Treatment of HIV infection (antiretroviral therapy)

Treatment of HIV infection is a complex, multifaceted and responsible process that requires a serious attitude. Moreover, the success of therapy depends on the efforts of not only the doctor, but also the patient. A positive effect can be achieved only if a large number of conditions are met. Both the doctor and the patient should know and clearly follow them.

The Russian Federation is a country that has impressive experience in the treatment of HIV infection. The basis is antiretroviral therapy (ARVT or HAART), thanks to which HIV infection has ceased to mean a death sentence. Now this disease is considered as chronic. With the help of antiretroviral therapy, the virus cannot be eliminated from the body, however, it is possible that such an opportunity will appear in the foreseeable future.

Reception of antiretroviral devices is carried out to achieve the following goals:

virological target. It is aimed at stopping the reproduction of viral cells in the human body. The successful achievement of the goal can be judged by the viral load in the blood. If it is at an undetectable level, then the virological goal is considered achieved;

immunological target. It is aimed at improving the immune status of the patient. When the viral load decreases, and ideally becomes undetectable, the number of CD4 lymphocytes in the blood begins to increase. They are responsible for the body's immune response to any infection. It is important that the patient understands that taking antiretrovirals does not directly increase the CD4 count;

clinical purpose. It is aimed at preventing the development of diseases that accompany AIDS. That is, the main thing in achieving this goal is to allow the body to fight HIV infection and prevent the development of AIDS, and hence diseases that could lead to death.

Treatment of HIV infection with antiretroviral drugs is based on the following principles:

Early initiation of therapy (it should be started when CD4 falls below 350 µl);

Regular intake of drugs;

Adherence to HIV treatment.

If a doctor suggests that a patient start antiretroviral therapy, the suggestion should not be refused. Moreover, if the patient wants to achieve the effect of treatment, he must strictly follow all the recommendations of the treating doctor. Only in this way does a person have the opportunity to live a full and long life. At the same time, the quality of life of an HIV-infected person will practically not differ in any way from the quality of life of healthy people.

In order not to miss the moment from which it is necessary to start antiretroviral therapy, the patient should be regularly examined at the AIDS Center. The fact is that without special tests it is almost impossible to detect the symptoms of HIV infection. This virus destroys the immune system slowly but steadily. Therefore, you can not wait for any subjective symptoms for many years. Meanwhile, time will be lost.

Three factors will indicate that it is necessary to start treatment for HIV infection:

The number of CD4 cells reflecting the state of the patient's immune status;

The number of viral cells in the blood, reflecting an indicator such as viral load;

The presence of diseases caused by HIV infection. These diseases are called "opportunistic". If they are diagnosed in a person, then therapy begins regardless of his immune status or viral load.

To determine the amount of virus in the blood, doctors conduct special tests. They give the result in the numerical number of copies of the virus in one ml of blood. The higher the CD4 count, the stronger the person's immunity. In addition, in the laboratory determine the percentage of CD4 lymphocytes (CD4%). However, when prescribing therapy, doctors start from the absolute, and not from the relative number of cells. That is, from the number of cells in a liter of blood, and not from their percentage ratio.

It should be borne in mind that the level of CD4 is a variable value. It depends on a huge number of factors, including alcohol intake, smoking, emotional upheavals, other infectious diseases, negative environmental conditions, etc. Therefore, it is not advisable to start treating HIV infection based solely on one indicator. The doctor must track the dynamics of the CD4 level over several months and correlate the results with factors that could affect the state of the person's immunity.

The risk of developing opportunistic diseases increases with a CD4 count of less than 300 cells/mm3, as immune defenses are weakened. The patient may develop infections associated with diarrhea, dehydration, weight loss.

Pneumocystis pneumonia is a disease that occurs in the majority of HIV-infected people whose CD4 count is below the threshold of 200 cells/mm3. If this indicator falls below 100 cells / mm3, then the risk of developing serious infectious diseases becomes very high.

