Groups at high risk of HIV infection. when HIV is transmitted from the blood of an HIV-infected mother to her child during pregnancy or childbirth

HIV infection is a disease provoked by the immunodeficiency virus, and also characterized by the relevant acquired immunodeficiency syndrome (AIDS), which, in turn, acts as a factor contributing to the development of secondary infections, as well as various malignant neoplasms. HIV infection, the symptoms of which manifest themselves in this way, leads to the deepest depression of those protective properties, which are inherent in the body as a whole.

general description

An HIV-infected person acts as a reservoir of infection and its direct source, and he remains so at any stage of this infection, throughout his life. As natural reservoir isolate African monkeys (HIV-2). HIV-1 in the form of a specific natural reservoir has not been identified, although it is possible that wild chimpanzees may act as it. HIV-1, as it became known based on laboratory research, can provoke an infection without any clinical manifestations, and this infection ends after some time full recovery. As for other animals, they are generally not susceptible to HIV.

Significant amounts of the virus are found in the blood, menstrual fluid, vaginal secretions and semen. In addition, the virus is also found in saliva, breast milk, cerebrospinal fluid and tear fluid. The greatest danger lies in its presence in vaginal secretions, sperm and blood.

In the case of an actual inflammatory process or in the presence of lesions of the mucous membranes in the genital area, which, for example, is possible with, the possibility of transmitting the infection in question in both directions increases. That is, the affected area acts in this case as an entry/exit gate through which HIV transmission is ensured. A single sexual contact determines the possibility of transmission of infection in a low percentage of probability, but with an increase in the frequency of sexual intercourse, the greatest activity is observed precisely with this method. Within living conditions there is no transmission of the virus. A possible variant of HIV transmission is the condition of a placental defect, which, accordingly, is relevant when considering HIV transmission during pregnancy. In this case, HIV appears directly in the bloodstream of the fetus, which is also possible during labor due to trauma that is relevant to the birth canal.

The implementation of the parenteral method of transmission is also possible through the transfusion of blood, frozen plasma, platelets and red blood cells. About 0.3% total number cases of infection are due to infection through injections (subcutaneous, intramuscular), including accidental injections. Otherwise, such statistics can be presented as 1 case for every 300 injections.

On average, up to 35% of children of HIV-infected mothers also become infected. The possibility of infection when breastfeeding by infected mothers cannot be ruled out.

As for the natural susceptibility of people to the infection in question, it is extremely high. The average life expectancy for HIV-infected patients is about 12 years. Meanwhile, due to the emergence of new products in the field of chemotherapy, there are now certain opportunities to prolong the life of such patients. The majority of people affected are sexually active people, mostly men, although during recent years The trend towards the prevalence of morbidity began to increase among women and children. When infected at the age of 35 years or more, AIDS is achieved almost twice as fast (compared to the transition to it in younger patients).

Also, when considering the period of the last few years, the dominance of the parenteral route of infection is noted, in which people who use the same syringe at the same time are infected, which, as can be understood, is especially true among drug addicts.

Additionally, the number of infections due to heterosexual contact is also subject to an increase. This kind of tendency is quite understandable, in particular, when it comes to drug addicts who act as a source of infection transmitted to their sexual partners.

A sharp increase in the prevalence of HIV has also recently been observed among donors.

HIV: risk groups

The following persons are at risk of increased risk of infection:

• persons who use injecting drugs, as well as common utensils required in the preparation of such drugs, this also includes the sexual partners of such persons;
• persons who, regardless of their current orientation, practice unprotected sexual intercourse (including anal);
• persons who have undergone a transfusion procedure donated blood without preliminary verification;
• doctors of various profiles;
• persons suffering from one or another sexually transmitted disease;
• persons directly involved in the field of prostitution, as well as persons using their services.

There are some statistics regarding the risk of HIV transmission according to the characteristics of sexual contacts, these statistics in particular are considered within every 10,000 such contacts:

• inserting partner + fellatio – 0.5;
• receiving partner + fellatio – 1;
• inserting partner (vaginal sex) – 5;
• receiving partner (vaginal sex) – 10;
• inserting partner (anal sex) – 6.5;
• receiving partner (anal sex) – 50.

Sexual contact in its protected form, but with a rupture of the condom or when its integrity is violated, is no longer such. To minimize such situations, it is important to use a condom according to the rules provided for this, and it is also important to choose reliable types.

Considering the characteristics of transmission and risk groups, it is worth noting how HIV is not transmitted:

• through clothes;
• through dishes;
• with any type of kiss;
• through insect bites;
• through the air;
• through a handshake;
• when using a shared toilet, bathroom, swimming pool, etc.

Forms of the disease

The immunodeficiency virus is characterized by a high frequency of genetic changes relevant to it, which are formed during self-reproduction. The length of the HIV genome is determined to be 104 nucleotides, but in practice, each virus differs from its previous version by at least 1 nucleotide. As for varieties in nature, HIV exists here in the form of various variants of quasi-species. Meanwhile, several main varieties have been identified, significantly different from each other on the basis of certain characteristics, especially this difference affected the structure of the genome. Above we have already highlighted these two forms in the text, now we will consider them in more detail.

• HIV-1 – This form is the first of a number of options; it was opened in 1983. Today it is most widespread.
• HIV-2 – this form of the virus was identified in 1986; the difference from the previous form so far lies in its insufficient knowledge. The difference, as already noted, lies in the features of the genome structure. There is also information that HIV-2 is less pathogenic, and its transmission is slightly less likely (again, compared to HIV-1). It was also noted that when infected with HIV-1, patients are more susceptible to the possibility of becoming infected with HIV-1 due to the weakness of the immune system characteristic of this condition.
• HIV -3. This variety is quite rare in its manifestation, it has been known about it since 1988. The virus discovered then did not react with antibodies of other known forms; it is also known that it is characterized by a significant difference in the structure of the genome. In a more common version, this form is defined as HIV-1 subtype O.
• HIV -4. This type of virus is also quite rare.

The global HIV epidemic centers on the HIV-1 form. As for HIV-2, its prevalence is relevant for West Africa, and HIV-3, as well as HIV-4, do not take a noticeable part in the prevalence of the epidemic. Accordingly, references to HIV in general are limited to a specific type of infection, that is, HIV-1.

In addition there is clinical classification HIV in accordance with specific stages: the incubation stage and the stage of primary manifestations, the latent stage and the stage of development of secondary manifestations, as well as the terminal stage. Primary manifestations in this classification, they can be characterized by the absence of symptoms, as the primary infection itself, including a possible combination with secondary diseases. For the fourth of listed stages division into certain periods in the form of 4A, 4B and 4C is relevant. The periods are characterized by passing through a progression phase, as well as through a remission phase, and the difference during these phases is whether antiviral therapy is used or not. Actually, based on the above classification, the main symptoms of HIV infection are determined for each specific period.

HIV infection: symptoms

Symptoms, as noted above, are determined for HIV infection for each specific period, that is, in accordance with a specific stage, we will consider each of them.

• Incubation stage

The duration of this stage can be on the order of three weeks to three months; in some fairly rare cases, the extension of this period can reach a year. This period is characterized by the activity of reproduction on the part of the virus; there is no immune response to it at this time. The completion of the incubation period of HIV infection is marked either by a clinical manifestation of acute HIV infection, or by the appearance of antibodies against HIV in the patient’s blood. At this stage, the basis for diagnosing HIV infection is the detection of viral DNA particles or its antigens in the blood serum.

• Primary manifestations

This stage is characterized by the manifestation of a reaction on the part of the body in response to the actively occurring replication of the virus, which occurs in combination with the clinic that occurs against the background of an immune reaction and acute infection. The immune reaction consists, in particular, in the production of a specific type of antibodies. The course of this stage can occur without symptoms, while the only sign that may indicate the development of infection is positive result during serological diagnosis regarding the presence of antibodies to this virus.

Manifestations characterizing the second stage appear in the form of acute HIV infection. The actual onset here is acute, and it is observed in more than half of the patients (up to 90%) 3 months after the infection occurred, while the onset of manifestations is often preceded by activation of the formation of HIV antibodies. The course of an acute infection with the exception of secondary pathologies can be very different. Thus, fever, diarrhea, pharyngitis, various types and specific rashes concentrated in the area of ​​visible mucous membranes and skin, lienal syndrome, polylymphadenitis may develop.

Acute HIV infection in about 15% of patients is characterized by the addition of a secondary type of disease to its course, this, in turn, is associated with a decreased this state immunity. In particular, such diseases often include herpes, sore throats and pneumonia, fungal infections etc.

The duration of this stage can be on the order of several days, but a course of several months is not excluded (average indicators are aimed at up to 3 weeks). After this, the disease, as a rule, passes into the next, latent stage of the course.

