Clinical periods of HIV infection. HIV: stages of the disease. HIV stages "in the context"

HIV infection is a disease caused by the human immunodeficiency virus, characterized by acquired immunodeficiency syndrome, which contributes to the emergence of secondary infections and malignant tumors due to a deep suppression of the body's defenses.

The peculiarity of the virus-causative agent of HIV infection is the development of a sluggish infectious and inflammatory process in the human body, as well as a long period of incubation. In more detail about what kind of disease it is, what are the causes of its development, symptoms and transmission routes, as well as what is prescribed as treatment, we will consider further.

What is HIV infection?

HIV infection is a slowly progressive viral disease that affects the immune system, the extreme stage of which is AIDS (acquired immunodeficiency syndrome).

HIV (Human Immunodeficiency Virus) is a retrovirus from the genus of lentiviruses, infection with which suppresses the activity of the immune system and leads to the development of a slowly progressive disease, HIV infection.

In the human body, nature has laid down a mechanism due to which immune cells produce antibodies that can resist microorganisms with foreign genetic information.

When antigens enter the body, lymphocytes begin to work in it. They recognize the enemy and neutralize it, but when the body is damaged by a virus, the protective barriers are destroyed and a person may die within a year after infection.

The main types of HIV infection:

HIV-1 or HIV-1 - causes typical symptoms, is very aggressive, is the main causative agent of the disease. Discovered in 1983, it is found in Central Africa, Asia and Western Europe, North and South America.
HIV-2 or HIV-2 - HIV symptoms are not so intense, it is considered a less aggressive strain of HIV. Discovered in 1986, it is found in Germany, France, Portugal and West Africa.
HIV-2 or HIV-2 are extremely rare.

Causes and ways of transmission

The higher the immune status of a healthy person, the lower the risk of getting an infection in contact with an HIV-infected patient. And vice versa - weak immunity will lead to an increased risk of infection and a severe course of the resulting disease.

A high viral load in a person with HIV in the body increases his danger as a carrier of the disease several times.

Ways of HIV transmission to humans:

During intercourse without using a condom. And also during oral sex if there are cuts or injuries.
The use of a syringe for injection, a medical instrument after a person infected with HIV.
The ingestion of blood already infected with a virus into the human body. Occurs during treatment, blood transfusion.
Infection of a child from a sick mother in the womb during childbirth or lactation.
Using a tool after a person infected with HIV during cosmetic procedures, manicure or pedicure, tattooing, piercing, etc.
The use of other people's personal hygiene items in everyday life, for example, shaving accessories, a toothbrush, toothpicks, etc.

How can you not get infected with HIV?

If there is an HIV-infected person in your environment, you must remember that you cannot become infected with HIV when:

Coughing and sneezing.
Handshake.
Hugs and kisses.
Sharing food or drinks.
In pools, baths, saunas.
Through "pricks" in transport and metro. Information about a possible infection through infected needles that HIV-infected people put on the seats, or try to inject people in a crowd with them, is nothing more than myths. The virus remains in the environment for an extremely short time, in addition, the content of the virus at the tip of the needle is too small.

HIV is an unstable virus, it quickly dies outside the host's body, is sensitive to temperature (reduces infectious properties at a temperature of 56 ° C, dies after 10 minutes when heated to 70-80 ° C). It is well preserved in blood and blood preparations prepared for transfusion.

At-risk groups:

intravenous drug addicts;
persons, regardless of orientation, using anal sex;
recipients (recipients) of blood or organs;
medical workers;
persons involved in the sex industry, both prostitutes and their clients.

Without highly active antiretroviral therapy, the life expectancy of patients does not exceed 10 years. The use of antiviral drugs can slow the progression of HIV and the development of acquired immunodeficiency syndrome - AIDS. Signs and symptoms of HIV at different stages of the disease have their own color. They are varied and grow in severity of manifestation.

The first signs of HIV in adults

Human Immunodeficiency Virus is a retrovirus that causes HIV infection. Depending on the clinical signs of HIV infection, the following stages are distinguished:

Incubation period.
Primary manifestations: acute infection; asymptomatic infection; generalized lymphadenopathy.
Secondary manifestations. damage to the skin and mucous membranes; persistent lesions of internal organs; generalized diseases.
Terminal stage.

HIV has no symptoms of its own and can disguise itself as any infectious disease. At the same time, bubbles, pustules, seborrheic dermatitis appear on the skin. The virus can be detected only with the help of tests: an HIV test.

The first signs to look out for are:

Fever of unknown origin for more than 1 week.
An increase in various groups of lymph nodes: cervical, axillary, inguinal - for no apparent reason (absence of inflammatory diseases), especially if lymphadenopathy does not go away within several weeks.
Diarrhea for several weeks.
The appearance of signs of candidiasis (thrush) of the oral cavity in an adult.
Extensive or atypical localization of herpetic eruptions.
A sharp decrease in body weight, regardless of any reason.

Symptoms of HIV infection

The course of HIV infection is quite diverse, all stages do not always take place, certain clinical signs may be absent. Depending on the individual clinical course, the duration of the disease can be as long as several months or 15-20 years.

The main symptoms of HIV infection:

Enlargement of 2 or more lymph nodes, unrelated to each other, which are painless, and the skin above them does not change its color;
Increased fatigue;
A gradual decrease in CD4-lymphocytes, at a rate of approximately 0.05-0.07 × 10 9 / l per year.

Such symptoms accompany the patient from about 2 to 20 years or more.

In the human body, HIV goes through 5 stages, each of which is accompanied by certain signs and symptoms.

Stage 1 Human Immunodeficiency Virus

HIV infection stage 1 (window period, seroconversion, incubation period) - the period from infection of the body with a virus until the appearance of the first antibodies detected in it. Usually it is from 14 days to 1 year, which largely depends on the health of the immune system.

Stage 2 (acute phase)

The appearance of primary symptoms, which are subdivided into periods A, B, C.

Period 2A - no symptoms.
Period 2B - the first manifestations of infection, similar to the course of other infectious diseases.
2B - manifests itself in the form of herpes, pneumonia, but at this stage of the development of the disease, infections respond well to treatment. Period 2B lasts 21 days.