This does not mean 100% that an infection will definitely occur, but people with this CD4 count are at significant risk to their health. Moreover, drugs aimed at treating opportunistic infections often cause much more harm to health than taking antiretroviral therapy.

Naturally, the prospect of starting antiretroviral therapy worries patients, but it should be understood that without proper treatment, HIV infection remains a deadly disease. Therefore, it is necessary to start treatment in a timely manner so that it is not too late. Indeed, with a CD4 count of less than 200 cells / mm3, deadly diseases can manifest at any time.

Therefore, regular scheduled visits to the doctor and strict adherence to his instructions are a necessity that ensures the safety of life. When a doctor does not prescribe treatment for HIV infection, this does not mean that it is no longer necessary to appear at the AIDS Center. It is important to monitor the state of your immunity at least once a year, and sometimes more often (once every 6 months or once every 3 months). During a visit to the doctor, he will definitely inform the patient when he needs to come next time.

In addition, people with HIV infection should, as necessary, be observed by other specialists (oculist, otolaryngologist, neuropathologist, gynecologist, etc.), as well as undergo diagnostic procedures (lung x-ray, ultrasound, ECG, etc.).

A person's adherence to HIV treatment

A person's adherence to HIV treatment is a concept that defines the extent to which a patient is involved or involved in their therapy. An adherent is a patient who seeks to receive treatment, shows an interest in their own health, and the decision to start antiretroviral therapy is made by the patient based on the knowledge gained in the process of consulting with a competent infectious disease specialist.

The goal of adherence is to regularly take antiretroviral therapy and achieve a stable therapeutic effect. To assess the degree of adherence, you can count the number of drugs taken or procedures completed. As a result, the percentage of completed medical appointments will indicate the indicator of adherence.

The effectiveness of HIV treatment directly depends on the patient's adherence to therapy. The higher the commitment, the higher the likelihood of a positive outcome. The level of adherence depends on the specific disease. So, in the treatment of hypertension, 61% is considered a sufficient level of adherence. This percentage is usually sufficient for most chronic diseases. However, HIV infection stands out against their background. In order for antiretroviral therapy to have a positive effect, adherence to treatment should be at least 90-95%.

The need for such a high level of adherence is explained by the characteristics of the immunodeficiency virus, namely its ability to mutate. Each skipped dose of antiretroviral drug creates conditions for the virus to quickly adapt to the therapy received and form resistant cells. Some drugs stop working at 4-6 mutations, and some at just one mutation. That is, sometimes a single dose skip is enough for the drug to lose its effectiveness for a particular patient. The virus will be able to multiply, despite the ongoing therapy.

Another pressing problem is the transfer of therapy-resistant strains of the immunodeficiency virus from one person to another. As a result, the infected person develops primary resistance, that is, initially a person becomes infected with a resistant strain of the virus. For example, in the countries of the European Union, there are already more than 10% of such infected people from the total number of HIV-positive people, and this figure is constantly increasing.

The more resistant strains of the immunodeficiency virus spread, the more expensive the therapy becomes, which means that the survival rate of patients decreases.

The two main threats to low adherence to antiretroviral therapy are:

Increasing the cost of drugs, reducing the effectiveness of the treatment received;

An increase in the number of people infected with resistant strains of the virus.

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HIV treatment and the emergence of resistance

The immunodeficiency virus, on the one hand, hides in those cells where it is difficult for drugs to penetrate. There he can live for many years. Latent CD4 lymphocytes and dendritic follicular cells of lymphoid tissue act as such reservoirs.

On the other hand, the virus constantly mutates inside the human cell. This process of mutation is called replication. In the process of replication, the virus copies the genetic information that is contained in a specific sequence of nucleotides. It is this copied information that it then passes on to the next generation of viruses.

