HIV infection. Symptoms, methods of infection, diagnosis and treatment. The source of HIV is people infected with the virus. HIV test

Attention. In case of positive and doubtful reactions, the term for issuing the result can be extended up to 10 working days.

Antibodies to HIV 1, 2 types, p24 antigen - a study of specific antibodies that have arisen in the body in response to infection with the human immunodeficiency virus (HIV) 1, 2 types and p24 antigen of the human immunodeficiency virus.

HIV(human immunodeficiency virus) is a virus of the retrovirus family (a virus with slow replication) that infects cells of the human immune system (CD4, T-helpers) and causes acquired immunodeficiency syndrome.

The duration of the incubation period is usually 3-6 weeks. In rare cases, antibodies to HIV do not begin to be detected until several months or more after infection. The level of their concentration can significantly decrease in the terminal period of the disease. In rare cases, antibodies to HIV infection may disappear for a long time.

HIV p24 antigen 1.2 type detected in blood serum, indicates early stage diseases. During the first few weeks after infection, the amount of virus and p24 antigen in the blood increases rapidly. As soon as antibodies to HIV 1,2 begin to be produced, the level of p24 antigen begins to decrease.

The determination of the p24 antigen makes it possible to diagnose HIV infection on early stages infection before the production of antibodies.

Simultaneous detection of antibodies to the HIV-1.2 virus and the antigen of the p24 virus increases diagnostic value research.

This test detects antibodies to HIV-1.2, as well as the p24 antigen of HIV-1.2. The analysis allows you to diagnose HIV infection at an early stage.

Ways of transmission of infection - sexual, with blood transfusion, from an infected mother to a newborn. The virus is present in blood, ejaculate (semen), pre-ejaculate, vaginal secretions, and breast milk. The condition of the mucous membranes of the genital organs / mouth / rectum during sexual transmission, the number of viral particles that enter the body, the state of the immune system, affect the likelihood of HIV infection, general state organism. With a massive intake of viral particles Clinical signs infections appear earlier. When infected with HIV I, the first symptoms of the disease occur faster than with HIV II.

HIV infection- long and serious disease, which is accompanied by damage to the cells of the human immune system, effective methods of treatment and means have not yet been developed against it specific prevention(vaccines).

Humans are the source of the immunodeficiency virus. The virus in humans can be isolated from seminal fluid, cervical secretions, lymphocytes, blood plasma, cerebrospinal fluid, tears, saliva, urine and mother's milk, but the concentration of the virus in them is different. The highest concentration of the virus is found in the following biological media: in semen, blood, cervical secretion

The ways in which the virus can be transmitted from an infected person to an uninfected person are limited.

Ways of transmission of HIV infection
There are 3 ways of transmission of the immunodeficiency virus:

1. The sexual route is the most common. Infection occurs through unprotected sexual contact, while the virus enters the body through the mucous membranes. Wounds on the mucous membrane, sores, inflammation increase the likelihood of infection. In persons suffering from sexually transmitted infections, the risk of infection by contact with an infected person is 2-5 times higher. For the transmission of the virus, not only the degree of intimacy of contact is important, but also the amount of the pathogen. During unprotected sex, a woman is about three times more likely to be infected by a man, because more of the virus enters her body, and the woman has much more surface area through which the virus can enter the body (vaginal mucosa). The risk of infection is highest with anal sex and least with oral sex.
2. contact with the blood of an infected person: a) when using shared needles, syringes, utensils for the preparation of drugs, non-sterile medical instruments, b) the introduction of drugs in the preparation of which blood is used, c) the use, transfusion of infected donor blood and preparations made from it (risk extremely low, as all donors, as well as blood, are carefully screened).
3. from an HIV-infected mother (vertical route) to the fetus during pregnancy, while passing through birth canal, while breastfeeding.

AIDS terminal stage HIV infection

AIDS does not develop overnight. In most people with the presence of antibodies to the immunodeficiency virus, clinical signs of AIDS may not appear for 2 to 10 years or more, and with successful treatment, this period is significantly increased. This is due to the fact that it takes a sufficiently long time to reduce the number of CD4 T cells to a level at which there is a weakening of the immune system.

The virus also infects other types of cells, including cells of the central nervous system and red and white blood cells, in which the virus appears to be dormant for a long time before it begins to actively multiply. The factors influencing the progression of the disease are diverse: genetic characteristics, strain of the virus, the psychological state of the patient, living conditions, and others.

The course of the disease and the duration of the stages also depend on whether the person is receiving treatment, and if so, what drugs.

4 stages of HIV infection

• The incubation period (“window period”) is the time from the moment of infection until the appearance in the human blood of antibodies (protective proteins of the immune system) to the virus. During this period, the infection does not manifest itself in any way, all tests are negative, but the person is already contagious. The incubation period can last up to 3 months (average 25 days).
• Stage primary manifestations. Lasts an average of 2-3 weeks and is characterized by sharp rise the amount of virus in the blood. This condition is called "seroconversion disease" because at this time antibodies to the virus appear in the blood in quantities sufficient to be detected during tests. This period in most people it does not manifest itself in any way, however, flu-like phenomena may be observed in 20-30%: an increase in body temperature, an increase lymph nodes, headache, sore throat, malaise, fatigue and muscle pain. This condition resolves after 2-4 weeks without any treatment.
• Asymptomatic period. It occurs after the end of the primary manifestations of the infection and lasts, in the absence of treatment, on average up to 10 years. During this period, the immune system fights the virus in the human body: the number of viral particles gradually increases and immunity decreases. By the end of this stage, infected individuals have swollen lymph nodes, night sweats, general malaise, and the first manifestations of opportunistic infections that occur in humans, with a strong weakening of the immune system. These infections are caused by microorganisms that surround us and are not causing infections in healthy people. A weakened immune system can also lead to the development of other diseases, such as cancer.
• AIDS is the last stage of this disease and is characterized by the appearance of a number of diseases due to the weakening of the body's immune system. Typically, patients have very low CD4 T counts; one or more severe opportunistic infections (pneumocystis pneumonia, severe fungal infection, tuberculosis, etc.), which cause death in the absence of treatment; oncological diseases; encephalopathy (brain damage, accompanied by the development of dementia).

Diagnosis of HIV infection is a complex process based on laboratory, clinical and epidemiological examination data, and leading role in the diagnosis plays a laboratory blood test.

The main method of laboratory diagnostics is the detection of antibodies to the virus using enzyme immunoassay.

The procedure for conducting a laboratory test for the presence of human immunodeficiency virus antigens and antibodies to this virus is strictly regulated by orders of the Ministry of Health Russian Federation and includes:

Stage of screening (selection) study by enzyme immunoassay (ELISA) methods approved for use;
stage of verification (confirmatory) study by immunoblot method in the laboratory of the city AIDS center.

In screening laboratories, a positive result is checked by ELISA twice, after which, if there is at least one positive result, the material is sent for confirmation by immunoblot, the principle of which is to detect antibodies to a number of virus proteins.

Laboratory diagnosis of the presence of the immunodeficiency virus in children born from mothers infected with this virus has its own characteristics. Maternal antibodies to the virus (class Ig G) can circulate in the blood of children up to 15 months from the moment of birth. The absence of antibodies to the virus in newborns does not mean that it has not crossed the placental barrier. Children of mothers infected with the immunodeficiency virus are subject to laboratory diagnostic examination within 36 months after birth.