• Latent stage

The course of this stage is accompanied by a gradual increase in the state of immunodeficiency. Compensation for death immune cells in this case, their intensive production occurs. Diagnosis of HIV within this period is possible, again, due to serological reactions, in which antibodies are detected in the blood against the impact of HIV infection. Concerning clinical signs, then they can manifest themselves in the enlargement of several lymph nodes in various groups that are not connected with each other (with the exception of the inguinal). There are no other types of changes in the lymph nodes, other than their enlargement (that is, there is no pain or any other characteristic changes in the area of ​​surrounding tissues). The duration of the latent stage can be about 2-3 years, although options for its course of 20 years or longer are not excluded (average indicators are mainly reduced to figures up to 7 years).

• Accession of secondary diseases

In this case join accompanying illnesses of various origins(protozoal, fungal, bacterial). As a result of a severe condition characterizing immunodeficiency, malignant tumors can develop. Based on the general severity of associated diseases, the course of this stage can proceed in accordance with the following options:

- 4A. Current weight loss is not very pronounced (within 10%), there are lesions of the mucous membranes and skin. Performance is reduced.

- 4B. Weight loss exceeds 10% of the patient’s normal body weight, temperature reaction is of a long-term nature. The possibility is not excluded long term diarrhea, and without the presence of organic reasons for its occurrence, in addition to this, tuberculosis may develop. The infectious type of disease recurs, subsequently progressing noticeably. In patients during this period, hairy leukoplakia and Kaposi's sarcoma are detected.

- 4B. This condition is characterized by general cachexia (a condition in which patients reach extreme exhaustion with simultaneously pronounced weakness); associated secondary diseases occur in their generalized form (that is, in the most severe form of manifestation). In addition, candidiasis of the respiratory tract and esophagus, pneumonia (pneumocystis), tuberculosis (its extrapulmonary forms), and severe neurological disorders are noted.

The listed substages of the disease are characterized by a transition from a progressive course to remission, which, again, is determined in their characteristics by whether concomitant antiretroviral therapy is present or not.

• Terminal stage

Secondary diseases within this stage, acquired during HIV infection, become irreversible in their own course due to the characteristics of the state of the immune system and the body as a whole. The treatment methods used against them lose any effectiveness, so after a few months death occurs.

It should be noted that HIV infection in its course is extremely diverse, and the given stage options can only be conditional, or even completely excluded from the picture of the disease. In addition, symptoms of HIV during any of these stages in these options may be completely absent or manifest differently.

HIV infection in children: symptoms and features

For the most part, the clinical manifestations of HIV infection in children are reduced to developmental delay at physical level and at the psychomotor level.
Children, more often than adults, are faced with the development of recurrent forms of bacterial infections, encephalopathy, and hyperplasia of the pulmonary lymph nodes. Thrombocytopenia is often diagnosed, the clinical manifestations of which include the development of hemorrhagic syndrome, due to the characteristics of which death often occurs. IN frequent cases is also developing.

As for HIV infection in children of HIV-infected mothers, there is a significantly more accelerated progression of its course. If a child becomes infected at the age of one year, then the development of the disease mainly occurs at a less accelerated pace.

Diagnosis

Considering the fact that the course of the disease is characterized by the duration of absence severe symptoms, diagnosis is possible only on the basis of laboratory tests, which boil down to identifying antibodies to HIV in the blood or directly upon detection of the virus. The acute phase mainly does not determine the presence of antibodies, however, three months after infection, they are detected in about 95% of cases. After 6 months, antibodies are detected in about 5% of cases, more than later- about 0.5-1%.

At the AIDS stage, a significant decrease in the amount of antibodies in the blood is recorded. During the first week from the moment of infection, the inability to detect antibodies to HIV is defined as the “seronegative window” period. It is for this reason that even negative results HIV tests are not reliable evidence of the absence of infection and, accordingly, do not provide a reason to exclude the possibility of infecting other people. In addition to blood testing, PCR scraping can also be prescribed - a fairly effective method that determines the possibility of detecting RNA particles belonging to the virus.

Treatment

There are currently no therapeutic methods through which it would be possible to completely eliminate HIV infection from the body. Taking this into account, the basis of such methods is constant control over one’s own immune status with simultaneous prevention of secondary infections (with their treatment when they appear), as well as control over the formation of neoplasms. Quite often, HIV-infected patients need psychological help, as well as corresponding social adaptation.

Considering significant degree distribution and a high level of social significance within the framework of national and global scales, support is provided along with rehabilitation for patients. Access to a number of social programs is provided, on the basis of which patients receive medical care, due to which the patients’ condition is alleviated to some extent and their quality of life is improved.

Treatment is predominantly etiotropic and involves the prescription of drugs that reduce the reproductive capabilities of the virus. In particular, these include the following drugs:

• nucleoside transcriptase inhibitors (otherwise known as NRTIs), corresponding to various groups: Ziagen, Videx, Zerit, combination drugs (combivir, trizivir);
• nucleotide reverse transcriptase inhibitors (otherwise known as NTRTIs): stocrine, viramune;
• fusion inhibitors;
• protease inhibitors.

An important point when making a decision regarding the initiation of antiviral therapy is to take into account such factors as the duration of use of such drugs, and they can be used almost for life. Successful result Such therapy is ensured solely by strict adherence by patients to recommendations regarding administration (regularity, dosage, diet, regimen). As for secondary diseases associated with HIV infection, their treatment is carried out in a complex, taking into account the rules aimed at the pathogen that provoked specific disease Accordingly, antiviral, antifungal and antibacterial drugs are used.

In case of HIV infection, the use of immunostimulating therapy is excluded, because it only contributes to the progression of HIV. Cytostatics prescribed in such cases for malignant neoplasms lead to immunosuppression.

In the treatment of HIV-infected patients, general strengthening drugs are used, as well as means that provide support for the body (dietary supplements, vitamins), in addition, methods are used that are aimed at preventing the development of secondary diseases.

If we are talking about the treatment of HIV in patients suffering from drug addiction, then in this case treatment in the conditions of the appropriate type of dispensary is recommended. Also, given the serious psychological discomfort against the background of the current condition, patients often require additional psychological adaptation.

If you suspect that your HIV diagnosis is relevant, you should visit an infectious disease specialist.

There are clearly defined groups increased risk in relation to HIV infection. These include homosexual men, drug addicts, prostitutes and hemophiliacs, who may receive contaminated blood through transfusions. Once a person is infected, the virus can also be transmitted through heterosexual relationships with people who do not fall into any of the high-risk groups. Group and anal sex especially contribute to the spread of the virus. The virus in the seed easily passes through inflamed or torn membranes. Drug addicts can catch and spread the virus through sharing needles. Those who engage in prostitution to purchase drugs spread the virus even more widely. Many hemophiliacs contracted the virus through contaminated "factor VIII" (produced from the blood), which is used to treat hemophilia. In most countries, donated blood is now tested for HIV.

The prevalence of AIDS is difficult to measure: an infected person may not feel sick and may unintentionally continue to spread the virus. Anyone who has sex with someone who has had another partner is taking a risk. The only absolute remedy is chastity. However, condoms that are made to high standards and used correctly can also prevent the spread of the virus.

Blood tests for HIV infection are now publicly available. About 12 weeks after sexual intercourse you can usually tell whether the virus has been transmitted. During the first two weeks, you may experience flu-like symptoms, but you may also experience no symptoms. Being a carrier of HIV can be very difficult psychologically; In addition to fear of the possible development of AIDS, patients may suffer discrimination from employment agencies and insurance companies and possibly loss of social and economic status. Therefore, it is important for the patient to seek help and advice, and his family and friends should provide him with love and support. Being diagnosed with HIV does not mean an immediate death sentence. According to one study, 75% of HIV-positive men felt fine and had no symptoms two years after diagnosis.

About 30% of HIV carriers develop persistent swelling lymph nodes. This is often accompanied by fatigue and malaise. Patients can be advised to avoid stress as much as possible and to healthy diet to prevent symptoms from getting worse.

Some patients infected with HIV continue to develop obvious symptoms immune system, thrush, skin disorders, fever, diarrhea, weight loss and constant fatigue.

HIV infection- an anthroponotic viral disease, the pathogenesis of which is based on progressive immunodeficiency and the development as a result of secondary opportunistic infections and tumor processes.

History of the discovery of HIV
The human immunodeficiency virus was discovered in 1983 as a result of research into the etiology of AIDS. The first official scientific reports on AIDS were two articles about unusual cases development of Pneumocystis pneumonia and Kaposi's sarcoma in homosexual men, published in 1981. In July 1982, the term AIDS was first proposed to designate a new disease. In September of that year, based on a series of opportunistic infections diagnosed in (1) homosexual men, (2) drug addicts, (3) patients with hemophilia A, and (4) Haitians, AIDS was first fully defined as a disease. Between 1981 and 1984, several works were published linking the risk of developing AIDS with anal sex or the influence of drugs. At the same time, work was carried out on a hypothesis about the possible infectious nature of AIDS. The human immunodeficiency virus was independently discovered in 1983 in two laboratories:
. at the Pasteur Institute in France under the direction of Luc Montagnier.
. at the National Cancer Institute in the USA under the leadership of Robert C. Gallo.