The virus has the ability to replicate information due to the presence of a protein called reverse transcriptase. This protein in the virus works with errors, making mistakes. That is, during the assembly of each new virus, from 5 to 10 mutations will occur (taking into account the fact that HIV has about 9000 nucleotide pairs). These mutations are most often fatal for the virus, as they deprive it of the possibility of further copying. But in some cases, the mutation changes the virus so much that it becomes able to survive even if it is exposed to an antiretroviral drug. Thus, the next batch of new viruses receives reliable protection and begins to reproduce new cells, protected from the harmful effects of drugs taken by humans. As a result, there is a loss of sensitivity of the virus to antiretroviral treatment.

If HIV mutates and acquires resistance to several drugs at the same time, then experts point to the occurrence of cross-resistance. The emergence of therapy-resistant strains significantly complicates the treatment of HIV-positive patients.

The emergence of HIV resistance

A person may initially be infected with an antiretroviral treatment-resistant strain of HIV. In this case, we are talking about primary resistance. For example, in North America, such a probability, according to various sources, ranges from 1 to 11%, and in the countries of the European Union - from 9 to 21%. The incidence of therapy-resistant strains is increasing every year. This is explained simply, because primary resistance is someone's induced resistance to drugs. The second concept means that mutations arose in the body of a certain person with insufficient effectiveness of antiretroviral therapy against the background of a viral load.

The risks of developing resistance of virus strains largely depend on the correct effect of the drug on the patient's body and on the effect of the patient's body on the drug being taken. That is, the likelihood of developing resistance depends on the pharmacokinetics of the drug and on its pharmacodynamics.

Any antiretroviral drug must be taken at a given time interval so that it can be properly absorbed, enter the bloodstream and accumulate in the tissues at the required concentration. A wide variety of factors can affect pharmacodynamics and pharmacokinetics, including the patient's age, gender, mealtime, genetic characteristics, concurrent use of other drugs, etc. All these factors must be taken into account when selecting an antiretroviral drug. If the patient does not comply with the dosage, takes the drug at the wrong time, or skips doses altogether, this can lead to resistance. Therefore, the high adherence of each infected person is the key to successful therapy, and hence the prevention of resistance.

Antiretroviral treatment for HIV should be selected only by a doctor, taking into account all possible factors that may affect the emergence of drug resistance in a particular patient. As necessary, the treatment regimen can be adjusted.

Resistance prevention in HIV treatment

Experts have found that if the level of copies of the virus in the blood is less than 50 and the load is undetectable, then the risk of developing resistance of HIV strains to antiretroviral treatment is very small.

In order to prevent HIV drug resistance, the following principles should be followed:

Regular monitoring of the viral load in the patient's blood;

Strict adherence to medical recommendations. It is strictly forbidden to deviate from the scheme prescribed by the doctor. The antiretroviral drug must be taken at a specific time and dosage. The level of its absorption can be affected by diarrhea, vomiting, taking other medicines, diseases. It is important that the patient promptly informs the doctor about his problems;

Antiretroviral therapy started for the first time should be qualitatively selected. The risks of developing resistance directly depend on this;

Resistant strains of HIV can be re-infected. Sometimes two or more strains of the virus enter the human body (co-infection). For example, one in four infected people living in San Francisco has resistance to one or more antiretroviral drugs. To prevent this from happening, it is necessary to follow measures to prevent HIV transmission;

Getting new knowledge. A person with HIV infection must constantly replenish his knowledge base about his disease. The source of information can be the media, the attending doctor, popular and scientific literature. The deeper the patient delves into the essence of the problem, the more he has knowledge about the treatment of the disease, the higher the chances that he will not make mistakes that lead to resistance.

However, the basic protection against resistance currently remains an undetectable viral load.

The danger and pace of the spread of HIV infection are so great that it has been called the "plague of the 20th century." Every day, about 5,000 people die from the consequences of this disease in the world. Until recently, nothing was known about this deadly disease to mankind. Only in the 70s of the last century it became known about.

