AIDS

AIDS

1981
:
Gay cancer Poppers
o ( )

n
n
n

n
n

N
N

 -
n

n
n

1. DNA
(CMV, EBV)
-

- ,

-
-

 -
n
n
n

n
n

2.
- R. GALLO M. ESSEX

HTLV I HTLV I
CD4
-HTLV I
HTLV I =

 -
n
n
n
n

n
n

3.
MONTAGNIER

1983 LAV
(LYMPHADENOPATHY ASSOCIATED VIRUS)

AIDS

 -
n

1911 Reyton Rous

( RNA DNA)

gag, pop, env

 PETO-IO
n

MPMV

MMTV

RSV

MLV
HTLV1 HTLV2

BLV
-
CAEV
VISNA

EIAV
HIV-1, HIV-2

SIV

 HIV-1
:
-gag, -pol, -env, -tat , -LTR
n :
- (RT)
- (P24, P13)
- (gp120, gp
41)
n - HIV-2 ( SIV)
n

 HIV AIDS
n
n

n
n

1.
2. test
HIV
3.
4.

5. SIV
maccaque



n
n

1. CD4
2.

HIV-1 Lifecycle

 HIV




(PGL)
-

( AIDS) CD4 <200
HIV CD4
<50

.
()
n
n
n

n
n

(96%)
(74%)
(70%)
(70%)

(54%)
(32%)

James O. Kahn and Bruce D. Walker. Acute Human Immunodeficiency virus

type I infection. NEJM. 1998; 339(1): 33-39.


()
n

(32%)

(27%)

(14%)

(13%)

Thrush (12%)

(12%)

CD8

CD4

HIV DNA

p24

HIV RNA

PGL

Chronic non-progressor

 II
n

CD4

Shacker TW et al. Biological and virologic

characteristics of primary HIV
infection. Ann Intrn. Med 1998; 128: 613

 III
CD4
n >1000/mm3
n 6 780 /mm3
n 1 680 /mm3
n 50 /mm3

Stein DS et al. CD4+ lymphocyte cell enumeration for prediction of clinical

course of human immunodeficiency virus disease: A review. J Infect Dis
1992; 165: 352

.
( symptoms)
(Thrush)


Herpes zoster > 2
> 1


( symptoms)
Bacillary angiomatosis
in situ
> 1

.
( AIDS) (I)
P. carinii 42.6%
15%
AIDS wasting syndrome 10.7%
Kaposi 10.7%
M avium 4.8%
(Tbc) 4.5%


AIDS) (II)
(CMV) 3.7%
HIV dementia 3,6%

3%
2.6%
1.9%


( AIDS) (III)
1.5%
Burkitt 1.5%
1%
0.9%
HSV 0.5%


:
n

 CD4

C.D.C/WHO Classification of HIV

infection
-----------------------------------------------------------------------------Absolute
Total
Clinical group
CD4
lymphocyte -----------------------------------count
count
A
B
C
-----------------------------------------------------------------------------Laboratory (x 106/l)
-----------------------------------------------------------------------------1 >500
>2000
A1
B1
C1
2 200-499
1000-1999
A2
B2
C2
3 <200
<1000
A3
B3
C3

 HIV

 HIV

 HIV

,

, , ,


, , ,
,

,
LATEX

1996 (HAART),


,
o
.
1996 12%,
1997 47%.



HIV RNA /ml
CD4 X 106
<350

<5000

5000-30000

350-500

>500

>30000

Guidelines for the use of antiretroviral Agents in HIV Infected Adults and
Adolescents. US Health & Human Services. January 2000.

 ..

World AIDS Day 2009

 -
CD4<100 CD4 : CD8<0,2

: 60%
30%
70%
>40mg >50%
+ 80%
+ 80%
: 20%
: , , ,

: 20% (, )

 -
400-600 mg/d
- 03-0,6 mg/
( 2-2,5 gr)
150 mg/kg/
2
:
100-200 mg/
- 0.8 mg/kg
100 mg/ Per os

 - AIDS
:
. Carinii
.
:
:
.
. Avium
:
.
.

