HIV infection - symptoms, causes, stages, treatment and prevention of HIV. Can you get HIV from an HIV infected person?

HIV infection develops in stages. The direct effect of viruses on the immune system leads to damage to various organs and systems, the development of tumor and autoimmune processes. Without highly active antiretroviral therapy, the life expectancy of patients does not exceed 10 years. The use of antiviral drugs can slow down the progression of HIV and the development of acquired immunodeficiency syndrome - AIDS.

Signs and symptoms of HIV in men and women at different stages of the disease have their own color. They are varied and increase in severity. The clinical classification of HIV infection proposed in 1989 by V. I. Pokrovsky, which provides for all manifestations and stages of HIV from the moment of infection to the death of the patient, has become widespread in the Russian Federation and the CIS countries.

Rice. 1. Pokrovsky Valentin Ivanovich, Russian epidemiologist, professor, doctor of medical sciences, president of the Russian Academy of Medical Sciences, director of the Central Research Institute of Epidemiology of Rospotrebnadzor.

Incubation period of HIV infection

The incubation period of HIV infection is determined by the period from the moment of infection to clinical manifestations and / or the appearance of antibodies in the blood serum. HIV in the "inactive" state (the state of inactive replication) can be from 2 weeks to 3-5 years or more, while the general condition of the patient does not noticeably worsen, but antibodies to HIV antigens already appear in the blood serum. This stage is called the latent phase or the "carrier" period. Immunodeficiency viruses, when they enter the human body, begin to reproduce themselves immediately. But the clinical manifestations of the disease appear only when a weakened immune system ceases to properly protect the patient's body from infections.

It is impossible to say exactly how long HIV infection manifests itself. The duration of the incubation period is influenced by the route and nature of infection, the infectious dose, the age of the patient, his immune status, and many other factors. When transfusing infected blood, the latent period is shorter than when the infection is transmitted sexually.

The period from the moment of infection to the appearance of antibodies to HIV in the blood (seroconversion period, window period) ranges from 2 weeks to 1 year (up to 6 months in weakened people). During this period, the patient still lacks antibodies and, thinking that he is not infected with HIV, continues to infect others.

Examination of contact persons with HIV-infected patients allows diagnosing the disease at the “carrier” stage.

Rice. 2. Oral candidiasis and herpes sores are indicators of a malfunction of the immune system and may be early manifestations of HIV infection.

Signs and symptoms of HIV in men and women in stage IIA (acute febrile)

After the incubation period, the stage of primary manifestations of HIV infection develops. It is due to the direct interaction of the patient's body with the immunodeficiency virus and is divided into:

• IIA - acute febrile stage of HIV.
• IIB - asymptomatic stage of HIV.
• IIB - stage of persistent generalized lymphadenopathy.

The duration of the IIA (acute febrile) stage of HIV in men and women is from 2 to 4 weeks (usually 7 to 10 days). It is associated with a massive release of HIV into the systemic circulation and the spread of viruses throughout the body. Changes in the patient's body during this period are non-specific and so diverse and multiple that it creates certain difficulties in diagnosing HIV infection by a doctor during this period. Despite this, the acute febrile phase resolves on its own even without specific treatment and passes into the next stage of HIV - asymptomatic. Primary infection in some patients is asymptomatic, in other patients the most severe clinic of the disease quickly unfolds.

Mononucleosis-like syndrome in HIV

In 50 - 90% of cases of HIV patients in the early stages of the disease, men and women develop a mononucleosis-like syndrome (acute retroviral syndrome). This condition develops as a result of the active immune response of the patient to HIV infection.

Mononucleosis-like syndrome occurs with fever, pharyngitis, rash, headaches, muscle and joint pain, diarrhea and lymphadenopathy, the spleen and liver are enlarged. Less commonly, meningitis, encephalopathy, and neuropathy develop.

In some cases, acute retroviral syndrome has manifestations of some opportunistic infections that develop against the background of deep suppression of cellular and humoral immunities. There are cases of oral candidiasis and candidal esophagitis, pneumocystis pneumonia, cytomegalovirus colitis, tuberculosis and cerebral toxoplasmosis.

In men and women with mononucleosis-like syndrome, the progression of HIV infection and the transition to the stage of AIDS is faster, and an unfavorable outcome is noted in the next 2-3 years.

In the blood, there is a decrease in CD4-lymphocytes and platelets, an increase in the level of CD8-lymphocytes and transaminases. There is a high viral load. The process is completed within 1 to 6 weeks even without treatment. In severe cases, patients are hospitalized.

Rice. 3. Feeling tired, malaise, headache, muscle and joint pain, fever, diarrhea, severe night sweats are symptoms of HIV in the early stages.

Intoxication syndrome in HIV

In the acute febrile stage, 96% of patients have an increase in body temperature. The fever reaches 38 0 С and lasts 1-3 weeks and often. Half of all patients develop headache, muscle and joint pain, fatigue, malaise, severe night sweats.

Fever and malaise are the most common symptoms of HIV during the febrile period, and weight loss is the most specific.

Enlarged lymph nodes with HIV

74% of men and women have enlarged lymph nodes. For HIV infection in the febrile stage, a gradual increase in the first posterior cervical and occipital, then submandibular, supraclavicular, axillary, ulnar and inguinal lymph nodes is especially characteristic. They have a pasty consistency, reach 3 cm in diameter, are mobile, not soldered to the surrounding tissues. After 4 weeks, the lymph nodes take on normal sizes, but in some cases there is a transformation of the process into persistent generalized lymphadenopathy. An increase in lymph nodes in the acute stage occurs against the background of elevated body temperature, weakness, sweating, and fatigue.

Rice. 4. Enlarged lymph nodes are the first signs of HIV infection in men and women.

Rash in HIV

In 70% of cases, a rash appears in men and women in the early acute period of the disease. Erythematous rash (areas of reddening of different sizes) and maculopapular rash (areas of seals) are more often recorded. Features of the rash in HIV infection: the rash is abundant, often purple in color, symmetrical, localized on the trunk, its individual elements can also be located on the neck and face, does not peel off, does not bother the patient, has a similarity with rashes with measles, rubella, syphilis and. The rash disappears within 2 to 3 weeks.

Sometimes patients have small hemorrhages in the skin or mucous membranes up to 3 cm in diameter (ecchymosis), with minor injuries, hematomas may appear.

In the acute stage of HIV, a vesiculo-papular rash often appears, which is characteristic of a herpes infection and molluscum contagiosum.

Rice. 5. A rash with HIV infection on the trunk is the first sign of the disease.

Rice. 6. Rash with HIV on the trunk and arms.

Neurological disorders in HIV

Neurological disorders in the acute stage of HIV are noted in 12% of cases. Lymphocytic meningitis, encephalopathy and myelopathy develop.

Rice. 7. A severe form of herpetic lesions of the mucous membrane of the lips, mouth and eyes is the first sign of HIV infection.

Gastrointestinal symptoms

In the acute period, every third man and woman develops diarrhea, nausea and vomiting are noted in 27% of cases, abdominal pain often appears, and body weight decreases.

Laboratory diagnosis of HIV in the acute febrile stage

Replication of viruses in the acute stage is most active, however, the number of CD4 + lymphocytes always remains more than 500 per 1 μl, and only with a sharp suppression of the immune system does the indicator drop to the level of development of opportunistic infections.

The CD4/CD8 ratio is less than 1. The higher the viral load, the more contagious the patient is during this period.