The Human Immunodeficiency Virus (HIV) is a widespread worldwide disease that poses a real threat not only to health, but also to human life. By the nature of the spread of HIV, it can definitely be compared with an epidemic. Although modern medicine is able to timely identify the disease and offer a person a quality one.

The root of this plant is one of the leaders among the means that strengthen health and increase the protective properties of the body. This is due to the large variety of useful substances included in it, including phelandrine, camphin, cineole, citral, vitamins, trace elements and essential oils. Thanks to these components, the root.

In addition to honey and herbs, of course, you also need to deal with your inner world, go to a hypnologist, otherwise nothing will help. In general, I already have a whole methodology for healing from any disease, but no one wants to be treated, people only whine, complain and are too lazy to work on themselves.

The information on the site is intended for familiarization and does not call for self-treatment, a doctor's consultation is required!

All information provided on this site is for informational purposes only and is not intended as a guide to action. ALWAYS consult with your doctor before using any medication. The site administration is not responsible for the practical use of the recommendations from the articles.

02.03.2016

Modern aspects of prevention, diagnosis and treatment of HIV infection

In the context of the deteriorating epidemiological situation and the steady increase in the incidence of HIV infection, as well as the diseases associated with it, countering the spread of the epidemic, creating the necessary conditions conducive to the prevention and prevention of new cases of infection, as well as ensuring high-quality diagnosis and treatment of this disease are priority tasks for both our country, and for the entire world community.

The AGP System is an innovative tool for assessing daily glycemic profile variability that clinicians and patients need to personalize their treatment regimen as much as possible, as well as to improve diabetes control and prevent its complications.

Discussion of the results achieved in the fight against HIV infection, the search for new solutions, taking into account existing national and international experience and knowledge, as well as regional characteristics, will be the main goal of the Scientific-practical conference "Modern aspects of prevention, diagnosis and treatment of HIV infection".

The conference will take place on November 17-18, 2016 in St. Petersburg at the Park Inn byRadissonPulkovskaya (Ploschad Pobedy, 1, metro station Moskovskaya)

Scientists, experts, public health policy makers, medical professionals and public figures will take part in the conference and exchange experiences on best strategies and practices in the response to HIV. Only by consolidating the efforts of all specialists affected by this problem, it is possible to further counter the epidemic.

CONFERENCE ORGANIZERS

Government of St. Petersburg

St. Petersburg Health Committee

St. Petersburg State Budgetary Health Institution "Center for the Prevention and Control of AIDS and Infectious Diseases"

CO ORGANIZERS OF THE CONFERENCE

Northwestern Department of Medical Sciences of the Federal Agency for Scientific Organizations

Federal Scientific and Methodological Center for the Prevention and Control of AIDS

Federal State Institution "Republican Clinical Infectious Diseases Hospital" of the Ministry of Health of the Russian Federation

"Scientific and Practical Center for the Prevention and Treatment of HIV Infection in Pregnant Women and

children" of the Ministry of Health of the Russian Federation

Federal State Budgetary Institution "Scientific Research Institute of Children's Infections of the Federal Medical and Biological Agency"

Office of the Federal Service for Supervision of Consumer Rights Protection and Human Welfarearound the city of St. Petersburg

NGO "Man and his health"

PROGRAM COMMITTEE:

Executive Secretary Vinogradova T.N.

MAIN DIRECTIONS:

The epidemiological situation of HIV infection in the world, Russia, St. Petersburg

Topical issues of HIV treatment: experience, results, new solutions

HIV and comorbidities (hepatitis and tuberculosis)

Prevention of perinatal transmission of HIV infection

Laboratory diagnosis of HIV infection and concomitant diseases

Working with key populations as a priority for prevention

spread of HIV

The HIV epidemic through the eyes of civil society

FORMS OF PARTICIPATION IN THE CONFERENCE

1. ORAL COMMUNICATION

All submissions are accepted by email only.in an attached MS WORD document with a note in the subject line "Modern Aspects of HIV".