Until a positive result is obtained in the immunoblot and if the result of the study is negative, the person is considered healthy and anti-epidemic measures are not taken with him.

The material for testing for antibodies to the immunodeficiency virus is venous blood, which is desirable to donate on an empty stomach.

Of course, testing for the presence of the virus is a voluntary matter for each person. Tests for the carriage of the immunodeficiency virus cannot be prescribed forcibly, without the consent of the patient. But you also need to understand that the sooner a correct diagnosis is made, the more likely you are to live a long and full life even as a carrier.

Indications

• Enlargement of lymph nodes in more than two areas.
• Leukopenia with lymphopenia.
• Night sweats.
• Sudden weight loss of unknown cause.
• Diarrhea for more than three weeks of unknown cause.
• Fever of unknown cause.
• Planning for pregnancy.
• Preoperative preparation, hospitalization.
• Identification of the following infections or their combinations: tuberculosis, overt toxoplasmosis, often recurrent herpesvirus infection, candidiasis of internal organs, repeated herpes-zoster neuralgia, caused by mycoplasmas, pneumocysts or legionella pneumonia.
• Kaposi's sarcoma at a young age.
• Casual sex.

Rules for applying for HIV:
Registration of applications for research in DNAOM is carried out according to a passport or a document replacing it (migration card, temporary registration at the place of residence, serviceman's certificate, certificate from the passport office in case of loss of a passport, registration card from a hotel). Document submitted to without fail must contain information on temporary or permanent registration on the territory of the Russian Federation and a photograph. In the absence of a passport (a document replacing it), the patient has the right to make an anonymous application for the delivery of biomaterial. With an anonymous examination, the application and the biomaterial sample received from the client are assigned a number known only to the patient and the medical staff who placed the order.

The results of studies performed anonymously cannot be submitted for hospitalization, professional examinations, and are not subject to registration with the ORUIB.

Interpretation of results
The HIV 1/2 antibody test is qualitative. In the absence of antibodies, the answer is “negative”. In case of detection of antibodies to HIV study repeated in another series. When a positive ELISA result is repeated, the sample is sent back for analysis by a confirmatory immunoblot method, which is the "gold standard" in HIV diagnosis.

Positive result:

• HIV infection;
• false positive result requiring repeated or additional studies*;
• the study is not informative in children under 18 months of age born to HIV-infected mothers.

Negative result:

• not infected (diagnostic terms of the analysis were observed);
• seronegative variant of the course of infection (antibodies are produced late);
• terminal stage of AIDS (impaired formation of antibodies to HIV);
• the study is not informative (diagnostic terms are not met).

HIV (human immunodeficiency virus), penetrating into the human body, affects the immune system, resulting in HIV infection. Its last stage is AIDS, or acquired immunodeficiency syndrome. The source of infection is an HIV-infected person at any stage of infection.

The time when HIV infection was considered the lot of drug addicts, homosexuals and prostitutes is long gone. Although, of course, they are the first to be at risk for this disease.

However, every person can “pick up” the virus, regardless of lifestyle, social status, gender, sexual orientation. You can become infected through direct contact with biological fluids patient (blood, semen, vaginal secretions, breast milk, etc.), from which the virus enters the body of another person.

Known in the popular literature, HIV is known to physicians as HIV-1. On the this moment they also know HIV-2, but it is rare in Russia. How HIV 1 infection develops, symptoms, treatment of this dangerous state, what are? Let's talk about it today:

immunodeficiency virus

As we have said, the immunodeficiency virus has a destructive effect on the immune system. You can become infected through unprotected sexual contact, through contact with infected blood, in particular, through transfusion. The infection can pass from the sick mother to the child during childbirth or through breast milk.

The virus has the ability to multiply rapidly. Having penetrated into a healthy cell, it a short time completely destroys it, leads to its death. Freed, he proceeds to destroy the next healthy cell and so on. The result of such exposure to the virus is the complete destruction of the immune system.

Unfortunately, modern medicine does not have a unified cure for HIV infection. Therefore, until now, for many sick people, the diagnosis sounds like a sentence.

How does HIV 1 infection manifest itself? Symptoms of the disease

This is the initial stage of the disease, often without any symptoms. Often at this stage, symptoms similar to the manifestation infectious mononucleosis: fever starts abruptly, headache occurs, diarrhea may begin. Patients complain of general malaise, drowsiness. observed: myalgia, lymphadenopathy, neurological symptoms. A rash may appear on the skin.

After some time, the symptoms disappear, a long asymptomatic course occurs. It can stretch in time from a year to two decades. During this period (in the absence of adequate treatment), develops a clear immunodeficiency.

This stage of HIV is expressed by obvious symptoms. There are signs of candidiasis of the vulva, vagina, which is difficult to treat. Cervical dysplasia, diseases of the pelvic organs are also diagnosed. Patients complain of constant fever, diarrhea, frequent manifestations of herpes, listeriosis, etc.

This last, life-threatening stage is called AIDS. Its start time is difficult to predict. But with adequate, regular treatment, this stage can move away for many years. If the patient is at this stage of the disease, the following symptoms are observed: pneumocystis pneumonia, candidiasis, including the esophagus. Diagnosed cytomegalovirus infection, tuberculosis, toxoplasmosis occurs, lymphoma is formed, etc.

HIV 1 infection - treatment of the disease

When establishing a diagnosis, the doctor applies a treatment regimen aimed primarily at restoring the function of the patient's immune system.

Treatment is with antiretroviral medications that inhibit the life processes of the virus. For example, they prescribe: Retrovir, Videx (idanosine), Zalcitabine (Khivid). Also used are antiretroviral drugs such as Stavudine, Nevirapine, Delavirdine, as well as Saquinavir, Ritonavir.

In addition to them, the doctor will individually select antiviral, antifungal, as well as antimicrobial, antitumor agents. Drugs are used to treat emerging complications.

Along with antiviral, antimicrobial and other means of treating HIV, immunomodulating drugs are used. Of course, these drugs cannot cure the disease, they do not kill the immunodeficiency virus. However, these drugs greatly facilitate the patient's condition, as they improve the state of his immune system, activating it.

For example, the treatment of HIV infection includes drugs such as: interferons, interleukins: Ampligen, Taktivin, Timogen, as well as Transfer Factor, Ferrovir, etc. Also used plant immunomodulators, for example, ginseng, lemongrass, as well as perennial aloe, etc.

At proper treatment, subject to the fulfillment of all doctor's prescriptions, patients can conduct their usual, normal life long years. Be healthy!

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In this section, you can anonymously ask a question about HIV/AIDS.

Notification of the response will be sent to the e-mail you specified. The question and answer will be posted on the website. If you don't want to post, please let us know in the question.

Please formulate the question clearly and carefully indicate your e-mail for timely notification.

1. How urgently does he need to appear in the SC for treatment?

2. How aggravated is the condition and course of the disease in combination with HIV and hepatitis C?

3. Is it possible and how to plan healthy children. (I really want children.)

What OP should be normal? What is OP kr.? What do THESE "numbers" mean: OP=400.6 with OPcr=1.;

These are my analyzes. loved one. He is currently on a business trip and will be back in 2 months.