The latency period and its symptoms

The latent stage of HIV lasts up to 2-20 years or more. Immunodeficiency progresses slowly, HIV symptoms are expressed - by an increase in lymph nodes:

They are elastic and painless, mobile, the skin retains its normal color.
When diagnosing latent HIV infection, the number of enlarged nodes is taken into account - at least two, and their localization - at least 2 groups that are not connected by a common lymph flow (the exception is the inguinal nodes)

Stage 4 (pre-AIDS)

This stage begins when the level of CD4 + lymphocytes drops critically and approaches the figure of 200 cells in 1 μl of blood. As a result of this suppression of the immune system (its cellular link), the patient appears:

recurrent herpes and, genitals,
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.

Stage 5 HIV infection (AIDS)

The terminal stage is characterized by irreversible changes, treatment is ineffective. The number of T-helpers (CD4 cells) falls below 0.05x109 / l, patients die in weeks or months from the onset of the stage. In drug addicts who have been using psychoactive substances for several years, the CD4 level can remain almost within the normal range, but severe infectious complications (abscesses, etc.) develop very quickly and lead to death.

The number of lymphocytes decreases so much that infections that would otherwise never occur to a person begin to cling to. These diseases are called AIDS-associated infections:

Kaposi's sarcoma;
brain;
, bronchi or lungs;
pneumocystis pneumonia;
pulmonary and extrapulmonary tuberculosis, etc.

Pathogenic factors that accelerate the development of the disease from stage 1 to AIDS:

Lack of timely and adequate treatment;
Coinfection (joining other infectious diseases with HIV);
Stress;
Poor quality food;
Elderly age;
Genetic features;
Bad habits - alcohol, smoking.

HIV has no symptoms of its own and can disguise for any infectious diseases. At the same time, bubbles, pustules, lichen appear on the skin. The virus can be detected only with the help of tests: an HIV test.

Diagnosis and test for HIV

If you suspect HIV infection, you need to contact an infectious disease specialist. The test can be taken anonymously at the AIDS Prevention and Control Center, which is located in every region. There, doctors provide consultations on all issues related to HIV infection and AIDS.

The acute phase predominantly does not determine the presence of antibodies, however, three months after the moment of infection, in about 95% of cases, they are detected.

HIV diagnosis consists of special tests:

1th test - enzyme-linked immunosorbent assay (ELISA)... This is the most common diagnostic method. Three months after the virus enters the bloodstream, the amount of antibodies accumulates in the human body, which can be determined by an enzyme-linked immunosorbent assay. In about 1% of cases, it gives false positive or false negative results.
2nd test - immunoblot (Immune Blotting)... This test detects the presence of specific antibodies to HIV. The result can be positive, negative, and questionable (or uncertain). An indeterminate result may mean that HIV is present in the person's bloodstream, but the body has not yet developed the full range of antibodies.
PCR or polymerase chain reaction used to identify any infectious agent, including the HIV virus. In this case, its RNA is detected, and the pathogen can be identified at very early stages (at least 10 days must pass after infection).
Rapid tests, thanks to which within 15 minutes you can determine the presence of HIV infection. There are several types of them:
- The most accurate test is immunochromatographic. The test consists of special strips on which capillary blood, urine or saliva is applied. If antibodies to HIV are detected, then the strip has a colored line and a control line. If the answer is no, only a line is visible.
- Home use kits "OraSure Technologies1". Developer - America. It was this test that was approved by the FDA.

Incubation period the HIV virus is 90 days. During this period, it is difficult to detect the presence of pathology, but this can be done by means of PCR.

Even after the final diagnosis of HIV infection, during the entire period of the disease, it is necessary to conduct regular laboratory examination of the patient in order to monitor the course of clinical symptoms and the effectiveness of treatment.

Treatment and prognosis

A cure for HIV has not yet been invented, a vaccine does not exist. It is impossible to remove the virus from the body, and this is a fact at this time. However, one should not lose hope: active antiretroviral therapy (HAART) can reliably slow down and even practically stop the development of HIV infection and its complications.

Mostly, treatment is etiotropic and implies the appointment of such drugs, due to which a decrease in the reproductive capabilities of the virus is ensured. In particular, these include the following drugs:

nucleoside transcriptase inhibitors (otherwise - NRTIs) corresponding to different groups: ziagen, videx, zerit, combined drugs (combivir, trizivir);
nucleotide reverse transcriptase inhibitors (otherwise - NTIOT): stcrin, viramune;
fusion inhibitors;
protease inhibitors.

The main task of the attending specialist in the selection of a drug regimen for antiviral treatment of HIV is to minimize adverse reactions. In addition to the use of specific drugs, the patient must necessarily correct the eating behavior, as well as the work and rest regime.

In addition, one should consider that some of the HIV-infected belong to the category of nonprogressors, who have viral particles in their blood, but the development of AIDS does not occur.

Factors slowing down the transition of HIV infection to the stage of AIDS:

Highly active antiretroviral therapy (HAART) started on time. In the absence of HAART, the patient's death occurs within 1 year from the date of the diagnosis of AIDS. It is believed that in regions where HAART is available, the life expectancy of HIV-infected people reaches 20 years.
Lack of side effects on taking antiretroviral drugs.
Adequate treatment of comorbidities.
Adequate food.
Rejection of bad habits.

The main role in curbing the developing AIDS is played by the patient's psychological state and his efforts to comply with the prescribed regimen.

It's all about HIV infection: what are the first symptoms in women and men, how to treat the disease. Do not be ill!

AIDS is a global problem for all mankind. At the moment, the prevalence of HIV infection has reached a pandemic. Worldwide, the immunodeficiency virus infects more than 8.5 thousand people every day.