The results of studies in which a new retrovirus was first isolated from patient tissue were published on May 20, 1983 in the journal Science. These articles reported the discovery of a new virus belonging to the HTLV group of viruses. The researchers suggested that the viruses they isolated could cause AIDS.

On May 4, 1984, researchers reported the isolation of the virus, then called HTLV-III, from the lymphocytes of 26 of 72 examined AIDS patients and 18 of 21 patients with a pre-AIDS condition. The virus could not be detected in any of the 115 healthy heterosexual individuals in the control group. The researchers noted that the low percentage of virus isolation from the blood of AIDS patients is caused by a small number of T4 lymphocytes, cells in which HIV presumably multiplies.

In addition, scientists reported the discovery of antibodies to the virus, the identification of previously described and previously unknown HTLV-III antigens from other viruses, and the observation of virus multiplication in the lymphocyte population.

In 1986, it was discovered that the viruses discovered in 1983 by French and American researchers were genetically identical. The original names of the viruses were dropped and one was proposed common name- HIV.

In 2008, Luc Montagnier and Françoise Barré-Sinoussi were awarded the Nobel Prize in Physiology or Medicine “for their discovery of the human immunodeficiency virus.”

Reservoir and source of infection- infected HIV person, in all stages of infection, for life. The natural reservoir of HIV-2 is African monkeys. The natural reservoir of HIV-1 has not been identified; it is possible that it could be wild chimpanzees. IN laboratory conditions HIV-1 causes a clinically silent infection in chimpanzees and some other monkey species that results in rapid recovery. Other animals are not susceptible to HIV.

IN large quantities The virus is found in blood, semen, menstrual fluid and vaginal secretions. In addition, the virus is found in human milk, saliva, lacrimal and cerebrospinal fluids. The greatest epidemiological danger is represented by blood, semen and vaginal secretions.

The presence of foci of inflammation or disruption of the integrity of the mucous membranes of the genital organs (for example, cervical erosion) increases the likelihood of HIV transmission in both directions, becoming an exit or entry point for HIV. The probability of infection during a single sexual contact is low, but the frequency of sexual intercourse makes this route the most active. Household transmission of the virus has not been established. Transmission of HIV from mother to fetus is possible due to defects in the placenta, leading to the penetration of HIV into the bloodstream of the fetus, as well as trauma to the birth canal and the child during childbirth.

The parenteral route is also implemented through transfusion of blood, red blood cells, platelets, fresh and frozen plasma. Intramuscular, subcutaneous injections and accidental needle sticks account for an average of 0.3% of cases (1 in 300 injections). Among children born from infected mothers or fed by them, 25-35% are infected. It is possible for a child to become infected during childbirth and through human milk.

Natural sensitivity of people- high. Recently, the possibility of the existence of minor genetically different population groups, found especially often among Northern European peoples, who are less likely to become infected through sexual contact, has been considered. The existence of these deviations in susceptibility is associated with the CCR5 gene; people with a homozygous form of the gene are resistant to HIV. Recent data indicate that the cause of immunity to HIV infection may be specific IgA found on the mucous membranes of the genital organs. People infected over the age of 35 develop AIDS twice as quickly as those infected at a younger age.

The average life expectancy of those infected with HIV is 11-12 years. However, the advent of effective chemotherapy drugs has significantly extended the life of HIV-infected people. Among the cases, people of sexually active age predominate, mainly men, but the percentage of women and children increases every year. In recent years, the parenteral route of infection has dominated in Ukraine (when one syringe is used by several people), mainly among drug addicts. At the same time, an increase in the absolute number of transmissions during heterosexual contacts is noted, which is understandable, since drug addicts become sources of infection for their sexual partners. The incidence of HIV infection among donors has increased sharply (more than 150 times compared to the beginning of the epidemic); in addition, donors who are in the “seronegative window” period are very dangerous. The detection of HIV among pregnant women has also increased sharply in recent years.

Main epidemiological features. The world is currently experiencing an HIV pandemic. If in the first years of the appearance of the disease the largest number of cases were registered in the United States, now the infection is most widespread among the population of countries in Africa, Latin America, and Southeast Asia. In a number of countries in Central and South Africa up to 15-20% of the adult population is infected with HIV. In countries of Eastern Europe, including in Ukraine, in recent years there has been an intensive increase in the infection rate of the population. The distribution of morbidity across the country is uneven. Large cities are the most affected.

The spread of HIV infection is associated mainly with unprotected sexual intercourse, the use of virus-contaminated syringes, needles and other medical and paramedical instruments, transmission of the virus from an infected mother to her child during childbirth or breastfeeding. In developed countries, mandatory testing of donated blood has greatly reduced the possibility of transmission of the virus through its use.

Timely initiation of treatment with antiretroviral drugs (HAART) stops the progression of HIV infection and reduces the risk of developing AIDS to 0.8-1.7%. However, antiretroviral drugs are widely available only in developed and some developing (Brazil) countries due to their high cost.

According to the Joint United Nations Program on HIV/AIDS (UNAIDS) and World Organization According to the WHO, from 1981 to 2006, 25 million people died from diseases associated with HIV infection and AIDS. Thus, the HIV pandemic is one of the most destructive epidemics in human history. In 2006 alone, HIV infection caused the death of approximately 2.9 million people. By the beginning of 2007, about 40 million people worldwide (0.66% of the world's population) were HIV carriers. Two thirds of the total number of people living with HIV live in sub-Saharan Africa. In the countries hardest hit by the HIV and AIDS pandemic, the epidemic is hampering economic growth and increasing poverty.

What causes HIV infection

HIV- human immunodeficiency virus, which causes the disease HIV infection, last stage which is known as acquired immunodeficiency syndrome (AIDS) - as opposed to congenital immunodeficiency.

Human immunodeficiency virus belongs to the family retroviruses(Retroviridae), genus of lentiviruses (Lentivirus). The name Lentivirus comes from the Latin word lente, meaning slow. This name reflects one of the features of viruses of this group, namely, the slow and unequal speed of development infectious process in the macroorganism. Lentiviruses also have a long incubation period.

The human immunodeficiency virus is characterized by a high frequency of genetic changes that occur during the process of self-reproduction. The error rate in HIV is 10−3 - 10−4 errors/(genome * replication cycle), which is several orders of magnitude higher than the same value in eukaryotes. The HIV genome is approximately 104 nucleotides in length. It follows from this that almost every virus differs by at least one nucleotide from its predecessor. In nature, HIV exists in the form of many quasi-species, while being one taxonomic unit. In the process of researching HIV, varieties were nevertheless discovered that differed significantly from each other in several ways, in particular different structure genome. Varieties of HIV are designated by Arabic numerals. Today, HIV-1, HIV-2, HIV-3, HIV-4 are known.

. HIV-1- the first representative of the group, opened in 1983. Is the most common form.
. HIV-2- a type of human immunodeficiency virus identified in 1986. Compared to HIV-1, HIV-2 has been studied to a much lesser extent. HIV-2 differs from HIV-1 in genome structure. HIV-2 is known to be less pathogenic and less likely to be transmitted than HIV-1. It has been noted that people infected with HIV-2 have weak immunity to HIV-1.
. HIV-3- a rare variety, the discovery of which was reported in 1988. The discovered virus did not react with antibodies from other known groups, and also had significant differences in the structure of the genome. The more common name for this variant is HIV-1 subtype O.
. HIV-4- a rare type of virus discovered in 1986.

The global HIV epidemic is primarily driven by the spread of HIV-1. HIV-2 is predominantly distributed in West Africa. HIV-3 and HIV-4 do not play a significant role in the spread of the epidemic.

In the vast majority of cases, unless otherwise stated, HIV refers to HIV-1.

Structure of the HIV virion
HIV virions have the form of spherical particles, the diameter of which is about 100-120 nanometers. This is approximately 60 times less than the diameter of a red blood cell.

The capsid of the mature virion has the shape of a truncated cone. Sometimes there are "multinuclear" virions containing 2 or more nucleoids.

Mature virions contain several thousand protein molecules of various types.
Names and functions of the main structural proteins of HIV-1.

Inside the HIV capsid there is a protein-nucleic acid complex: two strands of viral RNA, viral enzymes (reverse transcriptase, protease, integrase) and p7 protein. The Nef and Vif proteins are also associated with the capsid (7-20 Vif molecules per virion). The Vpr protein was found inside the virion (and most likely outside the capsid). The capsid itself is formed by ~2,000 copies of the viral p24 protein. The stoichiometric ratio of p24:gp120 in the virion is 60-100:1, and p24:Pol is approximately 10-20:1. In addition, ~200 copies of cellular cyclophilin A, which the virus borrows from the infected cell, bind to the HIV-1 (but not HIV-2) capsid.