I understand that more testing is needed. But while I wait, I'll go crazy from the unknown. Please answer my questions:

OD=3.403 with ODcr=0.205; AT to HCV-KP=33.0 - the result is positive. CP(core)=16.5 CP(NS)=29.9 POSITIVE RESULT.

2. Depends on the situation, but most often coinfection complicates treatment and aggravates the course of the disease.

DS-ELISA-ANTI-HIV: positive OD=3.403 with ODcr=0.205.

DS-ELISA-ANTI-HIV: positive OD=3.503 with ODcr=0.205

Test Name—— Result—- Reference Values

Antibodies to hepatitis C virus (anti-HCV) sum.——POSITIVE—-negative

Confirmatory HCV antibody test—POSITIVE—negative

Test system ——— Result

HIV COMBO ABBOTT: positive OD=400.6 with OD=1.

Remarks: AT to HCV-KP=33.0 - the result is positive. Confirmatory test-KP(core)=16.5 KP(NS)=29.9 POSITIVE RESULT. Requires additional counseling and follow-up.

Antibodies to HIV 1/2+AG— POSITIVE—— negative

Hepatitis B antigen "s" (HBsAg) ——negative—-negative

Antibodies to Nreponema pallidum (lgM and lgG) (ELISA)——negative——negative

Test name Result Reference values ​​Equipment

Antigen "s" of hepatitis B virus (HBsAg), ELISA method negative negative

Confirmatory test for antibodies to hepatitis C virus POSITIVE negative»>

Antibodies to hepatitis C virus (anti-HCV) sums. ELISA method POSITIVE negative

Confirmatory HCV antibody test POSITIVE negative

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What is the difference between HIV-1 and HIV-2 virus types

Four varieties of the human immunodeficiency virus have been officially registered, which differ from each other in the presence of different structural glycoproteins of the HIV envelope. The most common of them are the first and second types.

Methods for diagnosing HIV include the identification of these two groups of viruses. What does this mean if the tests indicate different serotypes of HIV-1 and HIV-2, we will consider in the article.

In 1983, from the family of retroviruses, scientists identified the human immunodeficiency virus, which causes suppression of the human immune system, which clinically looks like acquired immunodeficiency syndrome. Species strain 1 is the most common form of viral particles, disease-causing immunodeficiency.

The structure of this virus is quite simple: a spherical shape with a diameter of about 120 nm, which is approximately 60 times smaller sizes red blood cells - erythrocytes. Virions are structurally composed of several thousand protein molecular components.

There are several ways of transmitting the virus from an infected person to a healthy one: sexual, contact-household, transplacental, through breast milk. However, the likelihood of obtaining viral particles from an infected partner must be due to the presence of an entry gate for infection. It could be open wound on the skin, cuts or scratches, defects of the mucous membranes, among which erosion of the cervix stands out.

When it enters the human body, the virus penetrates into the immune cells and multiplies there, which leads to the death of the protective structures of the immune system. The condition is aggravated by the fact that the rate of increase in the number of viral elements is much higher than the production of immune cells by the hematopoietic system. Particles of the 1st strain are capable of affecting:

• T-lymphocytes;
• macrophages;
• cells of the nervous system;
• cellular elements of the heart and liver.

Clinically, this is manifested by four stages of the development of the disease: the incubation period, the stages of primary and secondary manifestations, the terminal phase - AIDS. On the initial stages infection disease manifests itself as a common cold. At the same time, patients complain of a slight increase in temperature, apathy, muscle weakness, and so on. In this case, the virus at this stage may not be detected by blood tests. However, even at this point there may be minor changes detected general analyzes blood and urine. As the suppression of the immune system develops, new, more formidable symptoms of the disease appear, which suggests AIDS.

The 2nd type is not found in residents of Europe and America. Reveal the 2nd type only in combination with the first. Type 2 immunodeficiency virus is most prevalent in the population of West African countries:

In total, the 2nd type of infection was registered in representatives of 15 African countries. Of the total proportion of those infected with the immunodeficiency virus, HIV-2 infection accounts for about 70%.

Symptoms and manifestations of type 2 infection in humans do not differ from HIV-1. It should only be noted that it is often impossible to detect HIV-2 at the first stage of the development of the disease, which is associated with a delayed phase of virus replication (multiplication).

The main route of transmission of the 2nd strain is sexual, with a significant advantage in heterosexual contacts. Studies conducted in West African countries note that women with a large number of sexual partners are most susceptible to morbidity. The largest number of people infected with the second type of infection was found among prostitutes. It is noted that the older the woman, the more likely the infection of the body with the human immunodeficiency virus.

What is the difference between 2 types of viruses

Despite the similar effect of different types of human immunodeficiency virus on the immune system of an infected person, there are also fundamental differences between them. So, what is the difference between HIV-1 and HIV-2:

Very rarely, when diagnosing by blood, two types of the virus are identified at once. More often it speaks of unreliable result, since the test captures cross-reactions. However, if it was possible to identify infection with several types, then in this case the disease is more severe and last stage(AIDS) comes on much faster even with antiretroviral treatment. With simultaneous damage to the body by two types of viral particles, often already at the first stage of the disease, therapy may be required in the conditions of the department of anesthesiology and resuscitation.

What is HIV infection and AIDS: stages, symptoms, diagnosis, drug treatment

For more than thirty years of studying HIV infection and AIDS, many works have been created on the etiology, diagnosis and treatment of the disease. Still improving clinical guidelines on a combination of antiretroviral drugs, as well as on the treatment of various forms of resistance to ART.

The organizational bases for preventive care and anti-epidemic measures are being developed. AT social work with infected people, the focus shifts towards their psychological support especially after the first diagnosis. So, let's take a closer look at what HIV infection is, its transmission routes, features of laboratory diagnosis and treatment.

1. HIV epidemic in the world

Currently, HIV infection has become a ubiquitous disease: it exists wherever there is a source of infection - a person.

The period from 1981 to 2000 is characterized by the rapid development of the epidemic. During this time interval, the epidemic went beyond the boundaries of control and acquired the status of a pandemic. So, over the years, the number of infected people has reached 26.5 million people.

The staggering number of people infected makes HIV infection the most devastating of all pandemics. From the point of view of the epidemic, according to the UNAIDS global information bulletin, relevant for 2015, about 75 million people have become infected with HIV in the world, more than 50 million people have died from it.

In 2014, there were 36.9 million people who were HIV positive worldwide. Coverage in the same year drug therapy patients accounted for about 40%.

The infection is distributed unevenly across continental regions and individual countries. In world statistics, the number of diagnosed cases of HIV and AIDS was used to assess the pandemic. However, this indicator is unreliable and does not provide a deep assessment of the current spread of the infection.

This is because the diagnosis of AIDS requires the presence of opportunistic infections (diseases that do not occur in a person with a normal immune status). Their diagnosis is lengthy and technically complex.

These factors, together with a long period time of development of AIDS make peculiar adjustments to the present statistics of HIV infection on the whole planet. The true picture of morbidity on different continents and in different countries is poorly presented.

For example, the largest number of people with AIDS (over the entire observation period) was found in the United States, but in fact the country has a low level of infection. Central Africa abounds with such patients. Currently, many forces of authorized infection control organizations are sent to this continent.