AIDS Facts:

It was possible to reliably identify the disease only in 1981 in the United States. A few years later, the pathogen was identified, and in 1987 its spread took on the character of an epidemic.
Infection with the immunodeficiency virus occurs mainly through sexual contact, through the blood during medical manipulations and from mother to child during intrauterine development.
The immunodeficiency virus infects CD4 lymphocytes, which are responsible for suppressing pathogens of infectious diseases and neutralizing malignant cells. HIV infection penetrates into all tissues of the body, changes the genetic code of cells and tunes them to work for their own replication.
The insidiousness of the virus is that the first symptoms of the disease can appear only 10 years after infection. It is possible to reliably identify HIV infection no earlier than 6–12 weeks after infection, sometimes at least six months must pass to obtain an objective result.

The variability of the virus makes it impossible to fight the disease through vaccination, so prevention is of paramount importance in the spread of AIDS.

CAUSES

The causative agent of the disease is the human immunodeficiency virus of the retrovirus family. Attaching to leukocytes and penetrating into them, it begins the process of active replication, spreading throughout the body. HIV not only malignant lymphocytes, but also destroys them. Gradually, the number of CD4 lymphocytes decreases and when their number is less than 200 in 1 ml, AIDS is diagnosed.

The source of infection is the carrier of the immunodeficiency virus at any stage of its development, regardless of the presence of clinical severity. The most common route of transmission is sexual, especially through unprotected homosexual intercourse.

Routes of HIV transmission:

Transmission through unprotected sex... Includes the vaginal, oral and anal routes of entry of the virus. On average, about 70% of patients become infected with this method. Most of them relate to heterosexual relationships, however, unprotected homosexual contact is considered the most dangerous due to traumatic effects. Microtrauma of the mucous surface of the anal canal creates favorable conditions for the penetration of the virus. In addition, the epithelium of the rectum serves as a kind of reservoir for the causative agent of immunodeficiency. Traditional heterosexual contacts with the presence of ulcerative lesions of the genital organs and occurring without the use of barrier methods of contraception, increase the risk of infection by 10-50 times. One such intercourse is enough to contract an incurable disease. The pathogen is found not only in the blood, it is found in the semen and secretions of the cervical canal in women.
Vertical transmission path during pregnancy from mother to child... The pathogen enters the child's body transplacentally or during childbirth. In the first case, this is possible with damage to the placental barrier. During childbirth, when the child passes through the birth canal, he receives minor skin lesions, through which infected blood and vaginal secretions penetrate into the child's body. The causative agent is excreted in small quantities along with breast milk, therefore, it is recommended to transfer such children to artificial feeding immediately after birth.
Broadcast through infected blood or its components (parenteral route). Use of infected medical instruments (needles, syringes, surgical instruments), administration of solutions and drugs, transfusion of contaminated blood and its components. With intravenous administration of the virus, the probability of infection approaches absolute. The risk group includes not only hospital patients and drug addicts, but also visitors to manicure and tattoo parlors. In addition, people with hemophilia who require frequent blood transfusions are susceptible to the disease.

At-risk groups:

Gay and bisexual men account for ¾ of AIDS patients;
people who have sex without using a condom;
drug addicts using drugs for intravenous injection, as well as their sexual partners;
persons suffering from sexually transmitted diseases;
patients with hemophilia and requiring hemodialysis;
children of HIV-infected mothers;
women in prostitution and their clients.

Infection with the immunodeficiency virus through dishes, with insect bites, kissing, shaking hands and airborne droplets is impossible.

SYMPTOMS

Long-term studies have shown that from the moment of infection to the appearance of signs of immunodeficiency syndrome, it takes from 5 to 10-12 years, and from the invasion to the massive spread of the virus - from 1 to 3 months.

The progression of the disease depends on many factors: the genetic characteristics of the patient, his social level and the strain of the pathogen. Modern antiretroviral therapy helps slow the progression of HIV and prevent the development of AIDS.

Stages of development of HIV infection:

Mononucleosis-like syndrome is typical for 50–70% of patients. It manifests itself 3–6 weeks after the moment of infection in the form of an increase in body temperature to subfebrile, sore throat, swollen lymph nodes, headaches, myalgia, drowsiness and skin rashes. These symptoms are nonspecific, so they may appear to varying degrees or be absent altogether. The acute phase is observed for one or several weeks, then turns into an asymptomatic course of the disease.
The asymptomatic phase in half of the patients is about 10 years, but it can vary widely, since it depends on the rate of viral replication.
Sometimes generalized lymphadenopathy is observed, which is characterized by an increase in all groups of lymph nodes or several in the neck, above the collarbone, in the groin or in the armpits.
The stage of the expanded AIDS clinic. With a sharp decrease in the number of CD4 lymphocytes (less than 200 / μl), a transition to immunodeficiency syndrome occurs. At this stage, opportunistic infections are sharply activated. The conditioned microflora, which previously could not provoke the development of diseases due to the counteraction of immunity, now manifests the properties of pathogenic agents in the body of an infected person.

Stages of development of AIDS:

Reducing the patient's weight by 10%. At this stage, a person is susceptible to fungal, viral and bacterial infections, which manifest themselves in the form of: shingles, herpes infection, candidal stomatitis, leukoplakia of the mouth. In addition, the likelihood of developing pharyngitis is high. Against the background of a reduced number of platelets, bleeding of the gums and minor hemorrhages on the skin of the extremities appear.
Reducing the patient's weight by more than 10%. The general clinical picture is joined by: prolonged diarrhea and fever, toxoplasmosis, pneumocystis pneumonia, oncological diseases (Kaposi's sarcoma, lymphoma). At this stage, symptoms progress steadily and are fatal.

With regard to children infected with HIV-positive mothers in the prenatal period, a feature of the course of the disease is rapid progression. Children who are infected over the age of one year develop the disease at a less accelerated rate.

DIAGNOSTICS

Differential diagnosis is performed to exclude or confirm other immunodeficiency conditions.

Basic symptoms for the diagnosis of AIDS:

belonging to risk groups;
frequent infectious diseases caused by opportunistic microflora (pneumocystis pneumonia);
respiratory infections with frequent relapses;
prolonged fever of unknown origin;
prolonged diarrhea;
a sharp decrease in weight by more than 10%;
inflammation of several groups of lymph nodes;
lymphomas of the central nervous system;
Kaposi's sarcoma;
long course of any diseases associated with immunodeficiency.