Antibodies to HIV and the maximum concentration of viruses in the stage of primary manifestations are found at the end of the acute febrile stage. In 96% of men and women, they appear by the end of the third month from the moment of infection, in the remaining patients - after 6 months. The analysis for the detection of antibodies to HIV in the acute febrile stage is repeated after a few weeks, since it is the timely administration of antiretroviral therapy during this period that is most useful for the patient.

Antibodies to HIV p24 proteins are detected, with the help of ELISA and immunoblot, antibodies produced by the patient's body are detected. Viral load (identification of virus RNA) is determined by PCR.

A high level of antibodies and low levels of viral load occur with an asymptomatic course of HIV infection in the acute period and indicate the control of the patient's immune system over the level of the number of viruses in the blood.

In a clinically pronounced period, the viral load is quite high, but with the advent of specific antibodies it falls, and the symptoms of HIV infection weaken and then disappear altogether even without treatment.

Rice. 8. Severe form of oral candidiasis (thrush) in an HIV patient.

The older the patient, the faster the HIV infection progresses to the stage of AIDS.

Signs and symptoms of HIV in men and women in stage IIB (asymptomatic)

At the end of the acute stage of HIV infection, a certain balance is established in the patient's body, when the patient's immune system restrains the reproduction of viruses for many months (usually 1-2 months) and even years (up to 5-10 years). On average, the asymptomatic stage of HIV lasts 6 months. During this period, the patient feels satisfactorily and leads a normal life for him, but at the same time, is a source of HIV (asymptomatic virus carrier). Highly active antiretroviral therapy prolongs this stage for many decades, during which the patient leads a normal life. In addition, the likelihood of infection of others is significantly reduced.

The number of lymphocytes in the blood is within the normal range. The results of ELISA and immunoblotting studies are positive.

Signs and symptoms of HIV in men and women in stage IIB (persistent generalized lymphadenopathy)

Generalized lymphadenopathy is the only sign of HIV infection during this period. Lymph nodes appear in 2 or more, anatomically unrelated places (except for the inguinal regions), at least 1 cm in diameter, persisting for at least 3 months, provided there is no causative disease. The most frequently enlarged posterior cervical, cervical, supraclavicular, axillary and ulnar lymph nodes. Lymph nodes either increase or decrease, but they persist constantly, soft, painless, mobile. Generalized lymphadenopathy should be differentiated from bacterial infections (syphilis and brucellosis), viral infections (infectious mononucleosis and rubella), protozoal infections (toxoplasmosis), tumors (leukemia and lymphoma), and sarcoidosis.

The cause of skin lesions during this period is seborrhea, psoriasis, ichthyosis, eosinophilic folliculitis, common scabies.

The defeat of the oral mucosa in the form of leukoplakia indicates the progression of HIV infection. Skin and mucosal lesions are recorded.

The level of CD4-lymphocytes gradually decreases, but remains more than 500 in 1 μl, the total number of lymphocytes is above 50% of the age norm.

Patients during this period feel satisfactory. Labor and sexual activity in both men and women are preserved. The disease is discovered by chance during a medical examination.

The duration of this stage is from 6 months to 5 years. At the end of it, the development of asthenic syndrome is noted, the liver and spleen increase, body temperature rises. Patients are concerned about frequent SARS, otitis media, pneumonia and bronchitis. Frequent diarrhea leads to weight loss, fungal, viral and bacterial infections develop.

Rice. 9. The photo shows signs of HIV infection in women: recurrent herpes of the skin of the face (photo on the left) and mucous lips in a girl (photo on the right).

Rice. 10. Symptoms of HIV infection - leukoplakia of the tongue. The disease can undergo cancerous degeneration.

Rice. 11. Seborrheic dermatitis (left photo) and eosinophilic folliculitis (right photo) are manifestations of skin lesions in stage 2 HIV infection.

Stage of secondary diseases of HIV infection

Signs and symptoms of HIV infection in men and women in stage IIIA

Stage IIIA of HIV infection is a transitional period from persistent generalized lymphadenopathy to an AIDS-associated complex, which is a clinical manifestation of HIV-induced secondary immunodeficiency.

Rice. 12. The most severe shingles occurs in adults with severe suppression of the immune system, which is observed, including with AIDS.

Signs and symptoms of HIV infection in stage IIIB

This stage of HIV infection is characterized in men and women by pronounced symptoms of impaired cellular immunity, and according to clinical manifestations, there is nothing more than an AIDS-associated complex, when the patient develops infections and tumors that are not found in the AIDS stage.

• During this period, there is a decrease in the CD4/CD8 ratio and the rate of blast transformation reaction, the level of CD4-lymphocytes is recorded in the range from 200 to 500 per 1 μl. In the general analysis of blood, leukopenia, anemia, thrombocytopenia increase, in the blood plasma there is an increase in circulating immune complexes.
• The clinical picture is characterized by prolonged (more than 1 month) fever, persistent diarrhea, profuse night sweats, pronounced symptoms of intoxication, weight loss of more than 10%. Lymphadenopathy becomes generalized. There are symptoms of damage to internal organs and the peripheral nervous system.
• Diseases such as viral (hepatitis C, common), fungal diseases (oral and vaginal candidiasis), bacterial infections of the bronchi and lungs, persistent and long-term, protozoal lesions (without dissemination) of internal organs, in a localized form, are detected. Skin lesions are more common, severe, and longer in duration.

Rice. 13. Bacillary angiomatosis in HIV patients. The causative agent of the disease is a bacterium of the genus Bartonella.

Rice. 14. Signs of HIV in men in the later stages: damage to the rectum and soft tissues (photo on the left), genital warts (photo on the right).

Signs and symptoms of HIV infection in stage IIIB (stage AIDS)

IIIB stage of HIV infection represents a detailed picture of AIDS, characterized by a deep suppression of the immune system and the development of opportunistic diseases that occur in severe form, threatening the life of the patient.

Rice. 15. Expanded picture of AIDS. In the photo, patients with neoplasms in the form of Kaposi's sarcoma (photo on the left) and lymphoma (photo on the right).

Rice. 16. Signs of HIV infection in women in the late stages of HIV. Pictured is invasive cervical cancer.

The more severe the symptoms of HIV in the early stages and the longer they appear in the patient, the faster AIDS develops. In some men and women, an erased (low-symptomatic) course of HIV infection is observed, which is a good prognostic sign.

Terminal stage of HIV infection

The transition to the terminal stage of AIDS in men and women occurs when the level of CD4-lymphocytes decreases to 50 and below in 1 µl. During this period, an uncontrolled course of the disease is noted and an unfavorable outcome is expected in the near future. The patient is exhausted, depressed and loses faith in recovery.

The lower the level of CD4-lymphocytes, the more severe the manifestations of infections and the shorter the duration of the terminal stage of HIV infection.

Signs and symptoms of HIV infection in the terminal stage of the disease

• The patient develops atypical mycobacteriosis, CMV (cytomegalovirus) retinitis, cryptococcal meningitis, widespread aspergillosis, disseminated histoplasmosis, coccidioidomycosis and bartonnellosis, leukoencephalitis progresses.
• Disease symptoms overlap. The patient's body is rapidly depleted. Due to constant fever, severe symptoms of intoxication and cachexia, the patient is constantly in bed. Diarrhea and loss of appetite leads to weight loss. dementia develops.
• Viremia increases, CD4-lymphocyte counts reach critically minimal values.

