Актуальная Медицина - AIDS and HIV

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AIDS and HIV

Introduction:
Human immunodeficiency virus (HIV).
HIV- positive.
People with HIV-related illness.
 The strategy for management of AIDS in Zambia has four phases:
- diagnosis and counseling;
- planned discharge;
- home-based care;
- hospital care.
The HIV-infection is now endemic in several African countries and estimates of the number of infected people range in the millions.

The clinical manifestation of HIV-infection in Africa:
- HIV belongs to a group of retroviruses.
- The proposed clinical staging system for HIV-infection and disease is primarily based on clinical criteria. Symptoms, signs and diseases should be defined according to medical judgment.
There are four prognostic categories:
1. asymptomatic (persistent generalized lymphadenopathy (PGL));
2. early (mild) disease; 
3. intermediate (moderate) disease;
4. late (severe) disease (basically equivalent to AIDS).

Proposed clinical staging system for HIV-infection:
The progression of HIV- infection to symptomatic disease and AIDS is unpredictable.
The stages of HIV-infection may include:
1. Acute conversion illness. May occur 2-4 weeks after infection and last a few weeks, or months. It may include fever, muscle pains, lymph node enlargement and itchy maculopapular rash.
2. Asymptomatic HIV-infection. A period in which a patient is in apparent normal health, but may transmit the infection and is at increased risk of infectious illness. This period may last from a few years to 10 or more.
3. Symptomatic HIV-infection. Weight loss, diarrhoea, and possible fewer lasting more than one month. There is no precise definition of AIDS-related complex. Diagnose the cause and treat each sign or symptom of HIV-infection.
4. Acquired Immune Deficiency Syndrome. It is a stage of HIV-infection, when a person starts getting sick a lot. It takes some time for HIV to kill enough of the white blood cells to seriously weaken the body.

AIDS stands for acquired immunodeficiency syndrome, a pattern of devastating infections caused by the human immunodeficiency virus, or HIV, which attacks and destroys certain blood cells that are essential to the body’s immune system. Most people infected with HIV are still healthy and can live for years with no symptoms or only minor illness. They are infected with HIV, but they do not have AIDS. Even when they look and feel healthy, they can transmit the virus to others,
After a variable period of time, the virus becomes activated and leads progressively to the serious infections and other conditions that characterize AIDS.

HIV targets two groups of white blood cells called:
- CD4+ lymphocytes;
- Monocytes /macrophages.
Those help recognize and destroy bacteria, viruses or other infectious agents that invade a cell and cause disease.
As the body’s CD4+ cells are depleted, the immune system weakens and is less able to fight of viral and bacterial infections. 
 The symptoms of HIV disease are varied and complex, but can include:
- fever;
- enlarged lymph glands;
- skin rash; 
- persistent diarrhoea;
- cough;
- severe weight loss;
- fatigue;
- skin lesions;
- loss of appetite.
A blood test for antibodies to the virus is used for diagnostics.
HIV was found to be an infectious agent known as a retrovirus. Since the discovery of HTV, several strains of the virus have been identified. 1985 – in parts of West Africa – HIV-2.
The pattern of illness is similar for both HIV-1 and HIV-2.
  
  The route of infection in infants and children:
- most HIV-infected infants acquired the infection from their mothers before or during birth, during breastfeeding;
- infected through HIV-contaminated blood transfusion or injections.