Rules for applying for an oral presentation:

The application is sent in electronic format (MS Word text editor). The document must contain the title of the report, last name, first name, patronymic of the speaker, full name of the organization, contact information

Together with the application for the report, it is necessary to send the abstract of the report and the completed registration form

The duration of the oral presentation is 10-15 minutes

Information about the inclusion of reports in the conference program and the acceptance of abstracts for publication will be sent additionally after October 1, 2016

2. PUBLICATION OF ABSTRACTS

Publication of abstracts - free of charge.

The number of abstracts from one (first) author is no more than 1.

Margins - 2 cm, Times New Roman font, size 14, spacing 1.5

Title of the work (lowercase letters without abbreviations)

Full name of the organization, city, in the case of several organizations, it is necessary to indicate the authors' affiliation with organizations

Contact person: Full name full, phone, e-mail

Structure the purpose of the study, materials and methods, results and discussion

The name of the files is given by the name of the first author, for example, “Ivanov A.S. docx".

Tables, formulas and figures are not accepted for publication.

3. POSTER PRESENTATION:

Structure and design rules:

The number of reports from one (first) author is no more than 1.

Poster size - 0.8 * 0.6 m (vertical placement),

Font Times New Roman, size 16, spacing 1.5.

Text blocks should be alternated with photographs, illustrations, etc.,

Title heading (title of the report, authors, organization name);

Abstract (summary of the entire work);

Materials, methods, results, discussion of results;

Conclusion (conclusions);

Thanks.

The conference program committee reserves the right to refuse to publish abstracts/articles if they do not correspond to the conference theme, are issued in violation of the requirements, or are sent after the deadline.

4. PERSONAL PARTICIPATION:

To participate in the conference you need:

fill in the registration form and send it to the address of the conference technical committee by e-mail with notice "Modern Aspects of HIV"

or register online on the website congress-ph. en

The Organizing Committee is ready to print posters sent strictly in the specified format.

The terms of participation in the conference can be found on the website www.congerss-ph.ru

One of the most serious diseases today is HIV - the human immunodeficiency virus. In a number of other diseases, HIV infection ranks second after cancer. However, many doctors argue that HIV infection is much worse than cancer, since modern medicine has learned to cope with most oncological diseases, while there are still no ways to cure HIV infection today. Although in fairness it should be noted that modern treatment of HIV infection today brings quite good results.

This disease causes global damage to the entire immune system of the human body, which completely disrupts its normal functioning. Due to such disorders of the immune system, various secondary infectious processes develop in the human body and multiple tumors appear.

The human immunodeficiency virus can reside in the genome of a human cell for three or more years. Even in blood plasma devoid of any cellular elements, the human immunodeficiency virus retains its viability and activity for at least one year, and sometimes even longer. By the way, doctors say that it is this feature that explains the high risk of infection with the immunodeficiency virus when pricked with needles that were previously injected into people with HIV infection.

The history of this disease began in 1981, when doctors in California first discovered a new virus for them in the blood of a group of homosexuals, which later became known as the “human immunodeficiency virus”. Scientists suggest that HIV infection has spread from Central Africa. Doctors noticed that the presence of such a disease leads to the fact that adults begin to suffer from immunodeficiency after infection.

But until now, immunodeficiency was known to doctors only as a congenital defect in children. In these people, infected with a type of virus that is still new for doctors, this very immunodeficiency occurred after the virus entered the body. Doctors studied such patients for a long time to rule out the possibility of a congenital immunodeficiency virus. That is why the disease was called AIDS - Acquired Immune Deficiency Syndrome, and the virus that causes it - HIV.

Ways to get HIV infection

The disease is contagious - HIV infection is transmitted from a person, either already sick or still being a virus carrier. In all cases, the human immunodeficiency virus is found in body fluids such as vaginal secretions, semen, and blood. Currently, there are several main ways of transmitting HIV infection from person to person:

• sexual transmission

This method of infection with the immunodeficiency virus accounts for up to 70% of all cases of infection with this disease. Moreover, there is a fairly widespread misconception that infection occurs only during traditional vaginal intercourse. However, this is not at all the case - the chances of contracting the immunodeficiency virus during anal or oral sex are no less. And in the event that there are microtraumas on the mucous membranes, the risk of infection becomes almost 100%.