The HIV capsid is surrounded by a matrix shell formed by ~2,000 copies of the matrix protein p17. The matrix shell, in turn, is surrounded by a bilayer lipid membrane, which is the outer shell of the virus. It is formed by molecules captured by the virus during its budding from the cell in which it was formed. 72 glycoprotein complexes are embedded in the lipid membrane, each of which is formed by three transmembrane glycoprotein molecules (gp41 or TM), which serve as the “anchor” of the complex, and three surface glycoprotein molecules (gp120 or SU). With the help of gp120, the virus attaches to the CD4 receptor and coreceptor located on the surface of the cell membrane. gp41 and especially gp120 are being intensively studied as targets for HIV drug and vaccine development. The lipid membrane of the virus also contains cell membrane proteins, including human leukocyte antigens (HLA) classes I, II and adhesion molecules.

Pathogenesis (what happens?) during HIV infection

HIV Risk Groups
High-risk groups:
. persons who use injection drugs and use common utensils for drug preparation (spread of the virus through a syringe needle and shared utensils for drug solutions); as well as their sexual partners.
. persons (regardless of sexual orientation) who practice unprotected anal sex (in particular, approximately 25% of cases of unprotected anal sex among seropositive gay men are so-called “barebackers” [comprising about 14% of all gay men in the studied sample] - persons who deliberately avoid using condoms , despite their awareness of the possibility of HIV infection; a small proportion among barebackers are “bug chasers” - individuals who purposefully seek to become infected with HIV and choose HIV-positive or potentially positive individuals, called “gift-givers”) as sexual partners
. persons who received a transfusion of untested donor blood;
. doctors;
. sick others venereal diseases;
. persons associated with the sale and purchase of the human body in the field of sexual services (prostitutes and their clients)

HIV transmission
HIV can be contained in almost all biological fluids of the body. However, a sufficient amount of virus for infection is present only in blood, semen, vaginal secretions, lymph and breast milk(breast milk is dangerous only for babies - their stomachs do not yet produce gastric juice, which kills HIV). Infection can occur when dangerous biological fluids enter directly into a person’s blood or lymph flow, as well as onto damaged mucous membranes (which is determined by the absorption function of the mucous membranes). If the blood of an HIV-infected person comes into contact with open wound As a rule, infection does not occur to another person from whom the blood flows.

HIV is unstable - outside the body, when the blood (sperm, lymph and vaginal secretions) dries, it dies. Infection does not occur through household means. HIV dies almost instantly at temperatures above 56 degrees Celsius.

However, when intravenous injections the probability of transmission of the virus is very high - up to 95%. Cases of HIV transmission to medical personnel through needle sticks have been reported. To reduce the likelihood of HIV transmission (to a fraction of a percent) in such cases, doctors prescribe a four-week course of highly active antiretroviral therapy. Chemoprophylaxis may also be prescribed to other people at risk of infection. Chemotherapy is prescribed no later than 72 hours after the probable entry of the virus.

Repeated use of syringes and needles by drug addicts with high probability leads to HIV transmission. To prevent this, special charity centers are being created where drug addicts can receive free clean syringes in exchange for used ones. In addition, young drug addicts are almost always sexually active and prone to unprotected sexual intercourse, which creates additional preconditions for the spread of the virus.

Data on HIV transmission through unprotected sex vary greatly from different sources. The risk of transmission depends largely on the type of contact (vaginal, anal, oral, etc.) and the role of the partner (injector/receiver).

Risk of HIV transmission (per 10,000 unprotected sexual contacts)
for the inserting partner during fellatio - 0.5
for the receiving partner during fellatio - 1
for the inserting partner during vaginal sex - 5
for the receiving partner during vaginal sex - 10
for the inserting partner during anal sex - 6.5
for the receiving partner during anal sex - 50

Protected sexual intercourse in which the condom breaks or its integrity is damaged is considered unprotected. To minimize such cases, it is necessary to follow the rules for using condoms, as well as use reliable condoms.

Vertical 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%.

HIV is not transmitted through
. bites of mosquitoes and other insects,
. air,
. handshake,
. kiss (any)
. dishes,
. clothes,
. use of a bathroom, toilet, swimming pool, etc.

HIV primarily infects cells of the immune system (CD4+ T lymphocytes, macrophages and dendritic cells), as well as several other types of cells. CD4+ T lymphocytes infected with HIV gradually die. Their death is due mainly to three factors
1. direct destruction of cells by the virus
2. programmed cell death
3. killing of infected cells by CD8+ T lymphocytes. Gradually, the subpopulation of CD4+ T lymphocytes decreases, resulting in cellular immunity decreases, and when the number of CD4+ T-lymphocytes reaches a critical level, the body becomes susceptible to opportunistic (opportunistic) infections.

Once in the human body, HIV infects CD4+ lymphocytes, macrophages and some other types of cells. Having penetrated into these types of cells, the virus begins to actively multiply in them. This ultimately leads to the destruction and death of infected cells. The presence of HIV over time causes disruption of the immune system due to its selective destruction of immunocompetent cells and suppression of their subpopulation. Viruses that leave the cell are introduced into new ones, and the cycle repeats. Gradually, the number of CD4+ lymphocytes decreases so much that the body can no longer resist pathogens of opportunistic infections, which are not dangerous or little dangerous for healthy people with a normal immune system.

The basis of HIV pathogenesis is still not very clear. Recent evidence suggests that hyperactivation of the immune system in response to infection is a major factor in the pathogenesis of HIV. One of the features of pathogenesis is the death of CD4+ T cells (T helpers), the concentration of which slowly but steadily decreases. The number of dendritic cells, professional antigen-presenting cells, which basically begin the immune response to the pathogen, also decreases, which may be even more important in terms of the consequences for the immune system strong factor rather than the death of T helper cells. The causes of dendritic cell death remain unclear.

Some reasons for the death of helpers:
1. Explosive reproduction of the virus.
2. Fusion of the membranes of infected and non-infected helpers with the formation of non-viable simplasts (helpers become sticky). Symplasts have only been detected in vitro under cell culture conditions.
3. Attack of infected cells by cytotoxic lymphocytes.
4. Adsorption of free gp120 on CD4+ uninfected helper cells with their subsequent attack of cytotoxic lymphocytes.

The main cause of T cell death is HIV infection is programmed cell death (apoptosis). Even at the AIDS stage, the level of infection of T4 cells is 1:1000, which suggests that the virus itself is not capable of killing the same number of cells that die during HIV infection. It is also impossible to explain such a massive death of T cells by the cytotoxic effect of other cells.

The main reservoir of HIV in the body is macrophages and monocytes:
1. Explosive reproduction does not occur in them.
2. Exit occurs through the Golgi complex.

Symptoms of HIV infection

Incubation period(the period of seroconversion - until the appearance of detectable antibodies to HIV) - the period from the moment of infection until the appearance of the body’s reaction in the form of clinical manifestations of “acute infection” and/or the production of antibodies. Its duration usually ranges from 3 weeks to 3 months, but in isolated cases can drag on for up to a year. During this period, HIV actively multiplies, but there are no clinical manifestations of the disease and antibodies to HIV have not yet been detected. The diagnosis of HIV infection at this stage is made on the basis of epidemiological data and must be confirmed in the laboratory by the detection of human immunodeficiency virus, its antigens, and HIV nucleic acids in the patient’s blood serum.

Stage 2. “Primary manifestation stage”. During this period, active replication of HIV in the body continues, but the body’s primary response to the introduction of this pathogen is already manifested in the form of clinical manifestations and/or the production of antibodies. Stage early HIV infection can occur in several forms.

2A. "Asymptomatic" when there are no clinical manifestations of HIV infection or opportunistic diseases developing against the background of immunodeficiency. The body's response to the introduction of HIV is manifested only by the production of antibodies.

2B. “Acute HIV infection without secondary diseases” may manifest itself in a variety of ways clinical symptoms. Most often this is fever, rashes (urticarial, papular, petechial) on the skin and mucous membranes, swollen lymph nodes, pharyngitis. There may be an enlargement of the liver, spleen, and diarrhea. Broad plasma lymphocytes (“mononuclear cells”) can be detected in the blood of patients with acute HIV infection.

Acute clinical infection observed in 50-90% of infected individuals in the first 3 months after infection. The onset of the period of acute infection, as a rule, precedes seroconversion, i.e. the appearance of antibodies to HIV. During the acute infection stage, a transient decrease in the level of CD4 lymphocytes is often observed.

2B. "Acute HIV infection with secondary diseases". In 10-15% of cases in patients with acute HIV infection, secondary diseases appear against the background of a decrease in the level of CD4 lymphocytes and the resulting immunodeficiency of various etiologies(angina, bacterial and Pneumocystis pneumonia, candidiasis, herpetic infection, etc.).