How HIV is transmitted?
There are only four primary methods of transmission:
  - sexual intercourse (anal and vaginal);
- contaminated blood and blood products, tissues and organs;
- contaminated needles, syringes and other piercing instruments;
- mother-to-child transmission (MTCT).
Anal and vaginal intercourse can transmit the virus from an HIV-infected man to a woman or to another man, or from an infected woman to a man.
 Four main risk factors:
- the probability that the sex partner is infected;
- the type of sex act;
- the amount of virus present in the blood or sexual secretions (semen, vaginal or cervical secretions) of the infected partner;
- the presence of other sexually transmitted diseases or genital lesions in either partner.
Age may be also a factor as young girls are physiologically more vulnerable.
All unprotected acts of sexual penetration (anal, vaginal, oral) carry a risk of HIV-transmission because they bring body fluids secreted during sex directly into contact with exposed mucous membranes (the lining of the rectum, the vagina, the urethra and the mouth).
1. Men and women who engage in unprotected receptive anal intercourse with an HIV-infected partner run the highest risk of becoming infected.
2. The next highest risk – unprotected vaginal intercourse.
Unprotected oral intercourse – particularly if there are mouth or throat injuries present such as bleeding gums, lesions, sores, abscessed teeth, throat infections, oral gonorrhea or the other STDs.
HIV may be transmitted even through unbroken mucous membrane.
HIV – infected individuals become more infectious as they progress to HIV-related disease and AIDS.
The presence of an untreated STD – such as gonorrhea, chlamidial infection, syphilis herpes or genital warts can enhance both the acquisition and transmission of HIV by factor of up to10. Thus, STD treatment is an important HIV prevention strategy in general population.
In the developing world, the risk of acquiring HIV-infection from transfusion is extremely high (HIV-infections may be caused by transfusions in high-prevalence areas such as Sub-Saharan Africa).
The lack of coordinated national blood transfusion systems, the absence of non remunerated volunteers blood donors, lack of testing and inappropriate use of blood products compound the problem.

Goals include:
1. educating, motivating, recruiting and retaining low-risk volunteer, non-remunerated blood donors; 
2. screening all donated blood;
3. reducing unnecessary or inappropriate transfusions;
4. developing a sustainable national blood transfusion service;
5. improving political commitment and support from within countries.

Thus, to prevent transmission by tissue and organ donation, including sperm for artificial insemination, the HIV-infection stains of the donor should be carefully evaluated.

The sharing of syringes and needles by injecting drug users is responsible for the very rapid rise in HIV-infection among these persons in many parts of the world.

A risk is also attached to non-medical procedures if the instruments used are not properly sterilized. Such procedures include ear and body piercing, tattooing, acupuncture, male and female circumcision, and traditional scarification. Pediatric AIDS can be difficult to diagnose because some symptoms of HIV-infection, such as diarrhoea, are also common in infants and children who are not infected.

There are special blood-based tests:
- ELISA (reliable only at 15 months of age);
- PCR tests (allow early diagnosis), are not available in developing countries.
 
Preventing transmission if you are infected with HIV:
- do not donate blood, semen or organs (kidney, cornea);
- inform sexual partners, avoid penetration, otherwise always use a condom;
- do not share syringes or needles;
- informs any doctors or dentists consulted;
- consider pregnancy carefully;
- cover any cuts or scratches with dressing until healed;
- do not share toothbrushes, razors or sharp instruments;
- seek early and correct treatment for STDs.

Common symptoms include an unusual discharge from vagina or penis, burning or pain during urination, and sores or blisters near the mouth or genitals.

Other symptoms in women:
- unusual bleeding (other than menstrual cycle);
- vaginal pain during intercourse.

Preventing transmission of HIV via blood products:
- before you travel, identify sources of reliable medical help in your destination country;
- carry sterile disposable needles and syringes for your personal use (as part of the WHO medical kit);
- be aware of emergency medical evacuating procedures;
- reduce your risk of injury by following safety precautions such as using seatbelts and driving carefully;
- if you are injured and lose blood, consider using a plasma substitute (crystalloids) colloids, if severe or acute blood loss has occurred, efforts should be made to ensure that the blood has been screened for HIV and hepatitis B virus.

Put your health first!
If you are HIV-infected, it is important to take care of your physical health to decrease the risk of progression toward a symptomatic form of AIDS.
- Adopt healthy diet.
- Exercise regularly.
- Avoid alcohol and tobacco.
- Avoid stress.
- Avoid all forms of infection if possible because they could compromise your health.
- Do not use illicit drugs.
- See your doctor regularly.  
HIV–screening tests can sometimes give false-positive reading, especially in populations where HIV is not present in high numbers, which is why confirmatory testing is always done on positive screening test results.
The HIV test is a blood test that can tell if someone has been infected with HIV.