In addition, the risk of HIV infection and sexually transmitted diseases that are present in sexual partners significantly increase. Doctors explain this fact by the fact that, firstly, many sexually transmitted diseases provoke the development of ulceration of the mucous membranes of the genital organs. And, secondly, we must not lose sight of the fact that sexually transmitted diseases, like, indeed, any other disease, significantly weaken the immune system.

• Transfusion

There is no lesser risk of infection with the immunodeficiency virus if a healthy person receives a transfusion of blood or its components, the donor of which is an HIV-infected person. Fortunately, this is very rare, as all blood donors undergo a thorough examination.

• Use of non-sterile instruments

Much less often, but still sometimes there is such a way of infection with the human immunodeficiency virus as the use of non-sterile medical instruments, injection syringes, manicure and cosmetic instruments. Many people have a persistent fear that they will be exposed to HIV infection during visits to beauty parlors or during dental treatment, but in fact the likelihood that this will happen is extremely low. Of all the percentage of infection, this method accounts for no more than 1%.

• transplant method

In the event that an organ is transplanted to a person from a donor infected with the human immunodeficiency virus, infection will occur in almost 100% of cases. However, this also happens very rarely.

• Transplacental

This mode of transmission of the human immunodeficiency virus is the transmission of HIV from a pregnant mother through the placenta to the child herself. Not so long ago, the risk of having infected children in HIV-positive mothers was approximately 50%. However, modern medicine can reduce this risk to 20%.

Doctors identify certain risk groups, which include people who have a much higher chance of contracting the human immunodeficiency virus: homosexuals, prostitutes, drug addicts, and people with sexually transmitted diseases.

Clinical course of the disease

The human immunodeficiency virus is introduced into the blood cells that are responsible for the full functioning of the immune system - into lymphocytes. It is on this that the principle of the action of the immunodeficiency virus is based - absolutely any disease can develop due to a decrease in the normal functioning of the immune system. Simply put, a person infected with the immune deficiency virus suffers from a wide variety of diseases - it gets sick almost non-stop.

Like any other disease, the immunodeficiency virus does not make itself felt immediately after infection - it has a fairly long incubation period. Moreover, the run-up can be very impressive - from several months to 15 years. Doctors note that the duration of the incubation period of HIV infection is greatly influenced by the way a person is infected with the virus.

For example, it has been reliably established that if the infection occurred sexually, the incubation period will be much shorter than if a person has been transfused with blood or its enzymes infected with the immunodeficiency virus. However, it goes without saying that there are exceptions to any rule.

Approximately 50% of all people infected with the human immune deficiency virus, already about three weeks after infection, a number of signs appear, indicating the onset of pathological processes in the human body. A person may experience a number of symptoms such as:

• Sustained subfebrile temperature, which lasts for two weeks.
• Enlargement of the lymph nodes, and any lymph node can become inflamed.
• An increase in the size of the liver and spleen, which persists for about two weeks.
• Angina, which, despite intensive treatment, does not go away for about 10 days.

This reactive state lasts for a maximum of one month, after which all symptoms disappear spontaneously, without any external intervention. There comes the so-called latent period, which can last for a very long time, sometimes for many years.

And the only possible symptom of the presence of an immune deficiency virus in the body of a sick person can be a steady increase in lymph nodes. Doctors insist on a blood test if a person has enlarged two or more lymph nodes located in two or more different groups for more than one month. Moreover, the greatest attention should be paid to such groups of lymph nodes as axillary, ulnar, posterior cervical and supraclavicular - they suffer much more than others when infected with HIV.