Laboratory tests for the diagnosis of HIV:

Serological methods are based on methods for detecting specific proteins - antibodies that arise in response to the penetration of the immunodeficiency virus into the body. The ability to detect antibodies appears only 3–6 months after infection. The standard laboratory diagnostic method is the enzyme-linked immunosorbent assay (ELISA). Despite its widespread prevalence, a significant drawback is the frequent diagnosis of false positive results, therefore, it is customary to check positive and dubious samples in more reliable ways. These methods include immunoblotting and PCR.
Immunoblotting, in addition to antibodies to HIV, is capable of detecting antibodies to the proteins of the envelope and core of viral particles.
Polymerase chain reaction (PCR). In addition to serological methods, methods of direct detection of the DNA and RNA of the virus are used. PCR is a rather expensive method, so it is not used for routine screening.

TREATMENT

No specific treatment for AIDS has yet been developed. Therapeutic measures are aimed at symptomatic, antiretroviral therapy, immunocorrection and treatment of cancer. Modern medicines are not able to restore the immune system, their function is to curb the development of the disease. The approach to prescribing drugs is always individual.

Methods for treating AIDS:

Antiretroviral drugs... The most pronounced effect of antiretroviral therapy can be achieved if it is prescribed even before the appearance of virological and immunological signs of disease progression. Antiviral drugs are prescribed when an acute infection develops. Their action is to suppress the multiplication of the virus. The structure of the immunodeficiency virus contains proteins, the active substance of the drug acts on them in such a way that replication of the virus becomes impossible. The complexity of such treatment lies in the high resistance of HIV, therefore, it is often necessary to take several drugs at the same time. Combination therapy can suppress the growth of the pathogen so much that it becomes difficult to detect it by laboratory methods. Monotherapy with a single antiretroviral drug is indicated for pregnant women to prevent transmission of the virus to the fetus. The disadvantage of this treatment is its high cost and side effects of the drugs.
Treatment of opportunistic infections and cancers start with the appointment of high doses of antibacterial and chemotherapy drugs. In this case, the doctor takes into account not only the sensitivity of the microflora, but also the patient's ability to endure such therapy. Infection caused by opportunistic microflora and Kaposi's sarcoma are treated for at least 6 weeks. The duration of treatment depends on the activity of the development of the pathological process. A common complication of treatment is the side effects of drugs to suppress fungi, bacteria, viruses and other pathogens at the last stage of the disease.

COMPLICATIONS

Complications of AIDS include the development of opportunistic infections, cancers and side effects of drugs.

Complications of AIDS:

HPV, or human papillomavirus;
histoplasmosis;
pneumocystis pneumonia;
cryptococcal meningitis;
cryptosporiasis;
herpes zoster;
Kaposi's sarcoma;
lymphoma;
invasive cervical cancer;
side effects of medications.

Complications are observed among patients who are diagnosed with HIV at the AIDS stage, as well as in people who are not receiving antiretroviral therapy or who are resistant to these drugs.

PREVENTION

There are no specific drugs (vaccines), so prevention is the most effective method of fighting AIDS.

Preventive actions:

the use of barrier contraception during sexual intercourse;
avoidance of sexual intercourse with prostitutes, drug addicts and unfamiliar people;
limiting the number of sexual partners;
refusal to use other people's personal hygiene products for shaving and brushing teeth;
for any manipulation, only disposable sterile instruments should be used.

The fight against AIDS in the health sector:

donor screening;
examination of persons at risk;
examination of all pregnant women for the presence of antibodies to HIV;
transfer of a child born to an HIV-positive woman to artificial feeding.

RECOVERY OUTLOOK

In general, the prognosis for AIDS is very disappointing. Life expectancy after diagnosis is no more than two years, with an average of 6 to 19 months. In the absence of antiretroviral therapy, the patient lives for no more than a year. In developed countries, where special drugs are available, mortality is reduced by 85–99%.

Factors affecting patient survival:

living conditions;
the age of the patient;
fulfillment of medical appointments;
immune status;
individual tolerance of drugs;
the presence of concomitant pathologies;
taking drugs.

The patient's life expectancy will depend on how quickly HIV is diagnosed and treatment is started. On average, it is about 20 years.

There is an upward trend in life expectancy with HIV. But, despite the constant development in this area and the production of new effective drugs, the virus is gradually developing resistance to them.

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It is a disease caused by the human immunodeficiency virus, characterized by acquired immunodeficiency syndrome, which contributes to the emergence of secondary infections and malignant tumors due to the deep suppression of the body's defenses. HIV infection has a varied course. The disease can last only a few months or stretch up to 20 years. The main method for diagnosing HIV infection remains the detection of specific antiviral antibodies, as well as viral RNA. Currently, HIV patients are treated with antiretroviral drugs that can reduce the reproduction of the virus.

General information

Characteristics of the pathogen

DNA-containing human immunodeficiency virus belongs to the genus Lentivirus of the Retroviridae family. There are two types: HIV-1 is the main causative agent of HIV infection, the cause of a pandemic, the development of AIDS. HIV-2 is an uncommon type, found mainly in West Africa. HIV is an unstable virus, it quickly dies outside the host's body, is sensitive to temperature (reduces infectious properties at a temperature of 56 ° C, dies after 10 minutes when heated to 70-80 ° C). It is well preserved in blood and blood preparations prepared for transfusion. The antigenic structure of the virus is highly variable.

The reservoir and source of HIV infection is a person: AIDS sufferer and carrier. Natural reservoirs of HIV-1 have not been identified; it is believed that wild chimpanzees are the natural host in nature. HIV-2 is carried by African monkeys. Susceptibility to HIV in other animal species has not been noted. The virus is found in high concentrations in blood, semen, vaginal secretions and menstrual flow. It can be secreted from human milk, saliva, lacrimal secretions and cerebrospinal fluid, but these biological fluids pose less epidemiological danger.

The likelihood of HIV transmission increases in the presence of damage to the skin and mucous membranes (trauma, abrasions, erosion of the cervix, stomatitis, periodontal disease, etc.) child) and artificial (mainly realized with the hemopercutaneous transmission mechanism: with transfusions, parenteral administration of substances, traumatic medical procedures).