Rice. 17. Terminal stage of the disease. Complete loss of the patient's faith in recovery. In the photo on the left is an AIDS patient with severe somatic pathology, in the photo on the right is a patient with a common form of Kaposi's sarcoma.

HIV prognosis

The duration of HIV infection is on average 10-15 years. The development of the disease is influenced by the level of viral load and the number of CD4-lymphocytes in the blood at the beginning of treatment, the availability of medical care, the patient's adherence to treatment, etc.

Factors of progression of HIV infection:

• It is believed that with a decrease in the level of CD4-lymphocytes during the first year of the disease to 7%, the risk of the transition of HIV infection to the stage of AIDS increases by 35 times.
• The rapid progression of the disease is noted with the transfusion of infected blood.
• Development of drug resistance of antiviral drugs.
• The transition of HIV infection to the stage of AIDS is reduced in people of mature and old age.
• The combination of HIV infection with other viral diseases negatively affects the duration of the disease.
• Bad nutrition.
• genetic predisposition.

Factors that slow down the transition of HIV infection to the stage of AIDS:

• Timely initiation of highly active antiretroviral therapy (HAART). In the absence of HAART, the death of the patient occurs within 1 year from the date of diagnosis of AIDS. It is believed that in regions where HAART is available, the life expectancy of HIV-infected people reaches 20 years.
• No side effects on taking antiretroviral drugs.
• Adequate treatment of comorbidities.
• Sufficient food.
• Rejection of bad habits.

HIV infection (infection caused by the human immunodeficiency virus) is a global health problem that kills about a million people every year. For example, in 2014, 1.2 million people died from HIV-related causes. The number of people infected with HIV is in the tens of millions. In Russia, as of the end of January 2016, the number of HIV-infected people reached 1 million people.

AIDS virus

At its core, HIV infection is a slowly progressive viral disease that affects the immune system, the extreme stage of development of which is AIDS (acquired immunodeficiency syndrome). Patients do not die from HIV infection itself, but the suppression of immunity that occurs under the influence of the virus leads to the fact that a person becomes unprotected against cancer and serious infectious diseases that are not dangerous for people with normal immunity.

In this regard, it is extremely important to detect HIV infection and start treatment in a timely manner, allowing an infected person to live quite actively and productively for decades.

HIV infection is caused by a specific retrovirus, the human immunodeficiency virus (HIV), which was opened in 1983. It is quite unstable to physical and chemical factors, when compared, for example, with hepatitis viruses. Both saliva enzymes and gastric juices are detrimental to HIV. Outside the body, it quickly dies - it only takes the blood, semen and other fluids of the human body to dry. Temperatures above 56 degrees kill this virus instantly. All these factors influence the characteristics of HIV transmission.

HIV is particularly prone to attack cells of the immune system that have specific CD4 receptors on their surface. These cells include T-helper lymphocytes, monocytes, macrophages, dendritic and other cells. The mechanisms by which HIV affects the immune system are quite complex, but their end result is a significant decrease in the number of CD4+ lymphocytes and suppression of the immune system.

Some people are not naturally susceptible to HIV. Their immune cells do not contain normal, but partially altered proteins (CCR5) on the membrane, which is why the interaction of cells with the virus simply cannot occur. In addition, among people infected with HIV, about 1-5% are nonprogressors. Their HIV infection does not progress, lymphocytes do not die, and AIDS does not develop. This phenomenon exemplifies the asymptomatic carriage that occurs in other infectious diseases.

How HIV is transmitted

HIV in a concentration that is sufficient to infect another person is found only in certain environments of the body: in the blood, pre-ejaculate, semen, vaginal secretions, milk, lymph. When these media come into contact with damaged skin and mucous membranes, or when they penetrate directly into the bloodstream of a healthy person, infection occurs. Saliva, tears and other bodily fluids do not pose a risk of transmission, provided that they do not contain blood.

Intact skin is a reliable barrier to HIV, but mucous membranes are more susceptible because they contain dendritic cells. They have CD4 receptors on their surface and can act as a carrier of a dangerous infection in the lymphatic system. Moreover, even minimal damage to the mucous membrane, which is not always noticeable to the naked eye, is already a high risk of infection. Therefore, with sexual infections that provoke the development of inflammatory processes, erosions, ulcers on the genital mucosa, the penetration of HIV into the internal environment of the body is greatly simplified.

Based on all this, it can be argued that HIV infection is highly likely in the following cases:

• When using contaminated needles. This route of transmission is especially relevant for injecting drug users.
• When transfusing insufficiently tested donor blood or its components.
• With unprotected sexual intercourse (if we evaluate the level of danger, then in the first place is anal, then vaginal and oral sex). The risk of infection is always higher in the receiving partner and in the presence of concomitant sexual infections.
• During pregnancy and childbirth from a sick mother to a child.
• When breastfeeding (in newborns, there are no enzymes in saliva and gastric juice that kill HIV).

It is also worth noting that HIV is not transmitted through:

• common utensils, bedding, etc.;
• insect bites;
• handshakes (if there are no open wounds on the hands);
• embrace;
• air;
• food;
• water (for example, in a swimming pool);
• kisses (again, provided that both partners do not have any damage on the lips or in the oral cavity).

At-risk groups

Some people are at particularly high risk of contracting HIV and should be tested regularly for this infection. These risk groups include:

• injection drug addicts and their sexual partners.
• People who have unprotected sex (both in homosexual and heterosexual couples) and who frequently change companions.
• Medical workers who, due to their professional activities, may have direct contact of blood or mucous membranes with the biological media of an infected person.
• Persons who have received blood or blood components.
• Children born to HIV-infected mothers.

Clinical picture

HIV infection has the following stages of development:

• Incubation period, which lasts from several days to 2-3 weeks.
• acute phase. It usually lasts 10-14 days and most often occurs in the form of "flu-like" or "mononucleosis-like" syndromes. Patients are disturbed by low-grade fever, enlargement and soreness of the lymph nodes, pain in the joints and muscles, rash on the body, ulcers on the oral mucosa, sore throat, general weakness. Nausea and diarrhea may also occur. The development of all these symptoms is associated with a very active reproduction of virions in the lymphoid tissue, a high viral load (concentration of viruses in the blood) and a sharp drop in the number of CD4+ lymphocytes. During the acute phase, the patient is considered the most contagious. It is also worth noting that this phase may be asymptomatic.
• latent period. At this stage of the disease, almost all the symptoms described above disappear, and the patient's immune system "comes to its senses" - the number of lymphocytes increases, and for some time the body maintains them at a level that provides adequate immune protection. This period lasts 5-10 years, if the patient receives antiretroviral treatment - for decades. The only sign that in the latent period may indicate that something pathological is happening in the body is an increase in lymph nodes.
• PreAIDS. This stage begins when the level of CD4+ lymphocytes falls critically and approaches the figure of 200 cells in 1 µl of blood. As a result of such suppression of the immune system (its cellular link), the patient develops: recurrent herpes and candidiasis of the oral cavity, genital organs, herpes zoster, hairy leukoplakia of the tongue (whitish protruding folds and plaques on the lateral surfaces of the tongue). In general, any infectious disease (for example, tuberculosis, salmonellosis, pneumonia) is more severe than in the general mass of people. In addition, this stage of HIV infection is characterized by a progressive decrease in the patient's weight.
• AIDS. This is already the terminal stage of the disease, which, without treatment, ends with the death of a person within 1-3 years. The cause of such deplorable consequences of HIV infection are opportunistic infections (those that do not develop in people with normal immunity), severe non-communicable diseases and cancers.

