Acquired Immunodeficiency Syndrome (AIDS) or HIV infection is a viral disease characterized by damage to the immune system and the development of acquired, secondary, immune deficiency. Human Immunodeficiency Virus Type 1 (HIV-1) infects lymphocytes and other cells that carry CD4 receptors on their surface. Virus infection leads to lymphopenia (deficiency of T4 helper cells) and impaired cellular and humoral immunity. These disorders underlie AIDS, which is manifested by opportunistic infections and unusual malignant neoplasms. The time between HIV infection and the appearance of signs of AIDS ranges from 1 month to many years (an average of about 10 years).
The main routes of transmission of the virus are sexual and parenteral.
The main risk groups: people who have sex with infected people, including homosexual men, infected drug addicts, infected blood recipients, and children of HIV-infected mothers.
Primary HIV infection.
The initial period after infection is usually asymptomatic, only sometimes there are symptoms resembling mononucleosis (fever, chills, sore throat, pharyngitis and tonsillitis, limo adenopathy, etc.).
Aseptic meningitis, myelitis, peripheral neuritis, and subacute encephalitis can also develop with HIV infection. The treatment is symptomatic.
Diagnostic research.
Recurrent oral candidiasis, lymphadenopathy, weight loss, fever, night sweats, and chronic diarrhea (AIDS-associated syndrome) are sometimes detected.
In laboratory studies, anemia, thrombocytopenia and leukopenia are detected.
The most important test in the first stage is the calculation of T-4 lymphocytes in peripheral blood. Their level below 500 in 1 μl usually indicates HIV-related immunodeficiency.
An HIV-infected patient with a T4 lymphocyte count of less than 500 in 1 μl is indicated for immunomodulator therapy, for example, zadovudine (inside 200 mg every 8 hours).
Complications of HIV infection, their prevention and treatment.
Tuberculosis.
In the examination plan for patients include chest x-ray (tuberculin skin tests of diagnostic value with the progression of immunodeficiency do not have). For prophylactic purposes, annual immunization with an influenza or pneumococcal vaccine or hepatitis B vaccine (in patients with a negative serological reaction to hepatitis B) is recommended. Tuberculosis treatment should be started immediately after the detection of mycobacteria in the sputum of the patient.
Viral infections.
AIDS patients often develop a cytomegalovirus infection, herpes simplex virus, Epstein-Barr virus, etc.
They can be manifested by viremia with fever and general symptoms, rhinitis, pharyngitis, laryngitis, tracheitis, retinitis, esophagitis, gastritis, enterocolitis, other pancreatitis and hepatitis, hepatitis and other symptoms, bone marrow depression, adrenal necrosis, and lower respiratory tract infection.
In the presence of such symptoms, the use of cyclic nucleoside analogues (acyclovir, ganciclovir, penciclovir, valaciclovir, valganciclovir, famciclovir) for a long time in a maintenance dose is indicated. If therapy is ineffective, analogs of pyrophosphates are prescribed (Foscarnet (foscavir), phosphonoacetyl acid).
Bacterial infections.
In patients with AIDS very often various bacterial infections join, which are often atypical and progress rapidly despite adequate treatment. Among them, non-typhoid salmonella, syphilis, etc. are often detected. Special attention is paid to bacterial pneumonia due to a diverse microbial flora.
When chest x-ray, along with a typical picture of lobar pneumonia, diffuse interstitial infiltrates resembling pneumocystic pneumonia can also be detected. Antibacterial therapy for bacterial complications of AIDS is usually effective, but relapses often occur.
Infections caused by fungi. HIV-infected patients often develop persistent candidiasis of the mouth, esophagus, vagina, and skin. The most common causative agent of fungal diseases of the central nervous system is Cryptococcus neoformans. A serious danger for AIDS patients is the dissemination of the histoplasma capsulatum fungus. It can cause septicemia and pancytopenia. In such situations, start therapy with Amphotericin B for 2 weeks, then continue treatment with Fluconazole (400 mg / day) for 8 weeks. However, relapses often occur.
Pneumocystis pneumonia is the most common complication and the leading cause of death in AIDS. Pneumocystosis is a protozoal disease caused by Pneumocystis carinii. Extrapulmonary lesions are also described, especially in patients who received prophylactic treatment with gentamicin in an aerosol. The drug of choice for pneumonia is Trimethoprim-sulfamethoxazole (bactrim, biseptol) and Pentamidine isothionate . Trimethoprim-sulfamethoxazole is prescribed orally or intravenously (at a dose of 20 mg / kg – trimethoprim and 100 mg / kg – sulfamethoxazole per day for 2 weeks, maximum 1 month). Pentamidine is administered intramuscularly or intravenously (slowly, over 1-2 hours in 100 ml of 5% glucose solution) at a dose of 4 mg / kg per day for 2-3 weeks. For patients cured of pneumonia, with a T-4 lymphocyte count of less than 200 in 1 μl, prophylactic treatment is indicated ( bactrim , 1 biseptol per tablet).
Recently, Alpha-difluoromethylornithine (DFMO) has been increasingly used to treat pneumocystosis in AIDS patients . The drug is well tolerated, low toxicity. In addition to acting on pneumocysts, DFMO blocks the replication of retroviruses and cytomegaloviruses, also has an immunomodulating effect (restores the function of T-suppressors). Prescribe the drug in a dose of 6 g per 1 m2 of body surface per day in 3 divided doses for 8 weeks.
Infections caused by protozoa.
Multiple lesions of the central nervous system with the development of encephalopathy and focal neurological disorders are associated with infection of the AIDS patient Toxoplazma gonodii, the development of acute intestinal disorders – Isospora belli.
HIV-infected in acute toxoplasmosis is prescribed antiparasitic drugs. Simultaneous treatment with pyrimethamine and sulfadiazine significantly reduces the number of pathogens in the body. To avoid inhibition of hematopoiesis, calcium folinate is prescribed together with pyrimethamine . Assign according to the following scheme: Pyrimethamine inside (a saturating dose of 200 mg, then 50-75 mg / day) in combination with Sulfadiazine inside (4-6 g / day in 4 divided doses). At the same time, calcium folinate is prescribed orally (10-15 mg / day for 6 weeks). Patients need lifelong treatment with pyrimethamine (25-50 mg / day) and sulfadiazine (2-4 g / day). With sulfadiazine intolerance, you can use a combination of pyrimethamine (75 mg / day) with clindamycin (450 mg orally 3 times a day). It is believed that for life-long treatment, Pyrimethamine alone (50-75 mg / day) is sufficient.
In AIDS, toxoplasmosis quickly leads to death.
Surveys of AIDS patients taking sulfanilamides (bactrim, biseptol) for the prevention of pneumocystis pneumonia showed that such preventive treatment also serves as a prophylaxis for central nervous system toxoplasmosis. A daily intake of Trimethoprim-sulfamethoxazole (bactrim, biseptol) at a dose of 50 mg / day and Pyrimethamine at a dose of 50 mg per week is recommended.
Malignant diseases associated with AIDS.
These include non-Hodgkin’s lymphomas and Kaposi’s sarcoma. Often there are primary lymphomas of the central nervous system, which can be multiple.
AIDS prevention is based on active health education among the population, strict control of dental clinics, laboratories, the fight against drug addiction, sexual licentiousness, sexual perversions.