The risk of HIV infection with a single contact with a carrier is low; regular sex with an infected person significantly increases it. Vertical transmission of infection from a sick mother to a child is possible both in the prenatal period (through defects in the placental barrier) and in childbirth, when the child comes into contact with the mother's blood. In rare cases, postnatal transmission with breast milk is recorded. The incidence among children in infected mothers reaches 25-30%.

Parenteral infection occurs through injections with needles contaminated with the blood of HIV-infected persons, during blood transfusions of contaminated blood, non-sterile medical procedures (piercings, tattoos, medical and dental procedures performed with instruments without proper treatment). HIV is not transmitted by household contact. A person's susceptibility to HIV infection is high. The development of AIDS in persons over 35 years old, as a rule, occurs in a shorter period of time from the moment of infection. In some cases, there is an immunity to HIV, which is associated with specific immunoglobulins A, which are present on the mucous membranes of the genital organs.

Pathogenesis of HIV infection

The human immunodeficiency virus, when it enters the bloodstream, is introduced into macrophages, microglia and lymphocytes, which are important in the formation of the body's immune responses. The virus destroys the ability of immune bodies to recognize their antigens as foreign, populates the cell and starts reproduction. After the multiplied virus enters the bloodstream, the host cell dies, and the viruses invade healthy macrophages. The syndrome develops slowly (over the years), in waves.

At first, the body compensates for the massive death of immune cells, producing new ones, over time, compensation becomes insufficient, the number of lymphocytes and macrophages in the blood decreases significantly, the immune system is destroyed, the body becomes defenseless against both exogenous infection and bacteria inhabiting organs and tissues is normal (which leads to the development of opportunistic infections). In addition, the defense mechanism against the multiplication of defective blastocytes - malignant cells - is disrupted.

The colonization of immune cells by the virus often provokes various autoimmune conditions, in particular, neurological disorders are characteristic as a result of autoimmune damage to neurocytes, which can develop even before the clinical picture of immunodeficiency appears.

Classification

In the clinical course of HIV infection, 5 stages are distinguished: incubation, primary manifestations, latent, stage of secondary diseases and terminal. The stage of primary manifestations can be asymptomatic, in the form of primary HIV infection, and also be combined with secondary diseases. The fourth stage, depending on the severity, is divided into periods: 4A, 4B, 4C. The periods go through phases of progression and remission, which differ depending on the antiretroviral therapy taking place or not.

Symptoms of HIV infection

Incubation stage (1)- can be from 3 weeks to 3 months, in rare cases it can be extended up to a year. At this time, the virus is actively multiplying, but there is still no immune response to it. The incubation period of HIV ends either with the clinic of acute HIV infection, or with the appearance of HIV antibodies in the blood. At this stage, the basis for the diagnosis of HIV infection is the detection of the virus (antigens or DNA particles) in the blood serum.

Primary manifestation stage (2) characterized by the manifestation of the body's response to active replication of the virus in the form of a clinic of acute infection and immune response (production of specific antibodies). The second stage may be asymptomatic, the only sign of developing HIV infection will be a positive serological diagnosis for antibodies to the virus.

The clinical manifestations of the second stage are of the type of acute HIV infection. The onset is acute, observed in 50-90% of patients three months after the moment of infection, often preceding the formation of HIV antibodies. Acute infection without secondary pathologies has a rather diverse course: fever, various polymorphic rashes on the skin and visible mucous membranes, polylymphadenitis, pharyngitis, lienal syndrome, diarrhea can be noted.

In 10-15% of patients, acute HIV infection proceeds with the addition of secondary diseases, which is associated with a decrease in immunity. It can be tonsillitis, pneumonia of various origins, fungal infections, herpes, etc.

Acute HIV infection usually lasts from several days to several months, on average 2-3 weeks, after which, in the vast majority of cases, it goes into a latent stage.

Latent stage (3) characterized by a gradual increase in immunodeficiency. The death of immune cells at this stage is compensated by their increased production. At this time, HIV can be diagnosed using serological tests (antibodies to HIV are present in the blood). The clinical sign may be an increase in several lymph nodes from different, unrelated groups, excluding the inguinal lymph nodes. At the same time, there are no other pathological changes on the part of enlarged lymph nodes (soreness, changes in the surrounding tissues). The latent stage can last from 2-3 years to 20 or more. On average, it lasts 6-7 years.

Secondary disease stage (4) characterized by the occurrence of concomitant (opportunistic) infections of viral, bacterial, fungal, protozoal genesis, malignant tumors against the background of severe immunodeficiency. Depending on the severity of secondary diseases, there are 3 periods of the course.

4A - the loss of body weight does not exceed 10%, there are infectious (bacterial, viral and fungal) lesions of the integumentary tissues (skin and mucous membranes). The performance is reduced.
4B - weight loss of more than 10% of the total body weight, prolonged temperature reaction, possible prolonged diarrhea that does not have an organic cause, pulmonary tuberculosis may join, infectious diseases recur and progress, localized Kaposi's sarcoma, hairy leukoplakia are detected.
4B - general cachexia is noted, secondary infections acquire generalized forms, candidiasis of the esophagus, respiratory tract, pneumocystis pneumonia, extrapulmonary tuberculosis, disseminated Kaposi's sarcoma, neurological disorders are noted.

Substages of secondary diseases go through phases of progression and remission, which differ depending on the antiretroviral therapy taking place or its absence. In the terminal stage of HIV infection, secondary diseases that develop in the patient become irreversible, treatment measures lose their effectiveness, and death occurs after a few months.

Features of the clinic of HIV infection in children

HIV in early childhood contributes to delayed physical and psychomotor development. Recurrence of bacterial infections in children is noted more often than in adults, often lymphoid pneumonitis, an increase in pulmonary lymph nodes, various encephalopathies, anemia. A common cause of infant mortality in HIV infections is hemorrhagic syndrome, which is a consequence of severe thrombocytopenia.

The most frequent clinical manifestation of HIV infection in children is a delay in the pace of psychomotor and physical development. HIV infection received by children from mothers ante- and perinatally is much more severe and progresses faster, in contrast to that in children infected after a year.