The following factors can accelerate the progression of HIV infection:

• Elderly age.
• The presence of other viral diseases (for example, hepatitis).
• Bad nutrition.
• Unsatisfactory living conditions.
• Stress.
• Bad habits.
• genetic features.

Signs of HIV infection

Assessing the symptoms of the disease and making diagnoses is the prerogative of doctors, but every sane person should know signs that may indicate HIV infection:

• Unreasonable prolonged increase in body temperature.
• Enlarged lymph nodes.
• Sharp unreasonable weight loss.
• Prolonged diarrhea of ​​unknown etiology.
• Tendency to chronicity and constant recurrence of bacterial and viral infectious diseases.
• The occurrence of ailments caused by opportunistic bacteria, fungi, protozoa (this indicates an immunodeficiency state).

Who needs an HIV test:

Why you need to know your HIV status:

• In case of a positive result, start treatment in a timely manner and prevent the development of AIDS.
• To prevent infecting other people if HIV infection is confirmed.

HIV testing is free, voluntary (with the exception of certain categories of citizens, which in the Russian Federation include the following) and optionally anonymous. However, it is worth noting that an anonymous result is not legally binding. For example, it cannot be attached to a pregnant woman's exchange card or submitted to the institutions of the migration service.

You can get tested for HIV in specialized centers for the prevention and control of AIDS, as well as in city clinics.

There are two types of HIV tests:

• Indirect, allowing to detect antibodies to the virus in the blood by ELISA (screening tests and confirmatory tests).
• Direct - detection of the virus itself, its antigens and RNA (viral load).

Screening tests for HIV are fast, affordable and sufficiently informative studies that are used for mass screening of people. If the screening test is positive, it is repeated to rule out an error. A repeated positive result requires confirmation by a more accurate, but also expensive analysis - immunoblotting.

In addition, with HIV infection, there is such a thing as the "window" period - this is the time during which, after infection, antibodies to HIV are not detected in the patient's blood. The duration of this period largely depends on the immune status of a person, that is, it is impossible to give an exact figure. However, it is believed that modern ELISA test systems can detect antibodies as early as 3-5 weeks after infection in most people. But still, in order not to be mistaken, it is advisable to undergo 2 more with an interval of 3 months after the first negative examination. In rare cases, if a person has problems with the immune system, the "window" period can be delayed up to a year.

With regard to direct tests for the detection of HIV, the most commonly used in practice is the detection of virus RNA by the polymerase chain reaction (PCR). This study can show that a person is infected with HIV even when they have a window period. But the doctor cannot make a diagnosis of HIV infection only on this result without confirmation by other tests, except in cases in which the assessment of the patient's immune response may be incorrect. For example, in children born to HIV-positive mothers. Maternal antibodies pass to newborns, which will be detected in a child up to 18 months. In addition, a PCR study (viral load determination) is used during the treatment of a patient to determine the effectiveness of the therapy received.

Treatment

There are no drugs that can completely remove HIV from the human body, so this disease is considered incurable. However, highly active antiretroviral therapy (HAART) can significantly slow the progression of the infection. In addition, against the background of antiretroviral therapy, the patient becomes less contagious (this is one aspect of HIV prevention).

HAART requires the patient to take three or four antiviral drugs (acting at different stages of the development of the virus) for life. It is very important that at the same time the patient observes the dosage and regularity of taking medications. Failure to follow the recommendations leads to the fact that the virus develops resistance to drugs, and you have to switch to other, often more expensive, treatment regimens.

Drugs used in the treatment of HIV infection include the following:

• Nucleoside reverse transcriptase inhibitors (Zidovudine, Lamivudine, Tenofovir, Abacovir, etc.).
• Non-nucleoside reverse transcriptase inhibitors (Nevirapine, Etravirine, Efavirenz, etc.).
• Protease inhibitors (Amprenavir, Atazanavir, Nelfinavir, Ritonavir, etc.).
• Integrase inhibitors (Dolutegravir, Raltegravir).
• Receptor inhibitors (Maraviroc).
• Fusion inhibitors (enfuvirtide).

It should be noted that HAART is not prescribed for all HIV-infected people. The selection of patients occurs according to three main criteria: the presence of symptoms of immunodeficiency, the concentration of CD4 + lymphocytes and viral load. But in September 2015, the WHO issued new recommendations that all people with HIV, as well as those at high risk of infection, should be treated with antiretroviral drugs (such prophylactic treatment is called pre-exposure prophylaxis). These measures, according to WHO estimates, should save tens of millions of lives in the near future and tens of millions more people from contracting a dangerous disease. WHO recommendations can be read.

Forecast

Without treatment, HIV infection ends with the death of the patient after an average of 9-11 years. In the case of HAART, the patient's compliance with all doctor's recommendations regarding lifestyle, bad habits, nutrition, as well as regular health monitoring, most people with HIV can live to old age.

HIV/AIDS prevention

• Use of condoms.
• Regular HIV testing of members of risk groups.
• Medical circumcision of the foreskin in men.
• Antiretroviral therapy for prophylactic purposes. This includes pre-exposure prophylaxis for HIV-negative partners of people living with HIV and post-exposure prophylaxis after possible exposure.
• Harm reduction for injecting drug users (programs should be implemented to replace used syringes, opioid substitution therapy, HIV testing, etc.).
• Elimination of mother-to-child transmission of the virus. To achieve this, all women with HIV and their newborns should be provided with antiretroviral therapy. In such situations, breastfeeding is also not recommended.

In addition, preventive measures include mandatory testing of donor blood, compliance with the appropriate regimen in medical institutions, and educational work among the population.

If we talk about the prevention of HIV infection for a particular person, then the following should become the rules of life for him: rejection of casual sex, protected sex and a negative attitude towards drugs.

Today in the world, perhaps, there is no person left who would not know what HIV is.

HIV, or human immunodeficiency virus, is the causative agent of HIV infection and AIDS, the acquired immunodeficiency syndrome. HIV infection is an infectious disease that is caused by HIV and ends with AIDS. AIDS, or Acquired Immune Deficiency Syndrome, is the final stage of HIV infection, in which a person's immune system is damaged to such a level that it is unable to resist any type of infection. Any, even the most insignificant infection, can cause serious illness and even death.

AIDS virus

When HIV enters the bloodstream, it attaches to the blood cells responsible for immunity. This is due to the fact that on the surface of such cells there are CD 4 molecules recognized by HIV. Inside these cells, HIV actively reproduces and, before an immune response occurs, the infection is distributed throughout the body. The lymph nodes, which contain many immune cells, are the first to be hit.

Throughout the entire period of illness, there is no effective response to the presence of HIV. This can mainly be explained by the fact that immune cells are damaged and cannot fully function. In addition, HIV is characterized by pronounced variability. The result of this is that immune cells simply do not identify the virus.

Progressing, HIV infects an increasing number of CD 4 lymphocytes (immune cells), with time their number decreases until they become critically small, which will be considered the beginning of AIDS.

How can you get HIV infection

2. For injecting drug users - while sharing syringes and needles.

3. During the procedure blood transfusions or its components.
HIV may be present in donated blood products, platelets, fresh frozen plasma, and coagulation factor preparations.
If infected blood was transfused to a healthy person, infection occurs in 90-100% of cases.
It is impossible to become infected with the introduction of normal immunoglobulin and special immunoglobulins, since these drugs are processed for complete inactivation of the virus.
After the introduction of mandatory testing of blood donors for HIV, the risk of getting an infection in this way has significantly decreased. However, if the donor is in a "blind period", that is, when infection has already occurred, but antibodies have not formed, the recipient cannot be saved from infection.