The statistics of epidemiological data (incidence, prevalence, strickenness) do not reflect the reality of the disease situation in Africa, since cases are recorded there poorly or not at all.

Eastern Europe is characterized by a much later onset of the epidemic than in the Western Hemisphere, so there are relatively few people with AIDS, again due to long-term development HIV infection in AIDS.

Regional statistics in 2014 are shown in Table 1.

Table 1 - Regional statistics on HIV infection, data for 2014. To view, click on the table

Summarizing the data, we can say that in the world, in 2014 there are:

1.1. Situation in the Russian Federation

The prevalence of infection in Russia is estimated with the help of specialized institutions for the prevention of these diseases.

These medical organizations in each subject of the Russian Federation carry complete information about the epidemiological situation in the region. The information obtained is representative of a general assessment of the situation in the country. The main statistics are presented in the annual report of the Office of Rospotrebnadzor of the Russian Federation.

In total, a huge number of people have been infected in Russia over the entire period of the epidemic. Thus, according to statistics, more than one million people were registered with HIV infection from the beginning of the registration of patients to 2016. In the same year, 103,438 new cases were known.

The prevalence of infection is also uneven across the regions of the Russian Federation. A higher percentage of infection (> 0.5) is observed in cities with a population of one million, in regions with a developed socio-economic and industrial infrastructure. There are about 30 such entities.

Table 2 shows the incidence in the constituent entities of the Russian Federation in 2016, in terms of per 100 thousand population.

Thus, there is a positive trend in the country regarding the increase in the incidence of infection. The level of morbidity remains, despite the slowdown in growth rates in certain regions of the Russian Federation. An important problem in Russia has been the emergence of the epidemic from risk groups into the general population.

This means that organizational, preventive, anti-epidemic measures to counteract the spread of infection are not aimed at the "driving force" of the epidemic process of HIV infection.

The current situation in the country requires proactive intervention from the health authorities and organizations involved in the problem.

2. Human immunodeficiency virus

Human immunodeficiency virus (HIV, HIV) belongs to the subfamily of lentiviruses, a family of retroviruses. The primacy in the discovery belongs to two groups of scientists. It was first isolated in 1983 by a French researcher. The material was the leukocytes of a French homosexual.

The first name was the syndrome of lymphadenopathy of that very Frenchman - the virus associated with lymphadenopathy (LAV). At the same time, an American group led by R. Gallo reported the isolation of the virus from a patient with the same symptoms of lymadenopathy. Subsequently, it was designated as human lymphotropic virus type 3.

There are currently two types of virus. These are HIV 1 and HIV 2. They differ in antigenic structure and genetic material. Each species has its own structural features. HIV 2 was isolated in 1985 and is considered less contagious. This is due to the longer time of RNA replication, respectively, the probability of its transmission in the early stages of the disease is reduced significantly.

However, there is also a "fly in the ointment" in HIV 2 infection - the ineffectiveness of standard antiretroviral therapy regimens, as well as the inability to study the level of viral load and drug resistance.

3. The structure of a viral particle

The virus is about 100 nm in diameter and has genetic material located inside the capsid (Figure 1). It is represented by 2 RNA molecules. RNA consists of 9749 nucleotide pairs, which are able to code for proteins and enzymes. The capsid surrounding the RNA is represented by 2000 p24 protein molecules (the main structural protein of the capsid).

HIV 1 contains three enzymes within the nucleocapsid:

The capsid, in turn, is surrounded by a matrix. It contains p17 protein (the main structural protein of the matrix). The matrix and nucleocapsid are surrounded by a lipid sheath (outer sheath).

The lipid envelope consists of phospholipids into which glycoprotein complexes (gp41-gp120 complex) are embedded. Gp120 binds to CD4 receptors when the virus enters the human body.

Figure 1 - The structure of the virion of the human immunodeficiency virus. Image source - Wikipedia.

HIV 2 is similar in structure to HIV 1. However, it differs in genetic material, molecular weight proteins and antigenic properties.

Currently, the disease is considered anthroponosis. The source of HIV type 1 is believed to be chimpanzees. However, this species of monkeys cannot be a full-fledged link in the epidemic process, due to the low potential for transmission of the virus from monkeys to humans and their relatively small numbers compared to the population of the Earth.

The natural reservoir of HIV 2 is a species of monkey, the so-called smoky mangabey. Individuals of these monkeys are more numerous, therefore, in the literature one can find an indication of the anthropozoonotic nature of the transmission of the HIV 2 virus.

5. Localization of the pathogen

The immunodeficiency virus and its particles are found in the full spectrum of human cells. In T- and B-lymphocytes, leukocytes, in macrophages, in non-specific cells nervous tissue etc.

6. Mechanism and routes of transmission

To maintain and develop the epidemic process, special conditions are needed to ensure the safety of the virus.

Epidemiological studies have proven the possibility of transmission in the following situations:

The most important role in the transmission of infection is played by the tropism of the virus to the cell receptor CD4?. Lymphocytes and macrophages carrying this receptor on their surface are localized mainly in oral cavity, in the vagina and in the intestines. This limits the infection of a potential susceptible host.

The presence of defects in the oral mucosa, inflammatory foci in the genital tract increases the risk of infection several times. That is, any violation of the integrity of the mucosa contributes to the penetration of virus-infected biological material into tissues and susceptible cells.

Reliable studies indicate 30-40% of infected sexual partners who have heterosexual contacts for one year with infected people.

The mechanisms of pathogenesis in HIV infection are standard and similar to any other infectious disease. This is the damaging effect of the virus and the immune response of the body. In our case, the pathogen is always “stronger”.

The virus ensures its long existence and survival in the human body. The circulation of the virus occurs in the internal fluids of the body. The virion lives for about 3 hours from the moment of attachment to the target cell to replication.

After the attachment of the virion to the CD4? RNA enters the cell. The enzyme reverse transcriptase is an auxiliary factor for the formation of HIV DNA. The resulting DNA is integrated into the genome of the cell.

Next comes the production of "new" particles of the virus. The assembly of particles is carried out with the help of an enzyme - protease. The introduction of "new" viral particles ends with the death of the susceptible cell. A feature of pathogenesis, which has an important diagnostic and clinical significance, is an inverse relationship between the number of viral particles in the blood and the quantitative content of CD4 cells.

The result of the above pathogenetic mechanisms will be a decrease in resistance to secondary infections and tumors. After many years of struggle between the virus and the immune system, the latter is depleted. As a result, a person develops a “bouquet” of opportunistic infections with a variety of clinical manifestations.

There are 5 stages of the disease. Stages are defined clinical picture. The main symptoms and syndromes of HIV infection are presented in Table 3.

Table 3 - Stages of HIV infection

9. Diagnosis of infection

Currently, for the diagnosis of the disease, a standard laboratory method for detecting HIV Ab/Ag is used, followed by confirmation using an immunoblot.

9.1. Linked immunosorbent assay

Pretty reliable method. Sensitivity - 99.7%. The method requires the use of certified kits. A feature of the analysis options is the use of enzyme conjugates associated with the antibody / antigen and the chromogen (which imparts color). ELISA, the advantage of which is the speed of research, high sensitivity, cost-effective, demonstrates the combination of the 3rd generation "sandwich" method.