As a rule, the last days of the incubation period also proceed in a very peculiar way - the lymph nodes increase again, there is a very strong fever - the temperature sometimes rises to 40 degrees, the person's physical activity decreases, there is profuse sweating, especially at night. In addition, sick people often experience intense weight loss - more than ten kilograms per month, often against the background of severe diarrhea.

In some cases, a sick person has a cough, severe shortness of breath, inflammation of the hair follicles, fungal infections, hair loss, baldness, seborrheic and atopic dermatitis. In the event that during this period - doctors call it pre - AIDS - to conduct a study of the composition of the blood of a sick person, you can detect a change in the balance of those components whose function is to protect the body from certain infectious agents.

As mentioned above, HIV is manifested mainly by a violation of the normal functioning of the body's immune system. Therefore, sick people often develop certain severe infections, or various neoplasms. Patients most often experience:

• Pneumonia. Most often, sick people have a disease such as pneumonia, the development of which is provoked by atypical pathogens. The main danger of such pneumonia lies in the fact that these atypical pathogens practically do not respond to the currently existing methods of treatment, and therefore a fatal outcome occurs very quickly, which is very, very difficult to avoid, and often completely impossible.
• Damage to the central nervous system. Approximately every third sick person has a lesion of the central nervous system. The most common neurological diseases are actively progressive dementia, encephalitis and meningitis, as well as the development of certain tumors of the brain, less often of the spinal cord.
• Damage to the skin. Approximately 20% of all people infected with the human immunodeficiency virus have some kind of skin or mucous membrane lesions. As a rule, the skin and mucous membranes are affected by a certain type of sarcoma - inflammation and proliferation of blood vessels that are located in the mucous membranes and skin. Moreover, for people with HIV, a very unusual location of these tumors is typical - on the mucous membranes of the mouth, on the neck, head, in the perianal region. The course of tumor development is extremely active, even lymph nodes and internal organs can be involved in the process.
• In addition, some patients have cryptococcosis and candidiasis, as well as viral lesions such as the herpes simplex virus, which affect not only the skin, but also the mucous membranes of the internal organs - the stomach, intestines, and lungs. And these lesions can be very extensive - up to 50 - 70% of the entire surface of the skin or mucous membranes.

Symptoms of the development of AIDS

Despite the fact that in recent years, a blood test to detect antibodies to HIV has been very widespread, most often the disease is detected only after a doctor pays attention to a number of symptoms that may occur in people with AIDS. Such symptoms include:

• Increased body temperature

A sick person, and his doctor, should be wary if an elevated body temperature lasts for a month or more, without any apparent reason for this - it is necessary first of all to exclude the possibility of the presence of certain hidden inflammatory processes. Moreover, body temperature can be very different - from low - 37.2 - 37.5, to very significant numbers - 39 - 40 degrees.

• Dry cough

Also, in such patients, doctors can observe a persistent dry cough that lasts for several months. As a rule, X-rays do not reveal any pathologies.

• bowel disorder

In almost all cases of AIDS, the sick person complains of persistent diarrhea that can last for months. In addition to diarrhea, there are other signs of intestinal upset - increased gas formation, bloating, often the presence of dysbacteriosis.

• Headache

Headaches that systematically occur and do not go away after taking painkillers are also often a companion of HIV infection and AIDS. However, it goes without saying that it is imperative to exclude all other possible causes that can provoke headaches.

• Deterioration of the general condition of a person

In all cases, without exception, there is a strong deterioration in the general state of human health and well-being. He complains of fatigue, weakness, emotional instability. At the slightest load, a person's hands and legs begin to tremble, cold sticky sweat appears, and the heartbeat quickens.

• Swollen lymph nodes, which have already been mentioned above, weight loss for no apparent reason

Of course, the presence of one or even several of the above signs does not in any way indicate that a person is HIV-infected. Such symptoms can be caused by a huge number of a wide variety of diseases that have absolutely nothing to do with HIV infection. But be that as it may, a sick person should seek medical help from a doctor as soon as possible, who can accurately determine the cause of the ailment and prescribe the necessary treatment.