4. From mother to child. HIV has the ability to cross the placenta, so infection of the fetus can occur during pregnancy or during childbirth. In European countries, the risk of HIV transmission from an infected mother to a child is about 13%, and in African countries - 45-48%. The magnitude of the risk depends on the level of organization of medical supervision and treatment of a woman at the stage of pregnancy, the medical indications of the mother and the stage of HIV.
Among other things, there is a real risk of transmission of infection during breastfeeding. The presence of the virus in breast milk and colostrum of a sick woman has been proven. If the mother is HIV-infected, breastfeeding is contraindicated.

5. From patients to medical staff and vice versa. Infection risk levels:
0.3% - when injured with sharp objects, on which the blood of HIV-infected people remains,
less than 0.3% - in contact with damaged skin and mucous membranes of infected blood.
Theoretically, it is difficult to imagine the transmission of HIV infection from a health worker to a patient. But in the 1990s, five patients were reported in the United States from a dentist who had HIV infection, and the mode of transmission was never clear. Follow-up on the patients of HIV-infected doctors (gynecologists, surgeons, dentists, obstetricians), the researchers did not reveal the facts of infection transfer.

How it is impossible to get HIV

Saliva and other bodily fluids contain very little virus, which is not enough to cause infection. The risk of infection is present if the body fluids (sweat, saliva, feces, urine, tears) contain blood.

Acute febrile phase

The acute febrile phase is non-specific manifestations such as:
Fever: an increase in temperature, in most cases not exceeding 37.5 degrees (the so-called subfebrile condition).
Soreness in the throat.
Lymph nodes in the armpits, in the groin and on it increase, forming painful swelling.
Pain in the head and eyes.
Pain in joints and muscles.
Malaise, drowsiness, weight loss, loss of appetite.
Vomiting, nausea, diarrhea.
Changes on the skin: skin rashes, the appearance of ulcers on the skin and mucous membranes.
It is also possible to develop serous meningitis when the membranes of the brain are affected (this condition is accompanied by pain in the head, photophobia).

The duration of the acute phase is up to several weeks. After this period, the majority of HIV-infected people enter an asymptomatic phase. At the same time, in approximately 10% of patients, HIV is characterized by a fulminant course, when the condition deteriorates sharply.

Asymptomatic phase of HIV infection

In the asymptomatic phase, clinical manifestations of the disease may be absent.

A number of infected patients suffer from lymphadenopathy - an increase in all groups of lymph nodes.

AIDS is an advanced stage of HIV

First stage .
Body weight is reduced by 10% compared to the original.
The skin and mucous membranes are affected by viruses, fungi, bacteria:
Candidiasis stomatitis: a white curdled plaque (thrush) forms on the oral mucosa.
Hairy leukoplakia of the mouth - white plaques covered with grooves grow on the lateral parts of the tongue.
Due to the presence of the varicella zoster virus (the causative agent of chickenpox), shingles appears. On large areas of the skin, as a rule, on the trunk, extremely painful rashes are formed, which are bubbles.
Frequent bouts of herpes infection.
Sinusitis (phronitis, sinusitis), sore throat (pharyngitis), inflammation of the middle ear (otitis media) are often observed. The patient has a decrease in the number of platelets, blood cells involved in the clotting process (thrombocytopenia). This causes the appearance of hemorrhages (hemorrhagic rash) on the skin of the legs and arms, as well as bleeding gums.

Second stage .
Body weight is reduced by more than 10%.
The infections that have already been mentioned include the following:
Diarrhea for no apparent reason and/or fever lasting more than 1 month
Toxoplasmosis
Tuberculosis of various organs
Pneumocystis pneumonia
Kaposi's sarcoma
Helminthiasis of the intestine
Lymphomas
Severe neurological disorders develop.

When should HIV infection be suspected?

Who is at increased risk of getting HIV infection

HIV prevention

1. Safe sex. Protection with a condom during sexual contact helps to avoid infection. But the use of this method of protection cannot give a 100% guarantee even if used correctly.
To make sure that there is no risk of infection, both sexual partners must undergo a special examination.
2. Avoid drug use. If it is not possible to get rid of the addiction, you need to use only one-time games, do not use syringes or needles that have already been used by someone.
3. If the mother is HIV-infected, it is necessary to exclude breastfeeding of the child.

Prevention of opportunistic infections

To improve the quality of life and increase its duration, opportunistic infections are prevented for AIDS patients:
Prevention of tuberculosis: in order to identify a patient who is infected with tuberculosis microbacteria in time, all patients with HIV are given a Mantoux test every year. If there is no immune response to tuberculin (i.e., the reaction is negative), it is advised to drink anti-tuberculosis drugs for 12 months.
Prevention of pneumocystis pneumonia: if an HIV-infected patient has a CD 4 lymphocyte level less than 200 / μl and an unreasonably elevated temperature (from 37.8 degrees) for two weeks, biseptol prophylaxis is carried out.
AIDS dementia syndrome. The gradual decline in intelligence, characterized by problems with attention and concentration, difficulty in solving problems and reading, memory loss, is called dementia.
In addition, AIDS-dementia syndrome can manifest itself as a violation in movement and behavior: it is difficult for a person to maintain a certain position, he has difficulty walking, becomes apathetic, different parts of his body begin to twitch (the so-called tremor).
The later stages of this syndrome are also characterized by fecal and urinary incontinence, in some cases a manifestation of a vegetative state.
AIDS-dementia syndrome is observed in a quarter of all HIV-infected people. The etymology of this syndrome has not been fully established. There is a version that its appearance is associated with the direct effect of the virus on the spinal cord and brain.
epileptic seizures. They can be caused by the following factors:
a) neoplasms
b) opportunistic infections that affect the brain
c) AIDS dementia syndrome
The most common causes are cerebral lymphoma, toxoplasma encephalitis, AIDS dementia syndrome, and cryptococcal meningitis.
Neuropathy. A common complication of HIV infection. It can appear at any stage of the disease. Varied in clinical manifestations. Early stages may be accompanied by symptoms such as progressive muscle weakness, mild sensory disturbances. After some time, the symptoms may worsen, aggravated by pain in the legs.

HIV testing

When is it necessary to get tested for HIV?
if there was unprotected vaginal, oral or anal intercourse (without a condom or if it broke in the process) with a new partner.
if you have been sexually assaulted.
if your sexual partner has had sex with another person.
if your past or present sexual partner is infected with HIV.
if already used needles were used to create tattoos and piercings, the introduction of narcotic or other substances.
if there was contact with the blood of a person infected with HIV.
if your sexual partner has used used needles or has been exposed to any other risk of transmission.
if another sexually transmitted infection has been detected.

In most cases, methods are used to diagnose HIV infection, the essence of which is to determine the content of antibodies to HIV in the blood, that is, specific proteins formed in the body of an infected person as a reaction to an invading virus. Such antibodies are formed after 3-24 weeks from the moment of infection. For this reason, an HIV test can only be performed after this period of time. The final analysis is best carried out after 6 months from the time of the alleged infection.

A commonly used method for diagnosing HIV is enzyme immunoassay (ELISA) , another name for ELISA. This method shows sensitivity to antibodies above 99.5%, therefore it seems to be the most reliable. Test results may be negative, positive, or questionable.