.:
.: Bleomycine
LIP

 Carinii
-CD4<200l
- AIDS: -57-84%
- -
-M : --
-
( :, , , ,
).
-x
20-30% (-.avium-)


.
. /
.
/ :
-

-
-


.
DLCO
PaO2
.
.
.


15-20mg/kg - 75-100mg/kg IV PerOs
, , , ,

3-4mg/kgIV IM
, , ,, , ,
50 4-5mg/kgAerosol -
30mg/ (20mg/kgV
)

(+)100mg/ (20mg/kgPerOs) , , ,
,
Eflornithine (DFMO)
400mg/kgIV PerO)

: 21 -

 AIDS

ISOSPORA BELLI

Avium

 HIV
. - (3-12% AIDS)
. (;)
.:
. ()
. :
. AIDS:

 - HIV
1. BELLI
2.
3.
4.
5.
6.
7.

- HIV

. avium

-AIDS
-90% CMV
- 25%
- 51%
.
.
- 10%
-
.
-
.
.

 AIDS

. 1,4% TBC AIDS

. 1980-1985 7%
. 1980-1987 1,4 inadence
. 3,8% AIDS TBC
. 1985-1987
12% 64%
. HIV
TBC

 AIDS

. - TBC
:
. :
. AIDS ARC: TBC
. AIDS ARC+TBC
- ,
- -
. TBC:

. -26-42%

 TBC AIDS
Tests:10-40% PPD (AIDS, ARC)
79% PPD ()

>5 mn PPD-

::

: 1/2 Ziehl-Neelsen


.
. AIDS
. 18% AIDS
. 53%

. <100 CD4/l

. ,
. + TNF.g.INF, IL2=
MAIC

1. + TNF, INF, IL2

2.
3. 10-10 CFU/ml
4. , ,, , .
5.
6.

 -MAIC
-
, , +,

. , ( )
. ( WHIPPLE)
.
. (Bactec, Dupont isolator)

 ADS
.
.AI D S:
. : (, ,
)
.
.:

.:
GLUCANTIME(60mg/kg/)
ITRACONAZOLE


.-
.:
.: ME TON -
.; - -
. :
-AIDS

 AIDS
A.

.
. .
.
.
.
.
.
. :
- (3-5 mg/)

Pn. carinii
C



AIDS
?
?
Rosenberg ES et al. Vigorous HIV-1 specific CD4+ T cell responses
associated with control of viremia. Science. 1997; 278: 1447-1450
2. Joel E. Gallant. Antiretroviral Therapy. Initial Strategies. Medscape
HIV/AIDS : Annual update 2000.
1.



HIV RNA /ml
CD4 X 106

<5000

5000-30000

>30000

<350

350-500

>500

Guidelines for the use of antiretroviral Agents in HIV Infected Adults and
Adolescents. US Health & Human Services. January 2000.

PI +2 NRTIs
NNRTI + 2 NRTIs
2PI +2NRTIs
3 NRTI ?
1. Charles C.J.Carpenter et al. Antiretroviral Therapy in Adults. Updated recommendations
of the International AIDS Society - USA Panel. JAMA. 2000; 283 (3): 381-389
2. Guidelines for the use of antiretroviral Agents in HIV Infected Adults and Adolescents.
US Health & Human Services. January 2000.

1. ?
IL-2
2. ?
1. Joseph A. Kovacs et al. Controlled trial of interleukin-2 infusions in patients
infected with the human immunodeficiency virus
2. Ronald T. Mitsuyasu . Immune reconstitution with antiretroviralws,
Immunotherapy, and afteer Structured Treatment Interruption. 7th Conference
on retroviruses and Opportunistic Infections. Day 2- January 31,2000.