymphocytes and increase in number of virus particles in a blood plasma.

Neurocognitive frustration prevail in the western countries (10 — 20%) and are insignificant, for example, in India (1-2%). Such distinctions, perhaps, are caused by other serotype of HIV prevailing in India. The maniacal syndrome caused by HIV meets at patients with the developed HIV infection more often. Neurologic frustration meet in case of therapy by many drugs less often.
Tumors.
Kaposha's sarcoma. HIV-positive patients often have the increased levels of developing of cancer tumors. It first of all is connected with coinfection oncogenous DNA viruses, especially, Epstein-Burra's virus (English EBV), gerpesvirusy, associated with Kaposha's sarcoma (герпесвирус the person 8), and a papillomavirus of the person (English HPV).
Kaposha's sarcoma is the most widespread tumor arising at HIV-positive patients. Emergence of such tumors among young homosexuals in 1981 became one of the first signs of epidemic AIDS. Kaposha's sarcoma is caused gammagerpesvirusy, the called herpes virus connected with Kaposha's sarcoma. A symptom of a disease is emergence of purple small knots on skin, or in an oral cavity, on an epithelium of digestive tract and in lungs. V-cellular lymphoma, for example, Berkitt's lymphoma, a diffusion macrocellular V-cellular lymphoma and primary lymphoma of TsNS, meet at HIV-positive patients more often. These forms of tumors often foretell the adverse forecast of a course of a disease. The virus Epstein-Barre is one of origins of such lymphoma. At HIV-positive patients of a lymphoma often arise in unusual places, for example, in a GIT. In case of diagnosis of sarcoma of Kaposha and an aggressive V-cellular lymphoma at the HIV-positive patient, the diagnosis AIDS is made. The invasive cancer of a neck of uterus caused by a papillomavirus of the person at HIV-positive women also indicates AIDS development. HIV-positive patients also often have other tumors, for example, Hodzhkin's (lymphogranulomatosis) disease, proctal cancer and a rectal carcinoma, a gepatokletochny carcinoma, cancer of the head and neck, lung cancer. The listed diseases can be caused by viruses (a virus Epstein-Barre, a papillomavirus of the person, a viral hepatitis In and C), or other factors, including contact with carcinogens, for example, with tobacco smoke in case of lung cancer.

It is remarkable that the frequency of development of many tumors, for example, of breast cancer or cancer of a rectum, does not increase at HIV-positive patients. In the countries where highly active anti-retrovirus therapy is intensively used for treatment of HIV infection, number AIDS-connected of new growths decreases, at the same time cancer tumors are the main reason for death of HIV-positive patients. In recent years the quantity of death from forms of the tumors which are not connected about AIDS grows.
Other infections. At patients with the diagnosis AIDS opportunistic infections which have nonspecific symptoms, for example, fever and weight reduction often develop. Such infections can be caused by intracellular Mycobacterium avium and a cytomegalovirus. The cytomegalovirus can cause colitis and an inflammation of a retina.

Penitsilloz called by Penicillium marneffei is a form of opportunistic infections, the third on frequency (after extra pulmonary tuberculosis and a cryptococcosis) which is shown at HIV-positive persons in the endemic Region of Southeast Asia.

At patients AIDS often happens to the diagnosis B19 which is not distinguished an infection by a parvovirus. One of the most frequent effects is anemia which is heavy for distinguishing from the anemia caused by anti-retrovirus drugs for treatment AIDS.
    * The I stage — initial (acute) HIV infection
    * The II stage — a persistent generalized lymphadenopathy
    * The III stage — the AIDS-associated complex (pre-SPID)
    * The IV stage — the developed AIDS

AIDS reasons:

Source of an infection is only the sick person.
The etiological agent - a human immunodeficiency virus.
Ways of transfer:
    * Sexual — at proctal, vaginal and oral sex, irrespective of sexual orientation (at oral sex (blowjob) the risk of infection of HIV is insignificant, but, nevertheless, is real at hit of sperm in the oral cavity having sores, mechanical damages or the inflamed mucous membrane);
    * Injection and tool — when using of the syringes polluted by a virus, needles, catheters, etc. — especially urgent and problematic among the persons using injecting drugs (drug addiction). The probability of transfer of HIV when using the general needles makes 67 cases on 10000 injections [22]:21. This way of transfer caused universal distribution of one-time syringes in the second half of the 20th century. [the source is not specified 452 days]
    * Hemotransfusionic (after transfusion of the infected blood or its components — plasmas, platelet, leukocytic or a packed red cells, concentrates of blood, blood-coagulation factors);
    * Perinatal (antenatal, transplacental — from the infected mother; intranatal — when passing the child on the infected patrimonial ways of mother);
    * Transplant (change of the infected bodies, marrow, artificial insemination the infected sperm);
    * Milk (infection of the child with the infected mother's milk);
    * Professional and household — infection through the damaged integuments and mucous membranes of the people contacting to blood or some secrets (slime from a vagina, the breast milk separated from wounds, cerebrospinal liquid, contents of a trachea, a pleural cavity, etc.) patients with HIV infection.
    * At the same time, HIV is not transmitted at household contacts through saliva, the lacrimal liquid and an airborne way, and also through water or food. Saliva can constitute danger only if at it there is blood.

Treatment of AIDS:

Treatment of patients with AIDS includes in use of antiviral drugs which suppress a virus reproduction.
After confirmation of the diagnosis define approaches to further maintaining patients.

Approach to the choice of therapy has to be individual, based on a risk degree. The decision on when to begin anti-retrovirus therapy, should be accepted depending on risk of progressing of HIV infection and degree of manifestation of an immunodeficiency. If anti-retrovirus therapy is begun before emergence of immunological and virologic signs progressed also diseases, then its positive effect can be the most expressed and long.

Antiviral therapy is appointed by the patient, since a stage of an acute infection. The main principle of treatment of AIDS, as well as other viral diseases, timely treatment of a basic disease and its complications, first of all pneumocystic pneumonia, sarcoma of the Galosh, DNS lymphoma is.

It is considered that treatment of opportunistic infections, Kaposha's sarcomas at patients with AIDS has to be carried out by rather high doses of antibiotics, himiopreparat. Their combination is preferable. At the medicine choice, except the accounting of sensitivity, patients need to take into account portability it, and also a functional condition of his kidneys in connection with danger of accumulation of drug in an organism. Results of therapy depend also on care of observance of a technique and sufficient duration of treatment.

Now for treatment of the infections caused by opportunistic microorganisms, and Kaposha's sarcoma the prolonged therapy lasting more than 6 weeks is applied. Its scheme depends on a phase and activity of a disease.

There are many recommendations and the systems regulating doses and ways of administration of drugs, and practically each specialist adheres to own scheme. Usually treatment is begun with high doses of an antibiotic or other himiopreparat, if necessary apply their combination. Further patients accept drugs in basal doses until activity of process does not begin to decrease and will stop at all.

Despite rather large amount of drugs and ways of treatment of AIDS, results of therapy are very modest now and cannot lead to an absolute recovery as clinical remissions are characterized only by oppression of process of reproduction of a virus and in some cases a considerable reduction of morphological features of a disease, but not their total disappearance. Therefore only with prevention of reproduction of a virus it will probably be possible to give to an organism resistance to opportunistic infections and development of malignant tumors by recovery of functions of immune system or replacement of the destroyed immune cells.

Quite often "chemical overloads" the drugs applied at a final stage of a disease against viruses, mushrooms, one-celled parasites, other microorganisms become a complication at treatment of AIDS. At the same time many patients die not of the accompanying infections, and of toxic action of high doses of drugs.

Adequate therapy consists in creation of a psychological situation, favorable for the patient, timely diagnosis and treatment of the basic, background, opportunistic diseases, careful dispensary observation.