Treatment of HIV and AIDS

After the diagnosis is confirmed, the course of treatment of patients is determined. Treatment should be individualized and take into account the level of risk. The decision to start antiretroviral treatment is made depending on the degree of risk of progression of HIV infection and the degree of risk of immunodeficiency. If antiretroviral treatment is started before virological and immunological signs of disease progression appear, then the positive effect of it may be less obvious and long-lasting.

Therapy against viruses is prescribed for patients who are at the stage of acute infection. The basic principle of the treatment of AIDS, as well as other viral diseases, is the timely treatment of the main disease and the complications caused by it, primarily Kalosh's sarcoma, pneumocystis pneumonia, and CNS lymphoma.

There is evidence that therapy in patients with AIDS opportunistic infections, Kaposi's sarcoma is based on large doses of antibiotics and chemotherapy. It is best to combine them. When a drug is selected, in addition to sensitivity data, it is important to consider how the patient tolerates it, as well as the functional state of his kidneys (this is important to prevent drug accumulation in the body). The result of treatment depends, moreover, on how carefully the chosen course is adhered to, as well as on the duration of therapy.
Despite the fact that the number of drugs and treatments for patients with AIDS is quite large, the final results of treatment at the moment are very modest and do not lead to complete elimination of the disease, since clinical remissions are associated only with a slowdown in the reproduction of the virus and, in some cases, with a visible decrease in morphological signs of the disease, but not with their complete disappearance. For this reason, only by preventing the progression of the virus, most likely, it is possible to give the body immunity to opportunistic infections and the formation of malignant tumors by restoring the immune system or replacing destroyed immune cells.

Educational work on the issue of HIV infection is given great attention by medical workers in primary health care. But many people continue to worry about whether HIV can be transmitted in everyday life.

Not always reliable information coming from TV screens only confuses and makes it difficult to fully understand how you can get HIV and how to protect yourself.

General characteristics of the virus

In the body of an infected person, viral agents are found in the highest concentration in the blood, vaginal secretions, semen and breast milk. It is through these liquid media that HIV infection can be transmitted to a healthy person.

Experts identify only three ways of infection - during unprotected sexual intercourse, from a pregnant woman to her baby, and also artificially - parenterally.

The viral particles themselves are very unstable in the external environment and quickly die under the influence of alcohol solutions. If a biologically contaminated substance gets on intact human skin, the virus is destroyed by the protective enzymes of the dermis. In domestic conditions, pathogenic agents die under the influence of high temperatures.

The lack of an effective drug for HIV infection is due to the high variability of the virus. Infection can occur in any of dozens of its variants of existence.

Basic transmission methods

A very relevant question for many: HIV infection - how is it transmitted in everyday life. To date, experts indicate natural and artificial ways:

The mechanism of transmission of this pathology, formidable in its complications, is well studied by specialists, and therefore the threat of infection in medical institutions is minimized.

Transmission of the virus in the home

A particularly exciting question for many is whether it is possible to become infected with HIV at home. The risk of such a situation is minimal, but still exists.

A possible route of infection is if a carrier of the virus lives in the apartment, and there has been direct contact with its biological material, for example, with stabbing injuries. If even a microdamage has occurred, and blood, semen or vaginal secretion has got into it, it is recommended to immediately treat it with an alcohol solution and contact the nearest center for the prevention and control of HIV infection.

Another option is for the sick person to use a shared razor. Microtraumas leave droplets of blood on the surface of the machine: a huge risk of infection.

Experts emphasize that the virus is not able to exist in the environment for a long time, therefore, through a common towel, slippers, dishes, it will not penetrate into the body of a healthy person.

You should also know that pathology is also not transmitted with urine and feces - using a shared toilet is quite safe. You can not be afraid to visit the pool, sauna, fitness centers - the main thing is to avoid microtraumas in them. Transmitted only through biological fluids, after their direct contact with an open wound surface, the virus leads to infection even in microscopic volumes.

Many are afraid to use plates and spoons that have been in the hands of an HIV-infected person - these are absolutely groundless fears. Regular washing of dishes with modern detergents completely disinfects them.

When is HIV not transmitted?

Conducted numerous medical studies convincingly prove that HIV is not transmitted:

Despite the above information, you should not lose vigilance - HIV has not been fully studied, its high ability to mutate makes it possible to get infected even in everyday life.

Can HIV be transmitted through a toothbrush?

The risk of infection through hygiene items is low. But it is recommended to constantly remember it. For example, you can get infected through a toothbrush - if the gums bleed in a sick person and a healthy person, and they both used the same cleaning brush.

Experts especially emphasize that this hygiene product should be only individual, change often, and be regularly treated with boiling water. In this case, the virus will not have any chance to enter the bloodstream of a healthy person.

In an infected person in the oral cavity, against the background of extremely low immune barriers, various secondary pathologies are formed - gingivitis, stomatitis, candidiasis. Many of them are accompanied by microtrauma and blood leakage. It is she who, after getting on the tissues of the mouth of an infected person, can lead to the emergence of a new case of HIV.

Can you get HIV from massage?

A very popular method of relaxation at home is massage. And many people during the consultation of a specialist ask the question - is there a risk of infection in this case.

Massage in the presence of a virus in the body is not prohibited, with the exception of the option when the pathology has already passed into the stage of AIDS. Concomitant opportunistic infections, for example, various staphyloderma and streptoderma will be contraindications to the procedure. Any massage therapist will confirm that the slightest damage to the skin will contribute to a significant increase in the risk of HIV infection.

Massage specialists care not only about the health of patients, but also do not forget about their own - after all, they are in contact with the skin with unprotected hands. If there are no dermatopathologies, then they only encounter the sweat of a sick person, and the concentration of the virus in it is extremely low. Even if there are fresh microtraumas on the hands of a massage therapist, the risk of infection is minimal.

Prevention

In order to be absolutely sure that HIV infection will not threaten a person’s health, even if he has to deal with a sick person on a daily basis, it is enough to follow some simple recommendations for prevention:

All health workers are doing a great job of promoting preventive measures. All categories of citizens belonging to the HIV risk group are carefully examined: those who have contacts with people already infected with the virus, prostitutes and drug addicts, donors and pregnant women.

It should be remembered that it is much easier to prevent HIV infection than to treat it later. At the moment, there is no effective medicine - only drugs have been developed that can lower the concentration of viral agents in the bloodstream of an infected person.

It is difficult to live with a disease like HIV. Answers to topical questions - what kind of disease it is, how it is transmitted, what ways to prevent infection exist - every person should know and remember. After all, the disease can be easily transmitted and no one is protected from accidental transmission of the virus, for example, when injured in public transport, during summer outdoor recreation, when medical care is not always available.

Good day, dear readers!

In today's article, we will consider with you such a serious disease as HIV infection, and everything connected with it - the causes, how it is transmitted, the incubation period, the first signs, symptoms, stages of development, types, tests, tests, diagnosis, treatment , medicines, prevention and other useful information. So…

What does HIV mean?

HIV infection in children

HIV infection in children in many cases is accompanied by a developmental delay (physical and psychomotor), frequent infectious diseases, pneumonitis, encephalopathy, hyperplasia of the pulmonary lymph nodes, hemorrhagic syndrome. Moreover, HIV infection in children, which they acquired from infected mothers, is characterized by a faster course and progression.

The main cause of HIV infection is infection with the human immunodeficiency virus. The cause of AIDS is also the same virus, because. AIDS is the last stage in the development of HIV infection.