The duration of clinical manifestations of acute HIV infection varies from several days to several months, but usually it is 2-3 weeks. In the vast majority of patients, the initial stage of HIV infection enters the latent stage.

Stage 3. “Latent”. It is characterized by a slow progression of immunodeficiency, compensated by modification of the immune response and excessive reproduction of CD4 cells. Antibodies to HIV are detected in the blood. The only clinical manifestation of the disease is an enlargement of two or more lymph nodes in at least two unrelated groups (not counting the inguinal ones).

Lymph nodes are usually elastic, painless, not fused with the surrounding tissue, and the skin over them is not changed.

The duration of the latent stage can vary from 2-3 to 20 or more years, on average 6-7 years. During this period, there is a gradual decrease in the level of CD4 lymphocytes, on average at a rate of 0.05-0.07x109/l per year.

Stage 4. “Stage of secondary diseases”. Continued replication of HIV, leading to the death of CO4 cells and depletion of their populations, leads to the development of secondary (opportunistic) diseases, infectious and/or oncological, against the background of immunodeficiency.

Depending on the severity of secondary diseases, stages 4A, 4B, 4C are distinguished.

The stages of secondary diseases include phases progression(against the background of the absence of antiretroviral therapy or against the background of antiretroviral therapy) and remission(spontaneous or against the background of antiretroviral therapy).

Stage 5. “Terminal stage”. At this stage, secondary diseases present in patients acquire an irreversible course. Even adequately administered antiviral therapy and therapy for secondary diseases are not effective, and the patient dies within a few months. This stage is characterized by a decrease in the number of CD4 cells below 0.05x109/l.

It should be noted that clinical course HIV infections are very diverse. The sequence of progression of HIV infection through all stages of the disease is not required. The duration of HIV infection varies widely - from several months to 15-20 years.

For consumers psychoactive substances the course of the disease has some peculiarities. In particular, fungal and bacterial lesions skin and mucous membranes, as well as bacterial abscesses, phlegmon, pneumonia, sepsis, septic endocarditis may develop against the background normal level CD4 lymphocytes. However, the presence of these lesions contributes to a more rapid progression of HIV infection.

Peculiarities of the HIV clinic in children
The most common clinical manifestation of HIV infection in children is a delay in the rate of psychomotor and physical development.

In children, more often than in adults, recurrent bacterial infections occur, as well as interstitial lymphoid pneumonitis and hyperplasia of the pulmonary lymph nodes, and encephalopathy. Thrombocytopenia is common, clinically manifested by hemorrhagic syndrome, which can cause death in children. Anemia often develops.

HIV infection in children born to HIV-infected mothers is characterized by a more rapidly progressive course. In children infected after one year of age, the disease usually develops more slowly.

Diagnosis of HIV infection

The course of HIV infection is characterized by long absence significant symptoms of the disease. The diagnosis of HIV infection is made on the basis of laboratory data: when antibodies to HIV are detected in the blood (or the virus is directly detected!). Antibodies to HIV are usually not detected during the acute phase. In the first 3 months. after infection, antibodies to HIV appear in 90-95% of patients after 6 months. - for the rest 5-9%, and at a later date - only for 0.5-1%. During the AIDS stage, a significant decrease in the level of antibodies in the blood is recorded. The first weeks after infection represent the “seronegative window period,” when antibodies to HIV are not detected. Therefore, testing negative for HIV during this period does not mean that the person is not infected with HIV and cannot infect others.

Virus isolation is not carried out in practice. IN practical work methods for determining antibodies to HIV are more popular. Initially, antibodies are detected by ELISA. If the ELISA result is positive, the blood serum is examined by immunoblotting. It allows you to detect specific antibodies to particles of the protein structure of HIV that have a strictly defined molecular weight. Antibodies to HIV antigens with molecular weights of 41,000, 120,000 and 160,000 are considered the most characteristic of HIV infection. When they are identified, a final diagnosis is made.

A negative immunoblotting result in the presence of clinical and epidemiological suspicions of HIV infection does not exclude the possibility of this disease and requires repeating the laboratory test. This is explained, as already mentioned, by the fact that during the incubation period of the disease there are no antibodies yet, and in the terminal stage, due to the depletion of the immune system, they cease to be produced. In these cases, the most promising is the polymerase chain reaction (PCR), which makes it possible to detect RNA particles of the virus.

When a diagnosis of HIV infection is made, multiple studies of the immune status are carried out over time to monitor the progression of the disease and the effectiveness of treatment.

To diagnose lesions of the oral mucosa in HIV-infected patients, a working classification approved in London in September 1992 was adopted. All lesions are divided into 3 groups:
. Group 1 - lesions clearly associated with HIV infection. This group includes the following nosological forms:
o candidiasis (erythematous, pseudomembranous, hyperplastic, atrophic);
o hairy leukoplakia;
o marginal gingivitis;
o ulcerative-necrotizing gingivitis;
o destructive periodontitis;
o Kaposi's sarcoma;
o non-Hodgkin's lymphoma.
. Group 2 - lesions less clearly associated with HIV infection:
o bacterial infections;
o diseases of the salivary glands;
o viral infections;
o thrombocytopenic purpura.
. Group 3 - lesions that may occur with HIV infection, but are not associated with it.

The most interesting and most common lesions are those belonging to group 1.

In Ukraine, when a diagnosis of HIV infection is made, the patient is given pre-test and post-test counseling and an explanation of the basic facts about the disease. The patient is invited to register with the territorial center for the prevention and control of AIDS for free dispensary observation by an infectious disease specialist. Approximately once every six months, it is recommended to take tests (for immune status and viral load) to monitor your health. In case of significant deterioration of these indicators, it is recommended to take antiretroviral drugs(therapy is free, available in almost all regions).

Treatment of HIV infection

To date, no treatment has been developed for HIV infection that could eliminate HIV from the body.

The modern method of treating HIV infection (the so-called highly active antiretroviral therapy) slows down and practically stops the progression of HIV infection and its transition to the AIDS stage, allowing an HIV-infected person to live a full life. If treatment is used and the effectiveness of the drugs is maintained, a person's life expectancy is not limited by HIV, but only by the natural processes of aging. However, after prolonged use of the same treatment regimen, after several years, the virus mutates, acquiring resistance to the drugs used, and to further control the progression of HIV infection, it is necessary to use new treatment regimens with other drugs. Therefore, any current treatment regimen for HIV infection sooner or later becomes ineffective. Also, in many cases, the patient cannot take individual drugs because of individual intolerance. That's why proper application therapy delays the development of AIDS indefinitely. To date, the emergence of new classes of drugs is mainly aimed at reducing side effects from taking therapy, since the life expectancy of HIV positive people Those taking therapy are almost equal to the life expectancy of the HIV-negative population. During the later development of HAART (2000-2005), the survival rate of HIV-infected patients, excluding patients with hepatitis C, reaches 38.9 years (37.8 for men and 40.1 for women).

Importance is given to maintaining the health of HIV-positive people non-drug means (proper nutrition, healthy sleep, avoidance severe stress and prolonged exposure to the sun, healthy image life), as well as regular (2-4 times a year) monitoring of health status by HIV specialists.

Resistance (immunity) to HIV
Several years ago, a human genotype resistant to HIV was described. The penetration of the virus into an immune cell is associated with its interaction with a surface receptor: CCR5 protein. But deletion (loss of a gene section) of CCR5-delta32 leads to the immunity of its carrier to HIV. It is believed that this mutation arose approximately two and a half thousand years ago and eventually spread to Europe.
Now, on average, 1% of Europeans are actually resistant to HIV, 10-15% of Europeans have partial resistance to HIV.

Scientists at the University of Liverpool explain this unevenness by saying that the CCR5 mutation increases resistance to bubonic plague. Therefore, after the Black Death epidemics of 1347 (and in Scandinavia also in 1711), the share of this genotype increased.

There is a small percentage of people (about 10% of all HIV-positive people) who have the virus in their blood, but do not develop AIDS for a long time (so-called non-progressors).

It was discovered that one of the main elements of the antiviral defense of humans and other primates is the TRIM5a protein, which is capable of recognizing the capsid of viral particles and preventing the virus from multiplying in the cell. This protein in humans and other primates has differences that determine the innate resistance of chimpanzees to HIV and related viruses, and in humans - innate resistance to the PtERV1 virus.