What is AIDS?  
AIDS is venereal disease caused by HIV-infection. It can take several years after HIV-infection for direct manifestation of the disease. HIV-infection kills enough leucocytes and weakens the body badly. 

The major symptoms of AIDS are:
1. Lasting fever, for more than 1 month, or intermittent fever.
2. Lasting diarrhoea, daily or intermittent.
3. Weight loss, more than10% of body weight.
4. Repeated or multi-focal abscesses.
Clinical case definition for AIDS for the Africa region is deviated into the major and minor symptoms. AIDS can be defined by the existence at least two of the major signs together with at least one minor sign, in the absence of diabetes, malignancy, or other disease known to cause immunosuppression.

Some minor signs of AIDS:
1. Cough >1 month.
2. Generalized itchy dermatitis.
3. Herpes Zoster multidermatomal.
4. Atypical pulmonary tuberculosis.
5. Extra-pulmonary tuberculosis.
6. Dementia.
7. Severe drug reaction.
8. Hairy leucoplakia.
9. Unexplained nerve palsies or nerve palsies of acute onset.
10. Recurrent oral candidiasis.

A clinical diagnosis of AIDS should be confirmed by an HIV-test. There are no remedies from AIDS nowadays. AIDS is unpredictable. Taking care of onset is the best way to prevent the progression of HIV-infection to symptomatic disease.

Vocabulary:

Endemic [ǐn`demǐk] Ендемічний
Clinical manifestation [`klǐnǐkl mənǐfǐs`teǐ∫n] Клінічний прояв
Retroviruses [retrəυ`vaǐrəsǐz] Ретровіруси
Medical judgment [`medǐkl`dзǎdзmǐnt] Медичні висновки
Prognostic categories [prə`gnəυstǐk`kætǐgorǐz] Категорії прогнозування
Stages [`steǐdзǐz] Стадії
Conversion [kənvə`seǐ∫n] Прояв
Enlargement [ǐn`lα:dзmǐnt] Збільшення
Maculo-papular rash [`mækјυlə`pæpјυlə] Плямисто-пухирковий виступ
Apparent [ə`pærnt] Очевидний, явний
Precise [prǐ`sa ǐz] Чіткий
Devastating [dǐvəs`teǐtǐŋ] Спустошливий
To destroy [dǐs`troǐ] Руйнувати
Minor [`maǐnə] Другорядний
Variable [`værǐəbl] Мінливий
To become activated [bǐ`kǎm] Активізуватися
To target [`tα:gǐt] Вражати
To recognize [rǐkə`gnaǐz] Впізнавати
Agents [`eǐdзənts] Фактори
To invade [ǐn`veǐd] Руйнувати, спустошувати
To be depleted [dǐ`pli:tǐd] Бути виснаженим
Persistent [pə`sǐstǐnt] Тривалий
Skin lesions [`skǐn`lǐзns] Враження, пошкодження шкіри
Glands [`glændz] Вузли
Strains [`streǐns] Спадкові риси
Route of infection [`ru:t əv ǐn`fek∫n] Протікання інфекції
Tissues [`ti:sјu:z] Тканини
Contaminated [kəntəmǐ`neǐ∫n] Заражений
To carry [tə`kærǐ] Нести
Fluids [`flu:ǐdz] Рідини
Rectum [`rektəm] Пряма кишка
Urethra [јυ`rǐθrə] Уретра
Vagina [və`dзaǐnə] Піхва
To engage [ǐn`geǐdз] Вступати
To run the risk [`rǎn ðə`rǐsk] Ризикувати
To enhance [ǐn`hæns] Збільшувати, підвищувати
Acquisition [əkwǐ`zǐ∫n] Придбання, набування (хвороби)
Prevention [prǐ`ven∫n] Попередження (хвороби)
Prevalence [`prevəlǐns] Поширення
Remunerated motivating recruiting 
[rǐnјυmǐ`reǐtǐd məυtǐ`veǐtǐŋ rǐ`kru:tǐŋ] Такий, що компенсує
Commitment [kəm`mǐtmǐnt] Зобов’язання 
Support [sə`po:t] Підтримка
Syringe [`sǐrǐndз] Шприц
Rapid rise [`ræpǐd`raǐz] Швидке зростання
Acupuncture [əkјυ`pǎnkt∫ə] Голковколювання
Infants [`ǐnfənts] Немовлята
Probability [prəbə`bǐlǐtǐ] Вірогідність
Amount [ə`ma υnt] Кількість
Cervical secretion [`sə:vǐkl] Секреція шийки матки
Genital lesions [`dзenǐtl li:зnz] Геніальні пошкодження
Semen [`semǐn] Сперма
Vulnerable [`vǎlnərəbl] Вразливий 
penetration [pǐnǐ`treǐ∫n] Проникнення
Exposed mucous membranes 
[ǐks`pəυzd`mјu:kəυəz mǐm`breǐnz] Розкриті слизові оболонки
Gums [`gǎmz] Ясна
Abscessed teeth [æb`sest`ti:θ] Зуби, які гниють
Gonorrhea [gonə`rǐə] Гонорея
Oral [`o:rəl] Оральний
Untreated [ǎn`tri:tǐd] Такий, що не лікується
Warts [`wo:ts] Бородавки, пухирці
Inappropriate [ǐnə`proprǐət] Неправильний
To compound [kəm`pa υnd] Ускладнювати
Retaining [rǐ`teǐnǐŋ] Збереження
Screening [`skri:nǐŋ] Відбір, перевірка
Donated blood [dəυ`neǐtǐd`blǎd] Донорська кров
Sustainable [səs`teǐnǐbl] Такий, що підтримується
Artificial insemination [ǎtǐ`fi:∫l ǐnsǐmǐ`neǐ∫n] Штучне запліднення
To be evaluated [bi: ǐlǐ`veǐtǐd] Бути оціненим
Attached [ə`tæt∫t] Такий, що належить 
Circumcision [səkəm`si:зn] Обрізання
Scarification [skərǐfǐ`keǐ∫n] Скарифікація
Reliable [rǐ`laǐəbl ] Надійний
Available [ə`veǐlǐbl] Наявний
Condom [`kondəm] Презерватив
Pregnancy [`pregnənsǐ] Вагітність
Cuts [`kǎts] Порізи
Destination country [dǐstǐ`neǐ∫n] Країна призначення
Medical kit [`medǐkl`kǐt] Медична скринька
Discharge [dǐs`t∫ǎdз] Виділення
Urination [јυrǐ`neǐ∫n] Сечовипускання
Blisters [`blǐstəz] Пухирі
Itchy [`ǐt∫ǐ] Сверблячий
Acute onset [`ækјu:t ən`set] Гострий наступ
Scratches [`skræt∫ǐz] Царапини
Razor [`reǐzə] Бритви
Sharp [`∫α:p] Гострий
To seek [`si:k] Домагатися
Disposable [dǐs`posǐbl] Одноразовий
Precaution [prǐ`kəυ∫n] Застереження
To ensure [ǐn`∫υə] Запевнити
To decrease [dǐ`kri:z] Зменшити
Illicit [ǐ`lǐsǐt] Заборонений
Nerve palsies [`nə:v`pǎlsǐz] Нервові імпульси
Dementia [dǐ`men∫ǐə] Слабкий розум

Exercises:
1. Complete the following situation:
Dr: Come in. What troubles you?
Patient: Oh, doctor I have problems with my PCR-test.
I’ve got fever and enlarged lymph glands. What should I do?
Dr:
Patient: Should I have my blood tested for Antibodies to the virus?
Dr:
Patient: The matter is that few months ago I had my blood transfused after the episode of anemia. They used donated blood for transfusion.
Dr:
   
  2. Answer the following questions:
1. What the HIV-infection prognostic categories?
2. What is the final stage of HIV- infection?
3. Is the blood best used for diagnostics of HIV and AIDS?
4. Does the infection carry a risk of transmission in protected sexual intercourse?
5. Will the presence of untreated STD influence the progression of HIV?





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