- a slowly developing virus belonging to the family of retroviruses (Retroviridae) and to the genus Lentiviruses (Lentivirus). It is the word "lente" in Latin that means "slow", which partially characterizes this infection, which develops rather slowly from the moment it enters the body to the last stage.

The size of the human immunodeficiency virus is only about 100-120 nanometers, which is almost 60 times smaller than the diameter of a blood particle - an erythrocyte.

The complexity of HIV lies in its frequent genetic changes in the process of self-replication - almost every virus differs from its predecessor by at least 1 nucleotide.

In nature, as of 2017, 4 types of the virus are known - HIV-1 (HIV-1), HIV-2 (HIV-2), HIV-3 (HIV-3) and HIV-4 (HIV-4), each of which differs in the structure of the genome and other properties.

It is HIV-1 infection that plays the role in the basis of the disease of the majority of HIV-infected people, therefore, when the subtype number is not indicated, it is 1 that is assumed by default.

The source of HIV is people infected with the virus.

The main routes of infection are: injections (especially injection drugs), transfusions (of blood, plasma, red blood cells) or organ transplantation, unprotected sexual contact with a stranger, unnatural sex (anal, oral), trauma during childbirth, breastfeeding an infant (if the mother is infected), trauma during childbirth, use of non-disinfected medical or cosmetic items (scalpel, needles, scissors, tattoo machines, dental and other instruments).

For HIV infection and its further spread throughout the body and development, it is necessary that the infected blood, mucus, sperm and other biomaterials of the patient enter the bloodstream or lymphatic system of a person.

An interesting fact is that some people in the body have an innate defense against the human immunodeficiency virus, so they are resistant to HIV. The following elements have such protective properties: the CCR5 protein, the TRIM5a protein, the CAML protein (calcium-modulated cyclophilin ligand), and the interferon-induced transmembrane protein CD317/BST-2 (“tetherin”).

By the way, the CD317 protein, in addition to retroviruses, also actively counteracts arenaviruses, filoviruses and herpesviruses. The cofactor for CD317 is the cellular protein BCA2.

HIV Risk Groups

• Drug addicts, predominantly injecting drug users;
• Sexual partners of drug addicts;
• Persons leading a promiscuous sex life, as well as those who engage in unnatural sex;
• Prostitutes and their clients;
• Donors and people in need of a blood transfusion or organ transplant;
• Sick people with sexually transmitted diseases;
• Doctors.

The classification of HIV infection is as follows:

Classification according to clinical manifestations (in the Russian Federation and some CIS countries):

1. Stage of incubation.

2. The stage of primary manifestations, which, according to the course options, can be:

• without clinical manifestations (asymptomatic);
• acute course without secondary diseases;
• acute course with secondary diseases;

3. Subclinical stage.

4. The stage of secondary diseases caused by damage to the body by viruses, bacteria, fungi and other types of infection that develop against a background of weakened immunity. Downstream it is subdivided into:

A) body weight decreases by less than 10%, as well as frequently recurring, infectious diseases of the skin and mucous membranes - pharyngitis, otitis media, shingles, angular cheilitis ();

B) body weight decreases by more than 10%, as well as persistent and often recurring infectious diseases of the skin, mucous membranes and internal organs - sinusitis, pharyngitis, herpes zoster, fever or diarrhea (diarrhea) for a month, localized Kaposi's sarcoma;

C) body weight is significantly reduced (cachexia), as well as persistent generalized infectious diseases of the respiratory, digestive, nervous and other systems - candidiasis (trachea, bronchi, lungs, esophagus), pneumocystis pneumonia, extrapulmonary tuberculosis, herpes, encephalopathy, meningitis, cancerous tumors (disseminated Kaposi's sarcoma).

All variants of the course of the 4th stage have the following phases:

• progression of pathology in the absence of highly active antiretroviral therapy (HAART);
• progression of pathology on the background of HAART;
• remission during or after HAART.

5. Terminal stage (AIDS).

The above classification largely coincides with the classification approved by the World Health Organization (WHO).

Classification by clinical manifestations (CDC - US Centers for Disease Control and Prevention):

The CDC classification includes not only the clinical manifestations of the disease, but also the number of CD4 + -T-lymphocytes in 1 μl of blood. It is based on the division of HIV infection into just 2 categories: the disease itself and AIDS. If the parameters below meet criteria A3, B3, C1, C2 and C3, the patient is considered to have AIDS.

Symptoms according to CDC category:

A (acute retroviral syndrome) - characterized by an asymptomatic course or generalized lymphadenopathy (GLAP).

B (AIDS-associated complex syndromes) - may be accompanied by oral candidiasis, herpes zoster, cervical dysplasia, peripheral neuropathy, organic damage, idiopathic thrombocytopenia, leukoplakia, or listeriosis.

C (AIDS) - may be accompanied by candidiasis of the respiratory tract (from the oropharynx to the lungs) and / or esophagus, pneumocystosis, pneumonia, herpetic esophagitis, HIV encephalopathy, isosporosis, histoplasmosis, mycobacteriosis, cytomegalovirus infection, cryptosporidiosis, coccidioidomycosis, cervical cancer, sarcoma Kaposi, lymphoma, salmonellosis and other diseases.

Diagnosis of HIV infection

Diagnosis of HIV infection includes the following examination methods:

• Anamnesis;
• Visual examination of the patient;
• Screening test (detection of blood antibodies to infection by enzyme immunoassay - ELISA);
• A test confirming the presence of antibodies in the blood (blood test by immune blotting (blot)), which is carried out only if the screening test is positive;
• Polymerase chain reaction (PCR);
• Tests for immune status (counting CD4 + lymphocytes - performed using automatic analyzers (flow cytometry method) or manually, using microscopes);
• Viral load analysis (counting the number of copies of HIV RNA in a milliliter of blood plasma);
• Rapid HIV tests - diagnostics is performed using ELISA on test strips, agglutination reaction, immunochromatography or immunological filtration analysis.

Tests alone are not enough to make a diagnosis of AIDS. Confirmation occurs only with the additional presence of 2 or more opportunistic diseases associated with this syndrome.

HIV infection - treatment

Treatment of HIV infection is possible only after a thorough diagnosis. However, unfortunately, as of 2017, officially, adequate therapy and drugs that would completely eliminate the human immunodeficiency virus and cure the patient have not been established.

The only modern method of treating HIV infection today is highly active antiretroviral therapy (HAART), which is aimed at slowing the progression of the disease and stopping its transition from the stage of AIDS. Thanks to HAART, a person's life can last for several decades, the only condition is the life-long intake of appropriate medications.

The insidiousness of the human immunodeficiency virus is also its mutation. So, if the drugs against HIV are not changed after a certain time, which is determined on the basis of constant monitoring of the disease, the virus adapts, and the prescribed treatment regimen becomes ineffective. Therefore, at different intervals, the doctor changes the treatment regimen, and with it the medications. The reason for changing the drug can also be its individual intolerance by the patient.

Modern drug development aims not only to achieve the goal of effectiveness against HIV, but also to reduce the side effects of them.

The effectiveness of treatment also increases with a change in a person's lifestyle, improving its quality - healthy sleep, proper nutrition, avoiding stress, active lifestyle, positive emotions, etc.

Thus, the following points in the treatment of HIV infection can be distinguished:

• Drug treatment of HIV infection;
• Diet;
• Preventive actions.

Important! Before using drugs, be sure to consult your doctor for advice!