Another important element of antiviral defense is the interferon-inducible transmembrane protein CD317/BST-2 (bone marrow stromal antigen 2), also called “tetherin” for its ability to suppress the release of newly formed daughter virions by retaining them on the cell surface. CD317 is a type 2 transmembrane protein with an unusual topology - a transmembrane domain near the N-terminus and glycosylphosphatidylinositol (GPI) at the C-terminus; Between them is the extracellular domain. It has been shown that CD317 directly interacts with mature daughter virions, “tethering” them to the cell surface. To explain the mechanism of this “binding”, four alternative models have been proposed, according to which two CD317 molecules form a parallel homodimer; one or two homodimers bind simultaneously to one virion and the cell membrane. In this case, either both membrane “anchors” (transmembrane domain and GPI) of one of the CD317 molecules, or one of them, interact with the virion membrane. The spectrum of activity of CD317 includes at least four families of viruses: retroviruses, filoviruses, arenaviruses, and herpesviruses. The activity of this cellular factor is inhibited by the proteins Vpu of HIV-1, Env of HIV-2 and SIV, Nef of SIV, the envelope glycoprotein of the Ebola virus and the K5 protein of Kaposi's sarcoma herpesvirus. A cofactor of the protein CD317 was discovered - cellular protein BCA2 (Breast cancer-associated gene 2; Rabring7, ZNF364, RNF115) - E3 ubiquitin ligase of the RING class. BCA2 enhances the internalization of HIV-1 virions tethered to the cell surface by the CD317 protein into CD63+ intracellular vesicles with their subsequent destruction in lysosomes.

CAML (calcium-modulated cyclophilin ligand) is another protein that, like CD317, inhibits the release of mature daughter virions from the cell and whose activity is suppressed by the HIV-1 Vpu protein. However, the mechanisms of action of CAML (a protein localized in the endoplasmic reticulum) and antagonism by Vpu are unknown.

People living with HIV
The term People Living with HIV (PLHIV) is recommended to refer to a person or group of people who are HIV-positive, as it reflects the fact that people can live with HIV for decades while leading active and productive lives. The expression “victims of AIDS” is extremely incorrect (this implies helplessness and lack of control), including incorrectly calling children with HIV “innocent victims of AIDS” (this implies that someone living with HIV is “to blame” for their HIV status or "deserved" it). The expression “AIDS patient” is only acceptable in a medical context, since PLHIV do not spend their lives in a hospital bed. The rights of HIV-infected people are no different from the rights of other categories of citizens: they also have the right to medical care, freedom of work, education, personal and family privacy, and so on.

Prevention of HIV infection

WHO 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, distributing condoms, treating other STDs, teaching behavior aimed at consciously treating these diseases;
2. Prevent bloodborne transmission of HIV by providing safe blood products.
3. Preventing perinatal transmission of HIV by disseminating information about preventing transmission HIV by providing medical care, including counseling for women infected with HIV and chemoprophylaxis;
4. Organization of medical care and social support for patients with HIV infection, their families and others.

Sexual transmission of HIV can be interrupted by teaching the population about safe sexual behavior, and intra-hospital transmission can be interrupted by observing the anti-epidemic regime. Prevention includes proper sex education population, prevention of promiscuity, promotion of safe sex (use of condoms). Special direction - preventative work among drug addicts. Since it is easier to prevent drug addicts from becoming infected with HIV than to rid them of drug addiction, it is necessary to explain ways to prevent infection when parenteral administration drugs. Reducing drug addiction and prostitution is also part of the HIV prevention system.

To prevent the transmission of HIV through blood, blood, sperm, and organ donors are examined. To prevent infection of children, pregnant women should be tested for HIV. Patients with STDs, homosexuals, drug addicts, and prostitutes are examined mainly for surveillance purposes.

The anti-epidemic regime in hospitals is the same as in viral hepatitis B, and includes security medical manipulations, donated blood, medical immunobiological preparations, biological fluids, organs and tissues. Prevention of HIV infection medical personnel comes down mainly to compliance with the rules for working with cutting and piercing tools. In case of exposure to an infected HIV blood It is necessary to treat the skin with 70% alcohol, wash with soap and water and re-treat with 70% alcohol. As a preventive measure, it is recommended to take azidothymidine for 1 month. The person exposed to the threat of infection is under the supervision of a specialist for 1 year. Means of active prevention have not yet been developed.

31.07.2018

In St. Petersburg, the AIDS Center, in partnership with the City Center for the Treatment of Hemophilia and with the support of the Hemophilia Society of St. Petersburg, launched a pilot information and diagnostic project for patients with hemophilia infected with hepatitis C.

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Everyone is widely known possible ways infection and prevention methods, however, some people are still interested in the ways of transmitting HIV infection. Let's figure it out.

There are two concepts - HIV and HIV infection. On the one side, significant differences they do not, but if you look at them from a scientific angle, then HIV is simply an immunodeficiency virus, and the infection is caused by this virus. HIV stands for human immunodeficiency virus.

This virus destroys a person's immunity, making him defenseless against other diseases and infections.

The immunodeficiency virus completely destroys immune cells. Over time, microorganisms that pose no threat to a healthy person become dangerous to the infected person’s body. IN certain moment As the infection progresses, it begins to destroy its own cells, trying to fight itself.

HIV is not resistant to environmental influences, but it spreads catastrophically quickly. It exists in the human body for a couple of days, and in the external environment for only a few minutes.

The virus has killed thousands of people who ignored doctors' instructions to lead a healthy lifestyle or at least use a barrier method of contraception. That is why the question of treatment, as well as possible routes of transmission of infection, is especially acute these days.

Before you find out exactly how HIV infection occurs, you should understand which groups of people are most susceptible to this disease.

Homosexuals

Initially, it was believed that only same-sex couples, most often homosexuals, were susceptible to HIV. Later it turned out that this was not so, but, nevertheless, homosexuals are more likely than others to become infected with HIV. Since gay men practice anal sex, and more often than not, unprotected sex, they are one of the main carriers of HIV infection.

Drug addicts and prostitutes

People addicted to drugs often share needles with several people; they are unable to control themselves and neglect their health just for the sake of the dose, which significantly increases the risk of infection. The most dangerous people are those who practice promiscuity, mainly prostitutes. They, at the behest of the client, who may also already be HIV-infected, often practice sex without a condom.

Medical workers

Medical workers are at risk only because of their profession, and not because of violation of simple precautions, like others. The number of infected people among medical workers is not so high, but each of them risks ending up on this list every day. Their work involves constant contact with infected people, which increases the risk of infection significantly.

Methods of infection

The infection can enter through the blood in case of direct contact - parenteral route. What can you get infected with HIV from?

During blood transfusion

HIV infection can occur through a transfusion of contaminated blood. IN modern hospitals This possibility is practically excluded. Donors are carefully screened for HIV infection before donation, and then the blood also goes through several stages of testing. There is strict regulation on the issue: how long after donation blood can be used for its intended purpose. At the blood bank this is possible only after passing all the tests.

In some exceptional cases, when blood is needed urgently, doctors may neglect this responsibility in order to save the patient's life. But even when using tested blood, there is a risk: immediately after the donor is infected, it is almost impossible to detect the disease; this takes several months, since the first symptoms appear only then. Therefore, the blood may be contaminated, even if the test did not reveal this. There is a possibility of infection within the hospital when instruments are reused in a healthcare facility.

Just like in the previous paragraph, the likelihood of such an infection is very low. Hospitals now use disposable instruments whenever possible. Reusable instruments undergo several stages of disinfection, which reduces the risk of infection. But if this happens, the infected person can sue the institution and receive compensation.

This method of infection is common among drug addicts who, while under the influence of drugs, are negligent about their health and can reuse injection materials. In this case of infection, one syringe used by a person with AIDS can infect dozens of other people. Poor quality cosmetic procedures can also cause HIV infection. These include all types of piercings and permanent tattoos. Clients of underground unlicensed salons are most at risk. Their prices are much lower than regular ones, but the quality of services and clientele are appropriate.

Sexual contact

Unprotected sex is the main cause of HIV infection. This only means barrier contraception, that is, condoms. Oral contraceptives only protect against pregnancy, but not against sexually transmitted diseases. During heterosexual intercourse, microcracks appear on the mucous membrane of the vagina and penis, which cannot be seen or felt. Contact with infected fluid on one such wound guarantees HIV infection through sexual contact if sex occurs without a condom.

Also, despite the fact that oral sex is recognized as one of the safest, infection through it is still possible. Virus cells are found in large numbers in genital secretions (lubricant and semen). A small wound or scratch in the mouth is enough for infection.

There are several factors that increase the risk of HIV transmission through sexual contact many times over: the presence of any STDs.

Also, how HIV infection occurs in men is somewhat different from in women. This is explained larger area mucous membrane of the woman’s genital organs and the fact that the concentration of the virus in semen is much higher. Menstrual days also increase the risk of infection.

Vertical path - from mother to child

There is a possible route of transmission of HIV from a sick mother to a child during pregnancy. During intrauterine development, the fetus receives all the substances it needs through the mother’s circulatory system, since it is connected to her. Therefore, if the activity of the virus is not suppressed with the help of special drugs, there is a high risk of giving birth to an infected child. Breast milk is especially rich in viral cells, so breastfeeding should be discontinued in case of illness.