These are tests performed in less than an hour. They are used in transplantation, in urgent delivery of pregnant women with unknown HIV status, in epidemiological surveillance, and in post-exposure prophylaxis of infection. As a material, saliva, blood, blood plasma, scraping from the mucous membrane of the gums are used. The results of the rapid tests are preliminary and must be confirmed by classical methods.

It is the "gold standard" in the diagnosis of HIV infection. Depending on the antibodies present in the sample that react with the separated immunodeficiency virus antigens, different band profiles appear. The combination of the profile and its intensity determines whether a person belongs to a certain status.

The method itself consists in conducting an ELISA with HIV antigens. Ag virus fractionated distributed on a nitrocellulose membrane depending on the molecular weight. Thus, antigenic determinants on the protein particles of the virus under the action of enzyme immunoassay appear as separate bands.

The interpretation of the results obtained during immunoblotting depends on various criteria.

An alternative to IB is linear analysis. The difference from immunoblotting is the absence of electrophoresis of the nitrocellulose strip. Linear analysis uses recombinant antigens of two types of immunodeficiency viruses.

The peculiarity of the use of "artificial" antigens contributes to a low concentration of contaminating particles, which reduces the appearance of false results.

10. Drug therapy

The treatment of the disease is basic therapy and therapies for secondary and comorbid conditions. The main therapy is determined by the stage, phase of the disease, CD4 level? - lymphocytes, HIV RNA.

Medicines are etiotropic. However, it is not yet possible to eradicate the virus from the body, so the action of chemicals only suppresses the reproduction of the virus.

With the advent of new drugs, there is a periodic review of treatment regimens by practitioners, researchers in favor of safety and efficacy over a long period of use.

ARVT acts on links life cycle HIV:

Currently, chemicals have been developed and put into practice that block the action of virus enzymes.

There are five main groups of drugs for the treatment of HIV infection (see table 4).

Table 4 - Drugs for the treatment of HIV infection (AVRT). Click on the table to view

ART is prescribed to patients at any stage, especially with unfavorable blood counts. The justification for prescribing ARVT based on epidemiological indications is enshrined in legal documents.

11. Preventive measures

Prevention of HIV infection in the country's population as a whole will be effective and achieve the greatest success only when all countermeasures are combined at different organizational levels. The role and support of other countries is great.

The directions of prevention are reduced to two main postulates:

The first point involves informing the public about the danger of infection, its transmission routes and the outcome of the disease.

The second point considers the possibilities of applying effective means therapy adapted to the age and other characteristics of patients.

According to UNAIDS, the global epidemic has reversed. Despite this, further containment of HIV requires the strengthening of all “counter-pandemic” measures. The goal of the World AIDS Organization is to end HIV by 2030.

An HIV test in a pharmacy: how it works, the subtleties of use and deciphering the results

Human Immunodeficiency Virus or HIV is a retrovirus that, when it enters the human body, infects cells such as T-helper cells, macrophages, monocytes, dendritic cells, microglia, and Langerhans cells, thereby disrupting the immune system.

As a result of the total suppression of the body's resistance, acquired immunodeficiency syndrome - AIDS develops.

In modern classifications, 4 main types of this virus are distinguished:

HIV-1 and HIV-2 are pathogenic to humans and can cause the development of AIDS. However, HIV-2 is considered less dangerous because it is less likely to be transmitted. This is because the concentration of virus particles per 1 ml of blood is less than with HIV-1.

Also, HIV-2 provokes the occurrence of AIDS much less frequently (only in 5% of cases), but much more often causes encephalitis, diarrhea (bacterial or chronic), cholangitis and cytomegalovirus diseases. HIV-1 is more likely to develop chronic fever, Kaposi's sarcoma and candidiasis of the oral mucosa and genital organs. The HIV-3 and HIV-4 viruses are practically non-existent and do not affect the spread of the disease.

HIV infection can occur in several main ways:

Since HIV infection can cause serious complications that threaten a person's life, and its full-fledged treatment still does not exist, a large role is given to diagnostics: laboratory tests and express methods. The latter include HIV test strips and specialized express tests.

Thanks to the opportunity to purchase an HIV test in a pharmacy, it becomes possible to confirm or deny infection at home in a short period of time, which is necessary after unprotected sexual intercourse or other potentially dangerous situations.

As a rule, a purchased express test for HIV in a pharmacy uses human saliva, urine or blood to determine the presence of a virus in the body. At the same time, the accuracy of such a test is about 99-99.5%, which practically guarantees reliable result diagnostics.

HIV strip test: analysis technique and interpretation of the results

AT modern conditions there is quite a large number of various options for rapid diagnosis of infection with this virus, since by purchasing an express test for HIV in the pharmacies of the city, and using it in a timely manner, it is possible to diagnose the infection in time. The most popular test strips for HIV, the most common of which are "ImmunoChrom-anti-HIV -? - Express" and "CITO TEST HIV?".

The use of these tests does not require any special training of a person before they are carried out. The only conditions that are recommended to be observed are to heat it up to room temperature and use immediately after unpacking.

These conditions are necessary to exclude false test results.

How to use the HIV test strip:

As a rule, subject to the rules of use, a purchased HIV test in a pharmacy gives an accurate result, and the probability of error is 0.5-1%.

After some time (sometimes up to 30 minutes) after applying the biological material of the test to the test strip, you can see the result.

There are 3 possible outcomes:

Rapid HIV test in pharmacies: popular tests, their composition and average cost

In today's world, it is not difficult to get an HIV test. In pharmacies, they are often available in stock, although not all. Also, an HIV test strip can be bought at specialized medical institutions such as AIDS centers.

Every hospital that performs operations or other manipulations with blood also has express tests in case an emergency diagnosis is needed for patients or medical personnel.

Most common in countries former USSR HIV test strips are:

• ImmunoChrome-anti-HIV - ? - Express.
• CITO TEST HIV?.

In Europe, the most common means are:

As a rule, regardless of the manufacturer, a standard rapid test kit contains all necessary components for a complete study. You don't need to buy anything extra.

Standard set includes:

1. Test strip sealed in sealed packaging.
2. A disposable pipette designed to collect material.
3. A special container or test tube with a ready-made buffer solution.
4. Lancet for skin puncture.
5. Alcohol wipe, for processing before a puncture.

The price for a rapid HIV test in CIS pharmacies ranges from 180 rubles. (70 UAH) up to 225 rubles. (85 UAH) depending on the pharmaceutical network and the city.