Diagnostics

Currently, the main diagnostic method for HIV infection is the detection of antibodies to the virus, which is carried out mainly using the ELISA technique. In case of a positive result, the blood serum is examined using the method of immune blotting. This allows the identification of antibodies to specific HIV antigens, which is a sufficient criterion for the final diagnosis. Failure to detect characteristic molecular weights by blotting antibodies, however, does not exclude HIV. During the incubation period, the immune response to the introduction of the virus has not yet been formed, and in the terminal stage, as a result of severe immunodeficiency, antibodies cease to be produced.

In case of suspicion of HIV and the absence of positive results of immune blotting, PCR is an effective method for detecting virus RNA particles. HIV infection diagnosed by serological and virological methods is an indication for dynamic monitoring of the state of the immune status.

Treatment of HIV infection

Therapy for HIV-infected individuals implies constant monitoring of the body's immune status, prevention and treatment of emerging secondary infections, and control over the development of neoplasms. Often, HIV-infected people require psychological assistance and social adaptation. Currently, due to the significant spread and high social significance of the disease on a national and global scale, support and rehabilitation of patients is being carried out, access to social programs is expanding, providing patients with medical care, facilitating the course and improving the quality of life of patients.

To date, the predominant etiotropic treatment is the appointment of drugs that reduce the reproductive capacity of the virus. Antiretroviral drugs include:

NRTIs (nucleoside transcriptase inhibitors) of various groups: zidovudine, stavudine, zalcitabine, didanosine, abacavir, combination drugs;
NTIOT (nucleotide reverse transcriptase inhibitors): nevirapine, efavirenz;
protease inhibitors: ritonavir, saquinavir, darunavir, nelfinavir and others;
fusion inhibitors.

When deciding to start antiviral therapy, patients should remember that the use of drugs has been carried out for many years, almost for life. The success of therapy directly depends on strict adherence to the recommendations: timely regular intake of drugs in the required dosages, adherence to the prescribed diet and strict adherence to the regimen.

Emerging opportunistic infections are treated in accordance with the rules of effective therapy against the causative agent that caused them (antibacterial, antifungal, antiviral agents). Immunostimulating therapy for HIV infection is not used, since it contributes to its progression, cytostatics prescribed for malignant tumors suppress immunity.

Treatment of HIV-infected people includes general strengthening and body support agents (vitamins and biologically active substances) and methods of physiotherapeutic prevention of secondary diseases. Patients suffering from drug addiction are recommended to be treated in appropriate dispensaries. Due to significant psychological discomfort, many patients undergo long-term psychological adaptation.

Forecast

HIV infection is completely incurable; in many cases, antiviral therapy has little effect. Today, on average, HIV-infected people live 11-12 years, but careful therapy and modern medications will significantly lengthen the life of patients. The main role in curbing the developing AIDS is played by the patient's psychological state and his efforts to comply with the prescribed regimen.

Prevention

Currently, the World Health Organization is carrying out general preventive measures to reduce the incidence of HIV infection in four main areas:

education on safety of sexual relations, distribution of condoms, treatment of sexually transmitted diseases, promotion of a culture of sexual relations;
control over the manufacture of drugs from donated blood;
managing the pregnancy of HIV-infected women, providing them with medical care and providing them with chemoprophylaxis (in the last trimester of pregnancy and during childbirth, women receive antiretroviral drugs, which are also prescribed to newborn babies for the first three months of life);
organization of psychological and social assistance and support for HIV-infected citizens, counseling.

At present, in the world practice, special attention is paid to such epidemiologically important factors in relation to the incidence of HIV infection as drug addiction, promiscuous sex life. As a preventive measure in many countries, free distribution of disposable syringes and methadone substitution therapy is carried out. As a measure to reduce sexual illiteracy, courses on sexual hygiene are being introduced into curricula.

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

general description

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

In a significant amount, the content of the virus is noted in the blood, menstrual flow, in vaginal secretions and in semen. In addition, the virus is also found in saliva, human milk, cerebrospinal and lacrimal fluids. The greatest danger lies in its presence in vaginal secretions, semen and blood.

In the case of an actual inflammatory process or in the presence of mucosal lesions in the genital area, which, for example, is possible when, the possibility of transmission of the infection in question in both directions increases. That is, the affected area acts in this case as an entrance / exit gate through which HIV transmission is ensured. A single sexual contact determines the possibility of transmission of infection in a low percentage of probability, but with an increase in the frequency of sexual intercourse, the greatest activity is noted precisely with this method. Under domestic conditions, the transmission of the virus does not occur. Possible is the variant of HIV transmission under the condition of placental defect, which, accordingly, is relevant when considering the transmission of HIV during pregnancy. In this case, HIV appears directly in the bloodstream of the fetus, which is also possible in the process of labor during traumatization, which is relevant for the birth canal.

The implementation of the parenteral mode of transmission is also possible through transfusion of blood, frozen plasma, platelets and erythrocyte mass. About 0.3% of the total number of infections is due to infection through injections (subcutaneous, intramuscular), including accidental injections. Otherwise, similar statistics can be presented in a variant of 1 case for every 300 injections.

On average, up to 35% of children of HIV-infected mothers also become infected. The possibility of infection when feeding by infected mothers is not excluded.

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

Also, within the framework of considering the period of the last several years, the dominance of the parenteral route of infection is noted, in which people who use the same syringe are exposed to infection at the same time, which, as you can understand, is especially important among drug addicts.

In addition, the indicators of the number of infection during heterosexual contact are also subject to increase. This kind of tendency is quite understandable, in particular, when it comes to drug addicts who act as a source of infection transmitted to their sexual partners.

Recently, there has been a sharp rise in HIV prevalence among donors.

HIV: risk groups

The risk groups for increased risk of infection include the following individuals:

persons using injecting drugs, as well as common utensils required for the preparation of such drugs, this also includes the sexual partners of such persons;
persons who, regardless of their actual orientation, practice unprotected sex (including anal);
persons who have undergone a donor blood transfusion procedure without prior screening;
doctors of various profiles;
persons suffering from one or another venereal disease;
persons directly involved in the field of prostitution, as well as persons using their services.