Sometimes, even if all precautions are taken: taking medications, careful actions of doctors, the child can become infected right during childbirth. This will depend on the length of pregnancy and the professionalism of the doctors. Many people believe that an infected mother will definitely give birth to an infected child. This is a very common misconception. According to statistics, 70% of children from such mothers are born absolutely healthy. Chance to give birth healthy child There is always one, but you should remember how long it will take for your baby to receive such a diagnosis.

How long will it take to find out whether a child is infected or not? Before the age of three, it is not possible to diagnose a child as HIV-infected. Until this age, the mother’s antibodies produced to the virus remain in the child’s body. If, upon reaching this age, the antibodies completely disappear from the child’s body, then he is healthy. If his own antibodies are detected, the child has been infected.

Myths about contracting HIV infection

Science has not identified any method of HIV transmission other than those listed above. Despite the fact that the population's medical literacy is increasing, many still wonder: is it possible to become infected through a handshake or through everyday contact? The correct answer is no. You should know the basic myths about HIV in order to be able to communicate normally with sick people and not be afraid of becoming infected.

Infection through saliva

The virus is contained in waste products human body, but there is negligible amount of it in saliva. It contains almost no virus, and it is also not present on the surface of the skin. Don't be afraid of infected people and avoid them. There are known couples where one partner is infected and the other is not. This proves that HIV cannot be transmitted through kissing.

Airborne path

The virus is transmitted only through fluids such as blood and genital secretions. Saliva, as we have already found out, is harmless. Therefore, you should not be afraid of a person sneezing or coughing: he will not be able to infect others.

Through food and drink

You can safely drink from the same mug with infected person or eating from the same plate: it is impossible to get infected from this. Through everyday activities. You can live completely calmly under the same roof with an infected person. You can use the same dishes and even hygiene products with him without fear of infection. Healthy, intact skin and mucous membranes will not allow the virus to pass through and will protect you from infection.

Get infected in a bathhouse or swimming pool

Can you get infected in a public bath or swimming pool? No you can not. The virus dies almost immediately upon entering external environment. Therefore, you should not be afraid of a shared toilet, public swimming pool or bathhouse, as the virus simply will not survive in water. Animals are carriers of HIV. Animals cannot carry the virus under any circumstances. HIV is a human immunodeficiency virus and is therefore not dangerous to animals. Mosquitoes also cannot transmit HIV.

As we have already understood, there is no need to be afraid of people infected with HIV if you follow simple rules precautions and monitor your health.

HIV infection is a disease provoked by the immunodeficiency virus, and is also characterized by the relevant acquired immunodeficiency syndrome (AIDS), which, in turn, acts as a factor contributing to the development of secondary infections, as well as various malignant neoplasms. HIV infection, the symptoms of which manifest themselves in this way, leads to a profound suppression of the protective properties that are inherent in the body as a whole.

general description

An HIV-infected person acts as a reservoir of infection and its direct source, and he remains so at any stage of this infection throughout his life. African monkeys (HIV-2) are identified as a natural reservoir. HIV-1 has not been identified in the form of a specific natural reservoir, although it is possible that wild chimpanzees may act as such. HIV-1, as it became known based on laboratory studies, can provoke an infection without any clinical manifestations, and this infection ends with complete recovery after some time. As for other animals, they are not susceptible to HIV.

Significant amounts of the virus are found in the blood, menstrual fluid, vaginal secretions and semen. In addition, the virus is also found in saliva, breast milk, cerebrospinal and tear fluids. The greatest danger lies in its presence in vaginal secretions, sperm and blood.

In the case of an actual inflammatory process or in the presence of lesions of the mucous membranes in the genital area, which, for example, is possible with erosion of the cervix, the possibility of transmitting the infection in question in both directions increases. That is, the affected area acts in this case as an entry/exit gate, through which HIV transmission is ensured. A single sexual contact determines the possibility of transmission of infection in a low percentage of probability, but with an increase in the frequency of sexual intercourse, the greatest activity is observed precisely with this method. There is no transmission of the virus within domestic settings. A possible variant of HIV transmission is the condition of a placental defect, which, accordingly, is relevant when considering HIV transmission during pregnancy. In this case, HIV is detected directly in the fetal bloodstream, which is also possible during labor due to trauma that is relevant to the birth canal.

The implementation of the parenteral method of transmission is also possible using blood transfusions, frozen plasma, platelets and red blood cells. About 0.3% of the total number of infections occurs through injections (subcutaneous, intramuscular), including accidental injections. Otherwise, such statistics can be presented as 1 case for every 300 injections.

On average, up to 35% of children of HIV-infected mothers also become infected. The possibility of infection when breastfeeding by infected mothers cannot be ruled out.

As for the natural susceptibility of people to the infection in question, it is extremely high. The average life expectancy for HIV-infected patients is about 12 years. Meanwhile, due to the emergence of new products in the field of chemotherapy, there are now certain opportunities to prolong the life of such patients. Mostly sick people are sexually active people, mostly men, although in recent years the trend towards the prevalence of morbidity has begun to increase among women and children. When infected at the age of 35 years or more, AIDS is achieved almost twice as fast (compared to the transition to it in younger patients).

Also, when considering the period of the last few years, the dominance of the parenteral route of infection is noted, in which people who use the same syringe at the same time are infected, which, as can be understood, is especially important among drug addicts.

Additionally, the number of infections due to heterosexual contact is also subject to an increase. This kind of tendency is quite understandable, in particular, when it comes to drug addicts who act as a source of infection, which is transmitted to their sexual partners.

A sharp increase in the prevalence of HIV has also recently been observed among donors.

HIV: risk groups

The following persons are at risk of increased risk of infection:

• persons who use injecting drugs, as well as common utensils necessary for the preparation of such drugs, this also includes the sexual partners of such persons;
• persons who, regardless of their current orientation, practice unprotected sexual intercourse (including anal);
• persons who underwent a blood transfusion procedure without prior testing;
• doctors of various profiles;
• persons suffering from one or another sexually transmitted disease;
• persons directly involved in the field of prostitution, as well as persons who use their services.

There are some statistics regarding the risk of HIV transmission in accordance with the characteristics of sexual contacts, this statistics in particular is considered within every 10,000 such contacts:

• inserting partner + fellatio - 0.5;
• receiving partner + fellatio - 1;
• inserting partner (vaginal sex) - 5;
• receiving partner (vaginal sex) - 10;
• inserting partner (anal sex) - 6.5;
• receiving partner (anal sex) - 50.

Protected sexual contact, but with the condom breaking or its integrity being damaged, is no longer the case. To minimize such situations, it is important to use a condom according to the rules provided for this, and it is also important to choose reliable types.

Considering the characteristics of transmission and risk groups, it is worth noting how HIV is not transmitted:

• for clothes;
• through dishes;
• with any type of kiss;
• through insect bites;
• through the air;
• through a handshake;
• when using a shared toilet, bathroom, swimming pool, etc.

Forms of the disease

The immunodeficiency virus is characterized by a high frequency of genetic changes relevant to it, which are formed during self-reproduction. The length of the HIV genome is determined to be 104 nucleotides, but in practice, each virus differs from its previous version by at least 1 nucleotide. As for varieties in nature, HIV exists here in the form of various variants of quasi-species. Meanwhile, several main varieties have been identified, significantly different from each other on the basis of certain characteristics, especially this difference concerns the structure of the genome. Above we have already highlighted these two forms in the text, now we will consider them in a little more detail.

• HIV-1 -
  This form is the first of a number of options; it was opened in 1983. Today it is the most widespread.
• HIV-2
  - This form The virus was identified in 1986; the difference from the previous form so far lies in its insufficient knowledge. The difference, as already noted, lies in the features of the genome structure. There is also information that HIV-2 is less pathogenic, and its transmission is slightly less likely (again, compared to HIV-1). It was also noted that when infected with HIV-1, patients are more susceptible to the possibility of becoming infected with HIV-1 due to the weakness of the immune system characteristic of this state.
• HIV
  -3.
  This variety is quite rare in its manifestation; it has been known about it since 1988. The virus discovered then did not react with antibodies of other known forms; it is also known that it is characterized by a significant difference in the genome structure. In a more common variant, this form is defined as HIV-1 subtype A.
• HIV
  -4.
  This type of virus is also quite rare.

The global HIV epidemic centers on the HIV-1 form. As for HIV-2, its prevalence is relevant for West Africa, while HIV-3, as well as HIV-4, do not take a noticeable part in the prevalence of the epidemic. Accordingly, references to HIV in general are limited to a specific type of infection, that is, HIV-1.

