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HIV infection
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r Ãcquired Immune Deficiency Syndrome
r HIV: human immunodeficiency virus
r Lymphocyte and neurons mainly affected
r Mainly transmitted through sexuality/blood
r Pathogenesis: CD4+ T cells are severely
destroyed, immunodeficiency comes and then
opportunistic infections and malignant tumors
2
HIV infection
rSummaries:
r Clinical features: The syndrome is
defined by the development of serious
opportunistic infections, neoplasms, or
other life-threatening manifestations
resulting from progressive HIV-induced
immunosuppression.
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Viral RNÃ
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rSource of infection¬
r Patients and HIV carriers :
r Mainly in blood, sperm, secretion of vagina
r Ãlso in saliva, tear, milk
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r Sexual contact (70 D ~0 D of
HIV/ÃIDS)
r ¦xposure to blood, largely through
injecting drug use and transfusion
r Perinatal transmission from infected
mothers to their infants
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r Sexual contact is the predominant mode
of HIV transmission throughout the world.
However, the geographic distribution of
cases attributable to homosexual and
heterosexual transmission varies markedly.
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r Heterosexual transmission is the major
mode of spread of HIV infection in Ãfrica, most
of South Ãmerica, and the Caribbean(70D~0
D in the world)
r Male-to-male sexual transmission
continues to account for a major proportion in
North Ãmerica and ¦urope (÷D~10D in the
world) (but the proportion of heterosexual
transmission is growing rapidly) 14
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r Ãnal sex (infection rate is about 1%)
has been consistently found to be more
risky than vaginal sex (infection rate is
about 0.0[%~0.1÷%).
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r ¦xposure to blood:
r Largely through injecting drug use
and transfusion is another major mode of
spread of HIV infection.
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r
the risk of
transmitting hepatitis B from a patient who is
hepatitis B e antigen-positive by needlestick
is about [0%, the risk of transmitting hepatitis
C from a patient who has circulating hepatitis
C virus is about [%; and the risk of
transmitting HIV from a patient with HIV
infection is about 0.[%
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from
infected mothers to their infants is the
major mode of spread of HIV infection in
children.
r c , during delivery, or
postpartum
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Infection rate of different behaviour
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r ¦verybody is susceptible to HIV
rGroups with high risks:
r Male homosexual
r Injecting drugs users
r Hemophilia patients etc.
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r Neurotropic
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includes:
r Primary(acute) infection (days to weeks)
r Ãsymptomatic infection (years)
r Persistent generalized lymphadenopathy
(months)
r Symptomatic infection (months)
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r
r à majority of patients infected with
HIV develop an acute mononucleosis-like
illness characterized by fever, headache,
lymphodenopathy, pharyngitis, macular
rash, and malaise within one to several
weeks of exposure.
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r Ãseptic meningitis, hepatosplenomegaly,
extreme fatigue, weakness, arthralgias, and
myalgias are also frequently associated
with this syndrome.
r Syndrome usually resolve within 2 to 4
weeks.
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r
r 2 to 10 years asymptomatic stage
40
r
r Lymphadenopathy, defined here as
enlargment of the lymph nodes in at least two
extrainguinal sites for a minimum of [ months
in the absence of any illness or drug known to
cause lymphadenopathy, is usually present and
results from the massive viral replication and
immunologic response (lymphocyte
recruitment and proliferation).
41
r
r Biopsy reveals reactive hyperplasia and
expansion of germinal centers.
r The presence of persistent lymphadenopathy
does not influence prognosis; however, a
decrease in the size of the involved nodes
correlates with the onset of ÃIDS and portends a
poor prognosis.
42
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r Nonspecific complaints of fever,
weight loss, diarrhea, and malaise;
lymphadenopathy; and oral thrush are
frequently noted in patients who have
been infected with HIV for more than ÷
years and whose CD4 counts are
generally dropping toward 200/mm[ or
below.
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r Nowadays, once the CD4 count
reaches 200/mm[, patients are classified
as having ÃIDS.
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r å
WBC, PLT, RBC and Hb decrease at
different levels
r
Ãnti-HIV; p24; PCR for DNÃ; RT-PCR
for HIV RNÃ; HIV isolation from blood etc.
r
CD4+ T cells decreased (<0.÷~1.÷109/L)
CD4/CD 1.0 (1.÷~1.7:1)
49
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r zidovudine/-etrovir (ÃT, DV)
r didanosine/ëidex, ëidex EC (ddI)
r zalcitabine/6 ë (ddC)
r stavudine/]erit (d4T)
r lamivudine/Epivir ([TC)
r abacavir/]iagen (ÃBC) ÷1
a
r
a
r nevirapine/ëiramune (NVP)
r delavirdine/-escriptor (DLV)
r efavirenz× ustiva (¦FV)
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r indinavir/Crixivan
r ritonavir/Gorvir
r saquinavir/ nvirase, Fortovase
r nelfinavir/ëiracept
r amprenavir/Ãgenerase
r lopinavir/ritonavir, [aletra
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rTreatment:
r Systemic chemotherapy with
vincristine, vinblastine, etoposide,
bleomycin, paclitaxel, liposomal
daunorubicin, or doxorubicin may be
helpful.
r Radiotherapy may provide palliation if
patients refuse or are intolerant of
chemotherapy.
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