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

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

Sexual contact in its protected version, but with a break in the condom or in violation of its integrity, is no longer such. To minimize such situations, it is important to use a condom according to the rules provided for this, it is also important to choose a reliable type of condom.

Considering the features of transmission and risk groups, it is not superfluous to note how HIV is not transmitted:

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

Forms of the disease

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

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

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

In addition, there is a clinical classification of HIV in accordance with specific stages: the incubation stage and the stage of primary manifestations, the latent stage and the stage of development of secondary manifestations, as well as the terminal stage. Primary manifestations in this classification can be characterized by the absence of symptoms, as a primary infection itself, including a possible combination with secondary diseases. For the fourth of the listed stages, it is relevant to subdivide for certain periods in the form of 4A, 4B and 4B. For periods, it is characteristic to pass through the progression phase, as well as through the remission phase, while the difference during these phases is whether antiviral therapy is applied to them or it is absent. Actually, based on the listed classification, the main symptoms of HIV infection are determined for each specific period.

HIV infection: symptoms

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

Incubation stage

The duration of this stage can be on the order of three weeks to three months, in some, rather rare cases, the lengthening of this period can reach a year. This period is characterized by the activity of reproduction on the part of the virus; there is no immune response to it at this time. The end of the incubation period of HIV infection is marked either by the clinic characterizing acute HIV infection, or by the appearance of antibodies against HIV in the patient's blood. Within the framework of this stage, the detection of DNA particles of the virus or its antigens in the blood serum serves as the basis for diagnosing HIV infection.

Primary manifestations

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

The manifestations that characterize the second stage are manifested in the form of acute HIV infection. Actually, the onset here is acute, and it is noted in about half of the patients (up to 90%) 3 months after the infection occurred, while the onset of manifestations is often preceded by the activation of the formation of HIV antibodies. The course of an acute infection with the exclusion of secondary pathologies in it can be very different. So, fever, diarrhea, pharyngitis, of various types and specifics of the rash, concentrated in the area of visible mucous membranes and skin, lienal syndrome, polylymphadenitis, can develop.

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

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

Latent stage

The course of this stage is accompanied by a gradual increase in the state of immunodeficiency. In this case, the compensation for the death of immune cells occurs by their intensive production. Diagnosis of HIV within this period is possible, again, due to serological reactions, in which antibodies are detected in the blood against the influencing HIV infection. As for the clinical signs, they can be manifested here in an increase in several lymph nodes in various groups that are not related to each other (with the exception of the inguinal). There are no changes of another type in the lymph nodes, in addition to their enlargement (that is, there is no soreness and any other characteristic changes in the area of the surrounding tissues). The duration of the latent stage can be about 2-3 years, although variants of its course within 20 years and longer are not excluded (average indicators are mainly reduced to figures up to 7 years).

Accession of secondary diseases

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

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

- 4B. Weight loss exceeds 10% of the usual parameters of the patient's body weight, the temperature reaction is long lasting. The possibility of a prolonged course of diarrhea is not excluded, and without the presence of organic reasons for its occurrence, in addition to this, tuberculosis may develop. The infectious type of the disease recurs, subsequently progressing in a noticeable way. In patients during this period, hairy leukoplakia, Kaposi's sarcoma is revealed.

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

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

Terminal stage

Secondary diseases within this stage, acquired during HIV infection, become irreversible in their own course due to the peculiarities of the state of immunity and the body as a whole. The methods of therapy applied to them lose any effectiveness, therefore, after a few months, a lethal outcome occurs.

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

HIV infection in children: symptoms and features

Most of the clinical manifestations of HIV infection in children are reduced to developmental delays at the physical and psychomotor levels.
Children more often than adults are faced with the development of recurrent forms of bacterial infections, with encephalopathy, hyperplasia of the pulmonary lymph nodes. Thrombocytopenia is often diagnosed, the clinical manifestations of which are the development of hemorrhagic syndrome, due to the peculiarities of which a fatal outcome often occurs. In frequent cases, it also develops.

With regard to HIV infection in children of HIV-infected mothers, there is a much more accelerated progression of its course. If a child becomes infected at the age of one year, then the development of the disease mainly occurs at a less accelerated rate.

Diagnosis

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

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

Treatment

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

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

nucleoside transcriptase inhibitors (otherwise - NRTIs) corresponding to different groups: ziagen, videx, zerit, combined drugs (combivir, trizivir);
nucleotide reverse transcriptase inhibitors (otherwise - NTIOT): stcrin, viramune;
fusion inhibitors;
protease inhibitors.

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

With HIV infection, the use of immunostimulating therapy is excluded, because it only contributes to the progression of HIV. Prescribed in such cases, cytostatics for malignant neoplasms lead to suppression of immunity.

In the treatment of HIV-infected patients, drugs are used for the general strengthening effect, as well as agents that provide support for the body (dietary supplements, vitamins), in addition, methods are used that are focused on the prevention of the development of secondary diseases.

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

If you suspect the urgency of the HIV diagnosis, you should visit an infectious disease specialist.

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 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 grow in severity of manifestation. The clinical classification of HIV infection proposed in 1989 by V.I.

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.

The 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 an "inactive" state (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 deteriorate, but antibodies in the blood serum to HIV antigens are already appearing. This stage is called the latent phase or the period of "carriage". When immunodeficiency viruses enter the human body, they begin to reproduce themselves immediately. But the clinical manifestations of the disease appear only when the weakened immunity ceases to properly protect the patient's body from infections.

It is impossible to say exactly how long the HIV infection takes place. The duration of the incubation period is influenced by the route and nature of infection, the infecting dose, the patient's age, his immune status and many other factors. With transfusion of infected blood, the latency period is shorter than with sexual transmission.

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's antibodies are still absent and he, thinking that he is not infected with HIV, continues to infect others.

Examination of contact persons with HIV-infected patients makes it possible to diagnose the disease at the "carrier" stage.

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

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

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 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 varied and multiple that they create certain difficulties in diagnosing HIV infection by a doctor during this period. Despite this, the acute febrile phase passes 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 clinical picture of the disease is rapidly developing.