In addition, there is a clinical classification of HIV in accordance with specific stages: the incubation stage and the stage of primary manifestations, the latent stage and the stage of development of secondary manifestations, as well as the terminal stage. Primary manifestations in this classification can be characterized by the absence of symptoms, as the primary infection itself, including a possible combination with secondary diseases. For the fourth of the listed stages, division into certain periods in the form of 4A, 4B and 4C is relevant. The periods are characterized by passing through a progression phase, as well as through a remission phase, and the difference in the course of these phases lies in whether antiviral therapy is applied to them or not. Actually, based on the above classification, the main symptoms of HIV infection are determined for each specific period.

HIV infection: symptoms

Symptoms, as we indicated above, are determined for HIV infection for each specific period, that is, in accordance with a specific stage, we will consider each of them.

• Incubation stage

The duration of this stage can be on the order of three weeks to three months; in some fairly rare cases, the extension of this period can reach a year. This period is characterized by the activity of reproduction on the part of the virus; there is currently no immune response to it. The end of the incubation period of HIV infection is marked either by a clinical picture that characterizes acute HIV infection, or by the appearance of antibodies against HIV in the patient’s blood. At this stage, the basis for diagnosing HIV infection is the detection of viral DNA particles or its antigens in the blood serum.

• Primary manifestations

This stage is characterized by the manifestation of a reaction on the part of the body in response to the active replication of the virus, which occurs in combination with the clinic, which occurs against the background of an immune reaction and acute infection. The immune reaction consists, in particular, in the production of a specific type of antibodies. The course of this stage can occur without symptoms, while the only sign that may indicate the development of infection is a positive result in serological diagnosis of the presence of antibodies to this virus.

Manifestations characterizing the second stage appear in the form of acute HIV infection. The actual onset here is acute, and it is noted in more than half of the patients (up to 90%) 3 months after the infection occurred, while the onset of manifestations is often preceded by the activation of the formation of HIV antibodies. The course of an acute infection with the exception of secondary pathologies can be very different. Thus, fever, diarrhea, pharyngitis, rashes of various types and specifics may develop, concentrated in the area of ​​visible mucous membranes and skin, lenal syndrome, polylymphadenitis.

Acute HIV infection in about 15% of patients is characterized by the addition of a secondary type of disease to its course, this, in turn, is associated with reduced immunity in this state. In particular, among such diseases, herpes, sore throats and pneumonia, fungal infections, etc. are most often noted.

The duration of this stage can be on the order of several days, but a course of several months is not excluded (average indicators are focused on a period of up to 3 weeks). After this, the disease, as a rule, passes into the next, latent stage of the course.

• Latent stage

The course of this stage is accompanied by a gradual increase in the state of immunodeficiency. In this case, compensation for the death of immune cells occurs through their intensive production. Diagnosis of HIV within this period is possible, again, due to serological reactions, in which antibodies are detected in the blood against the impact of HIV infection. As for clinical signs, they can manifest themselves in the enlargement of several lymph nodes with different groups, not connected to each other (with the exception of the inguinal ones). There are no other types of changes in the lymph nodes, other than their enlargement (that is, there is no pain or any other characteristic changes in the area of ​​the tissues surrounding them). The duration of the latent stage can be about 2-3 years, although options for its course of 20 years or longer are not excluded (average indicators are mainly reduced to figures up to 7 years).

• Accession of secondary diseases

In this case, concomitant diseases of various origins (protozoal, fungal, bacterial) are added. As a result of a severe condition that characterizes immunodeficiency, malignant tumors can develop. Based on the general severity of associated diseases, the course of this stage can proceed in accordance with the following options:

- 4A.
The current weight loss is not too pronounced (within 10%), there are lesions of the mucous membranes and skin. Performance is reduced.

- 4B.
Weight loss exceeds 10% of the patient’s usual body weight, and the temperature reaction is long-lasting. The possibility of long-term diarrhea cannot be excluded, and without the presence of organic causes for its occurrence; in addition, tuberculosis may develop. The infectious type of disease recurs, subsequently progressing noticeably. In patients during this period, hairy leukoplakia and Kaposi's sarcoma are detected.

- 4B.
This condition is characterized by general cachexia (a condition in which patients reach extreme exhaustion with simultaneously pronounced weakness); secondary diseases are added and occur in their generalized form (that is, in the most severe form of manifestation). In addition, candidiasis of the respiratory tract and esophagus, pneumonia (pneumocystis), tuberculosis (its extrapulmonary forms), and severe neurological disorders are noted.

The above substages of the disease are characterized by a transition from a progressive course to remission, which, again, is determined in their characteristics by whether concomitant antiretroviral therapy is present or not.

• Terminal stage

Secondary diseases within this stage, acquired during HIV infection, become irreversible in their own course due to the characteristics of the state of the immune system and the body as a whole. The treatment methods used against them lose all effectiveness, so within a few months death occurs.

It should be noted that HIV infection in its course is extremely diverse, and the given stage options can only be conditional, or even completely excluded from the picture of the disease. In addition, symptoms of HIV during any of these stages in these options may be completely absent or manifest differently.

HIV infection in children: symptoms and features

For the most part, the clinical manifestations of HIV infection in children are reduced to developmental delays at the physical level and at the psychomotor level.
Children, more often than adults, are faced with the development of recurrent forms of bacterial infections, encephalopathy, and hyperplasia of the pulmonary lymph nodes. Thrombocytopenia is often diagnosed, the clinical manifestations of which include the development of hemorrhagic syndrome, due to the characteristics of which death often occurs. In frequent cases, anemia also develops.

As for HIV infection in children of HIV-infected mothers, there is a significantly more accelerated progression of its course. If a child becomes infected at the age of one year, then the development of the disease mainly occurs at a less accelerated pace.

Diagnostics

Considering the fact that the course of the disease is characterized by a duration of absence of severe symptoms, diagnosis is possible only on the basis of laboratory tests, which boil down to identifying antibodies to HIV in the blood or directly upon detection of the virus. The acute phase mainly does not determine the presence of antibodies, however, three months after infection, in 95% of cases they are detected. After 6 months, antibodies are detected normally in 5% of cases, at later stages - about 0.5-1%.

At the AIDS stage, a significant decrease in the amount of antibodies in the blood is recorded. During the first week from the moment of infection, the inability to detect antibodies to HIV is defined as the “seronegative window” period. It is for this reason that even negative HIV test results are not reliable evidence of the absence of infection and, accordingly, do not provide a reason to exclude the possibility of infecting other people. In addition to blood testing, PCR scraping can also be prescribed - a fairly effective method that determines the possibility of identifying RNA particles belonging to the virus.

Treatment

There are currently no therapeutic methods through which it would be possible to completely eliminate HIV infection from the body. Taking this into account, the basis of such methods is constant control over one’s own immune status while simultaneously preventing secondary infections (with their treatment when they appear), as well as controlling the formation of tumors. Quite often, HIV-infected patients need psychological help, as well as appropriate social adaptation.

Given the significant degree of distribution and high level of social significance within the national and global scales, support is provided along with rehabilitation for patients. Access to a number of social programs is provided, on the basis of which patients receive medical care, due to which, to some extent, the patients’ condition is alleviated and their quality of life is improved.

In general, treatment is etiotropic and involves the prescription of drugs that reduce the reproductive capabilities of the virus. In particular, these include the following drugs:

• nucleoside transcriptase inhibitors (otherwise known as NRTIs), corresponding to various groups: Ziagen, Videx, Zerit, combination drugs (Combivir, Trizivir);
• nucleotide reverse transcriptase inhibitors (otherwise - NtIOT): Stocrin, viramune;
• fusion inhibitors;
• protease inhibitors.

An important point when deciding to start antiviral therapy is to take into account such factors as the duration of taking such drugs, and they can be used almost for life. The successful result of such therapy is ensured solely by strict adherence by patients to the recommendations regarding administration (regularity, dosage, diet, regimen). As for secondary diseases that are associated with HIV infection, their treatment is carried out in a complex manner, taking into account the rules aimed at the pathogen that provoked the specific disease; accordingly, antiviral, antifungal and antibacterial drugs are used.

In case of HIV infection, the use of immunostimulating therapy is excluded, since it only contributes to the progression of HIV. Cytostatics prescribed in such cases for malignant neoplasms lead to suppression of the immune system.

In the treatment of HIV-infected patients, general strengthening drugs are used, as well as means that provide support for the body (dietary supplements, vitamins), in addition, methods are used that are aimed at preventing the development of secondary diseases.

If we are talking about the treatment of HIV in patients suffering from drug addiction, then in this case treatment in the conditions of the appropriate type of dispensary is recommended. Also, given the serious psychological discomfort against the background of the current condition, patients often require additional psychological adaptation.

If you suspect that your HIV diagnosis is relevant, you should visit an infectious disease specialist.

If you think that you have HIV infection and symptoms characteristic of this disease, your doctor can help you infectious disease specialist.

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Date of publication: 05.15.17