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To a private clinic. I was told that the test HIV I have positive. Here are the results of the analysis: Antibodies to HIV. - Primarily positive. test system names CombiBest anti—HIV-1+2 (set 2) Treponema pallidum, antibodies, ELISA Result — . open

Passed the analysis on HIV. Test system D-0172 CombiBest anti—HIV-1.2 (set 2). Result: 0.074. Reference values ​​\u003d 0.232 - positive. It is not clear to me, some antibodies were still detected and. open

hello.pa was on September 8, 14 with ejaculation. 05.10.14 test for HIV negative, syphilis antibodies 0.1, Hepatitis negative and 5.01.15. 4 months later only in another laboratory negative. only ... open

For hospitalization-screening ( comprehensive study): HIV- Combo (Ab to HIV1, 2 + AG), Ab to.), HBsAg (Hepatitis B), Ab to hepatitis C virus ( Anti-HCV, total) is the syphilis method. here it is in January———Test system: CombiBest HIV-1.2 AG/AT, series 1571, . watch

maybe in the wrong thread, but tell me when the RPR analysis for syphilis after sex will be 100% open (23 more posts)

. (IgG + IgM), HBsAg (Hepatitis B), Ab against hepatitis C virus ( Anti-HCV, total) is the method of syphilis ELISA or not. 11/06/2014 this is in January———Test system: CombiBest HIV-1.2 AG / AT, series 1571, expiration date. watch

hello! help me please! I am 38 weeks pregnant. I donated blood for HIV 3 times in the LCD, always a negative result, the last 3 times I donated already with my husband, it was ... open (2 more posts)

Antibodies to HIV 1 / 2 (anti-HIV), ELISA Name of the test system CombiBest anti—HIV-1+2 (set 2) what does this analysis mean look

Alexandrov Pavel Andreevich, tell me more please test system d-0172 combibest anti hiv 1+2 set 2. what generation is it? watch

Hello! I took the test for hiv methods ifa( CombiBest anti—HIV-1+2) after 5 months, no antibodies were found. Is it necessary to take an analysis after 6 months? open

Hello! I passed the ifa analysis ( CombiBest anti—HIV-1 + 2, as I understand it, the 3rd generation test) hiv 5 months after contact, is it necessary to take an analysis after 6 months? Thank you in advance! open

Hello! How much can you trust the 4th generation ELISA test CombiBest anti hiv 1+2 (D-0172). 3 weeks "-", 5.5 weeks (38 days) "-". Thanks in advance! open (4 more posts)

what does the ELISA result mean (test system CombiBest anti—HIV-1+2(set 2)) VALUE-primarily positive REFERENCE VALUES-negative open

If for 100 days ifa of the 3rd p. minus, you can forget about HIV? Or how much more to take? open (3 more posts)

Do these test systems also have a window of 6 weeks?. HIV-Ag/At –IFA-Avicenna Avicenna, Russian Federation HIV. MBS, RF UniBest HIV-1, 2at Vector-Best, RF CombiBest anti—HIVHIV

I was in the store, took up the price tag, then I see it is smeared with something brown, as if dried blood. Is it possible to get infected with HIV like that? The skin on my hands is without wounds, yes ... open (6 more posts)

Similar test systems 3 months are applicable or not. HIV-Ag/At -IFA-Avicenna Avicenna, Russian Federation. MBS, RF UniBest HIV-1, 2at Vector-Best, RF CombiBest anti—HIV-1+2 Vector-Best, . AG/AT Vector-Best, RF DS-IFA- HIV-AG/AT-screen Diagnostic systems, RF. watch

1. Basic concepts of AIDS and HIV

AIDS is Acquired Immunodeficiency Syndrome. This disease is caused by the human immunodeficiency virus (HIV). The human immunodeficiency virus weakens the immune system, causing the body to lose its ability to resist various diseases. The term AIDS denoted the final stage of HIV infection; it is characterized by damage to the human immune system, against which the accompanying illnesses lungs, organs gastrointestinal tract, brain. The disease ends in death.

The abbreviation AIDS stands for: Acquired Immunodeficiency Syndrome.

FROM syndrome - this means that the infected person has many different signs, symptoms, characteristic of various diseases.

P acquired - this means that a person acquires a disease during his life as a result of infection, and does not receive it by inheritance.

And immunodeficiency - this means that the disease affects the body's immune system, which protects the body from various diseases.

D deficiencies - this means that the immune system stops working properly

The human immunodeficiency virus (HIV) infects living cells (lymphocytes) and develops in them. Living cells are used as an "incubator" in which viruses divide and multiply. The dimensions of HIV are very small: about 100,000 virus particles can fit on a 1 cm long line. The virus causes a slowly ongoing disease with a long latent (incubation) period (from the moment of infection to the appearance of signs of the disease). Therefore, having penetrated into the human body, HIV at first does not manifest itself in any way. Months and sometimes years pass before AIDS develops.

Thus, HIV infection is the pathogen that causes AIDS, that is, the state of the body from infection to the destruction of the immune system and the onset of other diseases. Unlike most diseases, AIDS does not show the same symptoms in all people. As a result of insufficient functioning of the immune system, diseases develop from which a person can die. But with a healthy immune system, the body usually copes with these diseases.

The Acquired Immune Deficiency Syndrome, or AIDS, is not for nothing called the "plague of the twentieth century", because so far no one knows for sure either the origin of this disease or effective methods its treatment or prevention. Nevertheless, now, when only about 20 years have passed since the first recorded cases of the disease, scientists have no doubts about extreme danger that AIDS brings to all mankind. If earlier it was believed that AIDS only threatened the underdeveloped countries of Africa or the "decaying" capitalist countries, now it has become obvious that AIDS knows no borders, is indiscriminate in relation to political regimes, and is merciless to the poor and the rich. Some religious figures argue that AIDS was sent to mankind by the Lord God on the eve of the new Last Judgment in order to punish people who are mired in debauchery and to carry out something harmful in the selection of those who live righteously and will be saved and doomed to death sinners. However, this turned out to be unfair, because even a “righteous person” can become infected with the immunodeficiency virus through non-sterile medical instruments, blood transfusions, etc.

In the modern human population, HIV-1 is the most prevalent, known in popular literature simply as HIV (in English literature - HIV).

HIV-1 and HIV-2 are now known (Fig. 7). There may be more varieties, but there is no exact evidence for this. Both "races" established today have common roots, although their origin was most likely independent. HIV-2 as a whole is very similar to HIV-1.

The division into two "races" of HIV is mainly due to a significant difference in the structure of the genomes: HIV-2 has one gene that HIV-1 does not have (vpx gene), and, conversely, HIV-1 has a gene that HIV-1 does not have. HIV-2 (vpu gene). The genetic apparatus of the two types of viruses is slightly more than 50% similar in nucleotide sequence. As a result, HIV-2, for example, has smaller envelope proteins than HIV-1. This results in HIV-1 test kits not "recognizing" HIV-2. Structurally, HIV-2 is more similar to the simian immunodeficiency virus (SIV) than HIV-1. According to available data, HIV-2 is not as diverse as HIV-1. Perhaps this is due to its later appearance on our planet.

HIV-1 is predominantly prevalent in the United States, Europe and Central Africa, while HIV-2 is prevalent in West Africa and India. In the United States, with a total number of HIV-infected people in the hundreds of thousands, there have been less than a hundred cases of HIV-2 detection. In Russia, HIV-1 is mainly found, and HIV-2 has been detected so far very rarely. Simian Immunodeficiency Virus (SIV)

25 million people died from diseases associated with HIV infection and AIDS. Thus, the HIV pandemic is one of the most devastating epidemics in human history. In 2006 alone, HIV infection caused about 2.9 million deaths. By the beginning of 2007, about 40 million people worldwide (0.66% of the world's population) were carriers of HIV. Two thirds of total number HIV-infected people live in sub-Saharan Africa. In countries hardest hit by the HIV and AIDS pandemic, the epidemic hinders economic growth and increases poverty

Discovery history

Transmission image of viruses electron microscope. The structure of the virus is visible, inside of which there is a cone-shaped nucleus.