Mononucleosis-like syndrome in HIV

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

Mononucleosis-like syndrome occurs with fever, pharyngitis, rash, headaches, muscle and joint pains, diarrhea and lymphadenopathy, enlarged spleen and liver. 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. Cases of development of oral candidiasis and candidal esophagitis, pneumocystis pneumonia, cytomegalovirus colitis, tuberculosis and cerebral toxoplasmosis have been reported.

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

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

Rice. 3. Fatigue, malaise, headaches, muscle and joint pains, fever, diarrhea, severe night sweats are symptoms of HIV in the early stages.

Intoxication syndrome in HIV

In the acute febrile stage, body temperature rises in 96% of patients. Fever reaches 38 0 C and lasts 1 - 3 weeks and often. Half of all patients have headaches, muscle and joint pains, a feeling of fatigue, malaise, and severe night sweats.

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

Swollen lymph nodes with HIV

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

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

HIV rash

In 70% of cases, a rash appears in men and women in the early acute period of the disease. More often, an erythematous rash (areas of redness of different sizes) and a maculopapular rash (areas of seals) are recorded. Features of the rash in HIV infection: the rash is profuse, often purple in color, symmetrical, localized on the trunk, its individual elements can also be located on the neck and face, does not flake off, does not bother the patient, is similar to rashes with measles, rubella, syphilis, etc. 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 vesicular-papular rash, characteristic of herpes infection and, often appears.

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 occur in 12% of cases. Lymphocytic meningitis, encephalopathy and myelopathy develop.

Rice. 7. 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, in 27% of cases nausea and vomiting are noted, abdominal pains often appear, 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 in 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 infectious 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 other 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 appointment of antiretroviral therapy during this period that is most useful for the patient.

Antibodies to HIV p24 proteins are detected, antibodies produced by the patient's body are detected using ELISA and immunoblot. The viral load (detection of RNA viruses) is determined using PCR.

High levels of antibodies and low levels of viral load occur during the 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.

During the clinically expressed period, the viral load is quite high, but with the appearance of specific antibodies it drops, and the symptoms of HIV infection subside and then disappear altogether, even without treatment.

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

The older the patient's age, the faster the HIV infection progresses to the AIDS stage.

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 multiplication 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 satisfactory and leads his usual lifestyle, 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 normal limits. The results of ELISA and immunoblotting studies are positive.

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

Generalized lymphadenopathy is the only sign of HIV infection during this period. Lymph nodes appear in 2 or more, not anatomically connected, places (except for the groin areas), at least 1 cm in diameter, lasting at least 3 months, provided there is no causal disease. Most often, the posterior cervical, cervical, supraclavicular, axillary and ulnar lymph nodes are enlarged. Lymph nodes sometimes increase, then decrease, but persist constantly, soft, painless, mobile. Generalized lymphadenopathy should be differentiated from bacterial infections (syphilis and brucellosis), viral (infectious mononucleosis, and rubella), protozoal (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. Lesions of the skin and mucous membranes 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 is preserved. The disease is detected 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, the body temperature rises. Patients are worried about frequent acute respiratory viral infections, otitis media, pneumonia and bronchitis. Frequent diarrhea leads to weight loss, fungal, viral and bacterial infections develop.

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

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

Rice. 11. Seborrheic dermatitis (left photo) and eosinophilic folliculitis (right photo) are manifestations of skin lesions in stage 2 of 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 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 in 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 in clinical manifestations there is nothing more than an AIDS-associated complex, when a patient develops infections and tumors that do not occur in the AIDS stage.

During this period, there is a decrease in the CD4 / CD8 ratio and the indicator of the blast transformation reaction, the level of CD4 lymphocytes is recorded in the range from 200 to 500 in 1 μl. In the general analysis of blood, leukopenia, anemia, thrombocytopenia are increasing, an increase in circulating immune complexes is noted in the blood plasma.
The clinical picture is characterized by prolonged (more than 1 month) fever, persistent diarrhea, profuse night sweats, severe symptoms of intoxication, weight loss of more than 10%. Lymphadenopathy becomes generalized. Symptoms of damage to internal organs and the peripheral nervous system appear.
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, more severe, and more prolonged downstream.

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: lesions of the rectum and soft tissues (left photo), genital warts (right photo).

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

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

Rice. 15. A detailed picture of AIDS. The photo shows patients with neoplasms in the form of Kaposi's sarcoma (left photo) and lymphoma (right photo).

Rice. 16. Signs of HIV infection in women in the late stages of HIV. In the photo, invasive cervical cancer.

The more severe the symptoms of HIV in the early stages and the longer they appear in a patient, the faster AIDS develops. Some men and women have an erased (low-symptom) course of HIV infection, 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 drops to 50 and below in 1 μl. During this period, an uncontrollable 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 has the development of atypical mycobacteriosis, CMV (cytomegalovirus) retinitis, cryptococcal meningitis, widespread aspergillosis, disseminated histoplasmosis, coccidioidomycosis and bartonnelosis, leukoencephalitis progresses.
Disease symptoms overlap. The patient's body is quickly depleted. Due to constant fever, severe symptoms of intoxication and cachexia, the patient is constantly in bed. Diarrhea and loss of appetite lead to weight loss. Dementia develops.
Viremia is increasing, and CD4-lymphocyte counts reach critically low levels.

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.

Prognosis of HIV infection

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 in the 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 HIV infection in the AIDS stage increases by 35 times.
The rapid progression of the disease is noted with transfusion of infected blood.
Development of drug resistance of antiviral drugs.
The transition of HIV infection to the AIDS stage 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.
Poor nutrition.
Genetic predisposition.

Factors slowing down the transition of HIV infection to the stage of AIDS:

Highly active antiretroviral therapy (HAART) started on time. In the absence of HAART, the patient's death occurs within 1 year from the date of the diagnosis of AIDS. It is believed that in regions where HAART is available, the life expectancy of HIV-infected people reaches 20 years.
Lack of side effects on taking antiretroviral drugs.
Adequate treatment of comorbidities.
Adequate food.
Rejection of bad habits.