1. Drug treatment of HIV infection

At the beginning, it is necessary to immediately remind once again that AIDS is the last stage in the development of HIV infection, and it is at this stage that a person usually has very little time left to live. Therefore, it is very important to prevent the development of AIDS, and this largely depends on the timely diagnosis and adequate treatment of HIV infection. We also noted that the only treatment for HIV today is highly active antiretroviral therapy, which, according to statistics, reduces the risk of developing AIDS to almost 1-2%.

Highly active antiretroviral therapy (HAART)- a method of treating HIV infection based on the simultaneous administration of three or four drugs (tritherapy). The number of drugs is associated with the mutagenicity of the virus, and in order to bind it at this stage for as long as possible, the doctor selects exactly the complex of drugs. Each of the drugs, depending on the principle of action, is included in a separate group - reverse transcriptase inhibitors (nucleoside and non-nucleoside), integrase inhibitors, protease inhibitors, receptor inhibitors and fusion inhibitors (fusion inhibitors).

HAART has the following goals:

• Virological - aimed at arresting the reproduction and spread of HIV, an indicator of which is a decrease in viral load by 10 or more times in just 30 days, to 20-50 copies / ml or less in 16-24 weeks, as well as keeping these indicators as long as possible;
• Immunological - aimed at restoring the normal functioning and health of the immune system, which is due to the restoration of the number of CD4-lymphocytes and an adequate immune response to infection;
• Clinical - aimed at preventing the formation of secondary infectious diseases and AIDS, it makes it possible to conceive a child.

Medicines for HIV infection

Nucleoside reverse transcriptase inhibitors- the mechanism of action is based on the competitive suppression of the HIV enzyme, which ensures the creation of DNA, which is based on the RNA of the virus. It is the first group of drugs against retroviruses. They are well tolerated. Among the side effects can be identified - lactic acidosis, bone marrow suppression, polyneuropathy and lipoatrophy. The substance is excreted from the body through the kidneys.

Among the nucleoside reverse transcriptase inhibitors are abacavir (Ziagen), zidovudine (Azidothymidine, Zidovirin, Retrovir, Timazid), lamivudine (Virolam, Heptavir-150, Lamivudine-3TS ”, “Epivir”), stavudine (“Aktastav”, “Zerit”, “Stavudin”), tenofovir (“Viread”, “Tenvir”), phosphazide (“Nikavir”), emtricitabine (“Emtriva”), as well as complexes abacavir + lamivudine (Kivexa, Epzicom), zidovudine + lamivudine (Combivir), tenofovir + emtricitabine (Truvada), and zidovudine + lamivudine + abacavir (Trizivir).

Non-nucleoside reverse transcriptase inhibitors- delavirdine (Rescriptor), nevirapine (Viramun), rilpivirine (Edurant), efavirenz (Regast, Sustiva), etravirine (Intelence).

Integrase inhibitors- the mechanism of action is based on blocking the virus enzyme, which is involved in the integration of viral DNA into the genome of the target cell, after which a provirus is formed.

Integrase inhibitors include dolutegravir (Tivicay), raltegravir (Isentress), elvitegravir (Vitekta).

Protease inhibitors- the mechanism of action is based on blocking the virus protease enzyme (retropepsin), which is directly involved in the cleavage of Gag-Pol polyproteins into individual proteins, after which the mature proteins of the human immunodeficiency virus virion are actually formed.

Protease inhibitors include amprenavir (Agenerasa), darunavir (Prezista), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir, Ritonavir), saquinavir-INV ( Invirase), tipranavir (Aptivus), fosamprenavir (Lexiva, Telzir), as well as the combination drug lopinavir + ritonavir (Kaletra).

Receptor inhibitors- the mechanism of action is based on blocking the penetration of HIV into the target cell, which is due to the effect of the substance on the co-receptors CXCR4 and CCR5.

Among the receptor inhibitors, maraviroc (Celzentri) can be distinguished.

Fusion inhibitors (fusion inhibitors)- the mechanism of action is based on blocking the last stage of the introduction of the virus into the target cell.

Among the fusion inhibitors, enfuvirtide (Fuseon) can be distinguished.

The use of HAART during pregnancy reduces the risk of transmission from an infected mother to her child to 1%, although without this therapy, the infection rate of the child is about 20%.

Side effects from the use of HAART drugs include pancreatitis, anemia, skin rashes, kidney stones, peripheral neuropathy, lactic acidosis, hyperlipidemia, lipodystrophy, as well as Fanconi syndrome, Stevens-Johnson syndrome and others.

The diet for HIV infection is aimed at preventing the patient from losing weight, as well as providing the cells of the body with the necessary energy and, of course, stimulating and maintaining the normal functioning of not only the immune system, but also other systems.

It is also necessary to pay attention to a certain vulnerability of immunity weakened by infection, therefore, to protect yourself from infection with other types of infection, be sure to follow the rules of personal hygiene and the rules of cooking.

Nutrition for HIV/AIDS should:

2. Be high-calorie, which is why it is recommended to add butter, mayonnaise, cheese, sour cream to food.

3. Include plenty of drink, it is especially useful to drink decoctions and freshly squeezed juices with plenty of vitamin C, which stimulates the immune system - decoction, juices (apple, grape, cherry).

4. Be frequent, 5-6 times a day, but in small portions.

5. Water for drinking and cooking should be purified. Avoid expired foods, undercooked meats, raw eggs, and unpasteurized milk.

What can you eat with HIV infection:

• Soups - vegetable, on cereals, with vermicelli, on meat broth, it is possible with the addition of butter;
• Meat - beef, turkey, chicken, lungs, liver, lean fish (preferably sea);
• Groats - buckwheat, barley, rice, millet and oatmeal;
• Kashi - with the addition of dried fruits, honey, jam;
, and zinc, therefore, they need to be given special attention when eating. In addition, we once again want to remind you that it stimulates the immune system, which is very important in the fight against infection.

What not to eat with HIV infection

With the human immunodeficiency virus, it is necessary to completely abandon alcoholic beverages, smoking, diets for weight loss, foods with high allergenicity, sweet carbonated drinks.

3. Preventive measures

Preventive measures for HIV infection that must be observed during treatment include:

• Avoiding re-exposure to infection;
• Healthy sleep;
• Compliance with the rules of personal hygiene;
• Avoiding the possibility of infection with other types of infection - and others;
• Avoidance of stress;
• Timely wet cleaning at the place of residence;
• Refusal to stay in the sun for a long time;
• Complete refusal of alcoholic products, smoking;
• Complete nutrition;
• Active lifestyle;
• Holidays at sea, in the mountains, i.e. in the most environmentally friendly places.

Additional HIV prevention measures will be discussed at the end of the article.

Important! Before using folk remedies against HIV infection, be sure to consult your doctor!

St. John's wort. Pour well-dried chopped grass into an enameled pan and fill it with 1 liter of soft purified water, then put the container on fire. After the agent boils, boil the agent for another 1 hour over low heat, then remove, cool, strain and pour the broth into a jar. Add 50 g of sea buckthorn oil to the decoction, mix thoroughly and set aside in a cold place for infusion, for 2 days. You need to take the drug 50 g 3-4 times a day.

Licorice. Pour 50 g of crushed into an enameled pan, pour 1 liter of purified water into it and put it on the stove, over a big fire. Bringing to a boil, reduce the heat to the minimum value and simmer the remedy for about 1 hour. After removing the broth from the stove, cool it, strain, pour into a glass container, add here 3 tbsp. spoons of natural, mix. You need to drink a decoction of 1 glass in the morning, on an empty stomach.