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 on unusual cases of pneumocystis pneumonia and Kaposi's sarcoma in homosexual men, published in. In July, the term AIDS was proposed for the first time to refer to a new disease. In September of that year, based on a series of opportunistic infections diagnosed in (1) gay men, (2) drug addicts, (3) hemophilia A patients, and (4) Haitians, AIDS was first fully defined as a disease. Between 1981 and 1984, several papers were published linking the danger of developing AIDS with anal sex or with the influence of drugs. In parallel, work was underway on the hypothesis of the possible infectious nature of AIDS. The human immunodeficiency virus was independently discovered in 1983 in two laboratories:

• in France under the direction of Luc Montagnier (fr. Luc Montagnier).
• at the National Cancer Institute in the United States under the direction of Robert Gallo (Eng. Robert C. Gallo).

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

In addition, the scientists reported the detection of antibodies to the virus, the identification of previously described in other viruses and previously unknown HTLV-III antigens, and the observation of virus replication in a population of lymphocytes.

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".

Biology of HIV

Once in the human body, HIV infects CD4+ lymphocytes, macrophages, and some other cell types. 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 a violation 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 that are not dangerous or slightly dangerous for healthy people with a normal immune system.

Classification

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

Related viruses

in the genus Lentivirus the following types are distinguished (according to data for 2008).

The most well studied is HIV.

Varieties of HIV

The human immunodeficiency virus is characterized by a high frequency of genetic changes that occur in 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 in eukaryotes. The length of the HIV genome is approximately 10 4 nucleotides. 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 HIV research, nevertheless, varieties were found that differed significantly from each other in several ways, in particular, by a different genome structure. Varieties of HIV are designated Arabic numerals. To date, HIV-1, HIV-2, HIV-3, HIV-4 are known.

The global epidemic of HIV infection is mainly due to the spread of HIV-1, HIV-2 is predominantly prevalent 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 specified, HIV refers to HIV-1.

The structure of the virion

The HIV capsid is surrounded by a matrix coat formed by ~2,000 copies of the matrix protein p17. The matrix shell, in turn, is surrounded by a bilayer lipid membrane, which is outer sheath virus. It is formed by molecules captured by the virus during its budding from the cell in which it was formed. There are 72 glycoprotein complexes built into the lipid membrane, each of which is formed by three molecules of a transmembrane glycoprotein ( gp41 or TM), serving as the "anchor" of the complex, and three molecules of surface glycoprotein ( gp120 or SU) . By using gp120 the virus attaches to the antigen-CD4 receptor and Co-receptor located on the surface of the cell membrane. gp41 and in particular 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.

HIV genome

HIV genome

The genetic material of HIV is represented by two unconnected strands of positive RNA. The HIV genome contains 9,000 base pairs. The ends of the genome are represented by long terminal repeats (LTRs), which control the production of new viruses and can be activated by both viral proteins and infected cell proteins.

HIV infection

The period from infection with the human immunodeficiency virus to the development of AIDS lasts an average of 9-11 years. Statistical data from numerous studies conducted in various countries over a period of more than two decades confirm this conclusion. These figures are valid only for cases where HIV infection is not subjected to any therapy.

High risk groups:

• people who inject drugs using shared utensils for drug preparation (spread of the virus through a syringe needle and shared utensils for drug solutions); as well as their sexual partners.
• men - homosexuals and bisexuals, practicing unprotected anal sex;
• heterosexuals of both sexes who practice unprotected anal sex;
• individuals who received a transfusion of unverified donor blood;
• patients with other venereal diseases;
• persons involved in the sale and purchase human body in the field of sexual services (and their clients)

Pathogenesis

PreAIDS- Duration 1-2 years - the beginning of the suppression of cellular immunity. Often recurrent herpes - long-term healing ulceration of the oral mucosa, genital organs. Leukoplakia of the tongue (growth of the papillary layer - "fibrous tongue"). Candidiasis - oral mucosa, genital organs.

Resistance (immunity) to HIV

A few years ago, a human genotype resistant to HIV was described. The penetration of the virus into the immune cell is associated with its interaction with the surface receptor: the CCR5 protein. But the deletion (loss of a gene section) of CCR5-delta32 leads to the immunity of its carrier to HIV. It is assumed that this mutation arose about 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.

Epidemiology

Brief global data on the epidemic of HIV infection and AIDS

According to the December 2006 report of the Joint United Nations Program on HIV/AIDS.

Number of people living with HIV in 2006 Total - 39.5 million (34.1 - 47.1 million) Adults - 37.2 million (32.1 - 44.5 million) Women - 17.7 million ( 15.1 - 20.9 million) Children under 15 - 2.3 million (1.7 - 3.5 million) Number of people infected with HIV in 2006 Total - 4.3 million (3.6 - 6, 6 million) Adults - 3.8 million (3.2 - 5.7 million) Children under 15 - 530,000 (410,000 - 660,000) Number of deaths from AIDS in 2006 Total - 2.9 million (2.5 - 3 .5 million) Adults - 2.6 million (2.2 - 3.0 million) Children under 15 - 380,000 (290,000 - 500,000)

Adult HIV prevalence by country 15–50% 5–15% 1–5% 0.5–1.0% 0.1–0.5%<0.1% нет данных

At the same time, of the total number of infected, two thirds (63% - 24.7 million) of all adults and children with HIV in the world live in sub-Saharan Africa, mainly in southern Africa. One third (32%) of all people living with HIV in the world live in this subregion, and 34% of all AIDS-related deaths in 2006 occurred here.

Overview of the global epidemiology of HIV/AIDS

In total, about 40 million people in the world are living with HIV infection. Over two-thirds of them inhabit sub-Saharan Africa. The epidemic began here in the late 1970s and early 1980s. The epicenter is considered to be a strip stretching from West Africa to the Indian Ocean. Then HIV spread south. Most of the HIV carriers in South Africa - about 5 million. But on a per capita basis, the figure is higher in Botswana and Swaziland. In Swaziland, one in three adults is infected.

With the exception of countries in Africa, HIV is spreading fastest today in Central Asia and Eastern Europe. Between 2002 and 2002, the number of infected people here almost tripled. These regions contained the epidemic until the late 1990s, and then the number of infected people began to increase sharply - mainly due to drug addicts.

HIV infection in Russia

The first case of HIV infection in the USSR was discovered in 1986. From this moment begins the so-called period of the emergence of the epidemic. The first cases of HIV infection among citizens of the USSR, as a rule, occurred as a result of unprotected sexual contacts with African students in the late 70s of the XX century. Further epidemiological measures to study the prevalence of HIV infection in various groups living on the territory of the USSR showed that the highest percentage of infection at that time was among students from African countries, in particular from Ethiopia. The collapse of the USSR led to the collapse of the unified epidemiological service of the USSR, but not the unified epidemiological space. A short outbreak of HIV infection in the early 90s among men who have sex with men did not spread further, also due to the high level of organization and educational level of this risk group. In general, this period of the epidemic was distinguished by an extremely low level of infection (for the entire USSR less than 1000 detected cases) of the population, short epidemic chains from infecting to infected, sporadic introductions of HIV infection and, as a result, a wide genetic diversity of detected viruses. At that time, in Western countries, the epidemic was already a significant cause of death in the age group from 20 to 40 years.

This prosperous epidemic situation led to complacency in some now independent countries of the former USSR, which was expressed, among other things, in the curtailment of some broad anti-epidemic programs, as inappropriate for the moment and extremely expensive. All this led to the fact that in 1993-95 the epidemiological service of Ukraine was unable to localize two outbreaks of HIV infection in time among injecting drug users (IDUs) in Nikolaev and Odessa. As it turned out later, these outbreaks were independently caused by different viruses belonging to different subtypes of HIV-1. Moreover, the transfer of HIV-positive prisoners from Odessa to Donetsk, where they were released, only contributed to the spread of HIV infection. The marginalization of IDUs and the unwillingness of the authorities to carry out any effective preventive measures among them greatly contributed to the spread of HIV infection. In only two years (1994-95) in Odessa and Nikolaev, several thousand HIV-infected people were identified, in 90% of cases - IDUs. From that moment on, the next stage of the HIV epidemic, the so-called concentrated stage, begins on the territory of the former USSR, which continues to the present (2007). This stage is characterized by the level of HIV infection of 5 percent or more in a certain risk group (in the case of Ukraine and Russia, this is IDUs). In 1995, there was an outbreak of HIV infection among IDUs in Kaliningrad, then successively in Moscow and St. Petersburg, then outbreaks among IDUs followed one after another throughout Russia in the direction from west to east. The direction of the concentrated epidemic and molecular epidemiological analysis have shown that 95% of all studied cases of HIV infection in Russia have their origin in the initial outbreaks in Nikolaev and Odessa. In general, this stage of HIV infection is characterized by the concentration of HIV infection among IDUs, the low genetic diversity of the virus, and the gradual transition of the epidemic from the risk group to other populations.

About 60% of HIV infections among Russians occur in 11 out of 86 Russian regions (Irkutsk, Saratov regions, Kaliningrad, Leningrad, Moscow, Orenburg, Samara, Sverdlovsk and Ulyanovsk regions, St. Petersburg and the Khanty-Mansi Autonomous District).

By September 2005, more than 31,000 HIV-infected people were registered in institutions that are part of the Federal Penitentiary Service of the Russian Federation, which is a thousand more than in 2004.

Virus transmission

HIV can be found in almost all body fluids. However, the amount of virus sufficient for infection is present only in blood, semen, vaginal secretions, lymph and breast milk (breast milk is dangerous only for babies - their stomach does not yet produce gastric juice, which kills HIV). Infection can occur when hazardous bioliquids enter directly into the blood or lymph flow of a person, as well as onto damaged mucous membranes (which is due to the suction function of the mucous membranes). If the blood of an HIV-infected person comes into contact with an open wound of another person, from which blood flows, infection usually does not occur.

HIV is an unstable virus - it dies outside the body when the blood (sperm, lymph and vaginal secretions) dries out. Domestic infection does not occur. HIV almost instantly dies at temperatures above 56 degrees Celsius.

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

Repeated use of syringes and needles by drug addicts is highly likely to lead to HIV transmission. To prevent this, special charitable points are being created where drug addicts can receive clean syringes for free in exchange for used ones. In addition, young drug addicts are almost always sexually active and prone to unprotected sex, which creates additional prerequisites for the spread of the virus.

Data on HIV transmission through unprotected sex differ greatly from source to source. The risk of transmission largely depends on the type of contact (vaginal, anal, etc.) and the role of the partner (introducer/receiver).

Protected intercourse, in which the condom broke or its integrity was violated, is considered unprotected. To minimize such cases, it is necessary to follow the rules for the use of condoms, as well as use reliable condoms.

A vertical route of transmission from mother to child is also possible. With HAART prophylaxis, the risk of vertical transmission of the virus can be reduced to 1.2%.

The content of the virus in other biological fluids - saliva, tears - is negligible; there is no information on cases of infection through saliva, tears, sweat. Breastfeeding can cause infection because breast milk contains HIV, so HIV-positive mothers are advised not to breastfeed their babies.

Immature and mature forms of HIV (stylized image)

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.

Anti-HIV creams and gels

The Times, referring to the findings of scientists from the University of Minnesota, reports that "glycerol monolaurate" or "lauric ester" used as a food additive, which is part of cosmetics, probably interferes with the signaling processes in the immune system of monkeys, blocking the virus at a key stage of potential Infection". When the virus enters the body, it captures T-cells and spreads through the blood vessels, and lauric ester acts so that the inflammatory reaction does not develop.

People living with HIV

The term People Living with HIV (PLHIV) is recommended for a person or group of people who are HIV positive, as it reflects the fact that people can live with HIV for many years, leading an active and productive life. 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 from PLHIV is “himself to blame” for their HIV status or "deserved" it). The expression “AIDS patient” is only acceptable in a medical context, because most of the life of PLHIV is not spent in a hospital bed.

Legal Consequences of Infecting Another Person with HIV

Infecting another person with HIV infection or placing him or her at risk of contracting HIV infection is criminalized in a significant number of states. In Russia, the corresponding penalties are provided for in article 122 of the Criminal Code of the Russian Federation.

Sources of information

1. Palella F. J. et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. The New England journal of medicine, 1998, v. 338, p. 853-860.
2. UNAIDS/WHO AIDS Epidemic Update: December 2006 . PDF file, 2.7 MB
3. Greener, R. "AIDS and macroeconomic impact", in S, Forsyth (ed.): State of The Art: AIDS and Economics, IAEN, - 2002, p. 49-55.
4. Wolfgang Hübner (2009). "Quantitative 3D Video Microscopy of HIV Transfer Across T Cell Virological Synapses". Science 323: 1743-1747. DOI:10.1126/science.1167525 http://www.sciencemag.org/cgi/content/full/323/5922/1743
5. Wolfgang Hübner (2009). "Quantitative 3D Video Microscopy of HIV Transfer Across T Cell Virological Synapses". Science 323: 1743-1747. DOI:10.1126/science.1167525 (Photo) http://www.sciencemag.org/content/vol323/issue5922/images/small/323_1743_F1.gif
6. Wolfgang Hübner (2009). "Quantitative 3D Video Microscopy of HIV Transfer Across T Cell Virological Synapses". Science 323: 1743-1747. DOI:10.1126/science.1167525 (Video) http://www.youtube.com/watch?v=1wTCYnWYsCQ
7. Kaposi's sarcoma and Pneumocystis pneumonia among homosexual men--New York City and California. Morbidity and Mortality Weekly Report, 1981, v. 30, p. 305.(English)
8. Centers for Disease Control. Pneumocystis Pneumonia--Los Angeles. Morbidity and Mortality Weekly Report, 1981, v. 30, p. 250.(English)
9. The history of AIDS 1981-1986
10. Centers for Disease Control. Current trends update on acquired immune deficiency syndrome (AIDS) --United States. Morbidity and Mortality Weekly Report, 1982, v. 31, p. 507.(English)
11. Gottlieb et al. Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men: evidence of a new acquired cellular immunodeficiency; N. Engl. J. Med. 1981, 305 1425-1431
12. Durack D. T. Opportunistic infections and Kaposi's sarcoma in homosexual men; N. Engl. J. Med. 1981, 305 1465-1467
13. Goedert et al. Amyl nitrite may alter T lymphocytes in homosexual men; Lancet 1982, 1 412-416
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