However, if a doctor offers a person to donate blood for testing for the presence of antibodies to HIV, you should not refuse, arguing that this possibility is completely excluded. Unfortunately, no one is immune from this disease. And in the event that for some reason the work of the immune system is disrupted, the human immunodeficiency virus that has drooped in the body can manifest itself very quickly, and in a very acute form.

And in the event that the disease is not diagnosed as soon as possible, and appropriate treatment for HIV infection is not started, the consequences can be very serious - a person's life expectancy will decrease from an average of 10 years to 1-3 years. And even during this short time without treatment, the human condition will be much worse. Therefore, you still should not accept with hostility the doctor's offer to test blood for HIV.

Diagnosis of HIV and AIDS

As a rule, a person, having learned that he is infected with HIV, experiences a strong psychological shock. And this is a completely natural reaction, because HIV infection completely and completely changes a person's lifestyle. A sick person can experience a variety of feelings - fear, anger, despair, panic. These feelings are completely natural and should not be shy.

However, in no case should you close yourself in and refuse help. There are a huge number of organizations that help HIV-infected people. As a rule, psychologists work in them, who will help to accept and realize the very fact of the disease, and fight for their lives. Yes, and doctors in such organizations have very extensive experience in working with HIV-initiated patients - they know exactly how to help each individual patient.

Timely treatment allows HIV-infected people to live up to 15, and sometimes up to 20 years. Agree, this is not such a small figure, especially considering the fact that without specific therapy started in a timely manner, life expectancy is rarely more than three, maximum five years. Moreover, the majority of HIV-infected people mistakenly believe that all these years of life they will feel very unwell.

However, this is not at all the case - if the treatment was started in a timely manner, a person can lead an almost full life. Although, of course, a certain number of restrictions still exist - and first of all, a person is closely associated with various pharmacological drugs, without which modern therapy for HIV infection is simply impossible.

In order to start the treatment needed in this case, the doctor must accurately diagnose the presence of HIV infection. Diagnosis of the disease in all cases begins with the collection of an anamnesis, which includes the living conditions of a sick person, his lifestyle, and the clinical picture of the disease. If the doctor has reason to believe that a person may be infected with the immunodeficiency virus, he will prescribe specific serological and virological blood tests. Antibodies to HIV are detected within a month after infection.

Treatment of HIV infection

Before starting a story about the treatment of HIV infection, it is worth briefly explaining how HIV differs from AIDS. After the human immune deficiency virus largely affects the immune system, which ceases to function normally, a person begins to develop various infectious diseases in a severe form, or tumors appear - in a word, his condition worsens significantly. That's it in this case, doctors talk about AIDS.

Therapy for HIV infection should be started as early as possible - this will help prevent the development of AIDS and, accordingly, all concomitant diseases. Often people ignore the need for special treatment, but this should never be done - despite the fact that for a very long time the disease does not manifest itself in any way, the immunodeficiency virus has the most negative impact on the immune system of the infected person. And timely treatment will allow a person to remain healthy as long as possible and delay the development of AIDS. For these purposes, doctors use a fairly large number of a variety of techniques. Here are the main ones:

• Virus suppression

Practically from the first day after the diagnosis of HIV infection, a sick person should receive specially developed pharmacological preparations that have a detrimental effect on the life cycles of the virus, largely suppress its development, reproduction and life processes. These drugs belong to the group of antiretroviral drugs.

• Antiretroviral drugs

As HIV infection progresses, doctors expand the range of antiviral drugs used. This need is dictated by the following feature of the human immunodeficiency virus - if the same antiviral drug acts on the virus for a very long time, its effect will gradually weaken, up to the complete immunity of the immunodeficiency virus. This phenomenon is called or resistance of the virus.

Accordingly, it is easy to guess that further treatment with the same drug does not bring the expected result - the disease continues to progress. And in this case, doctors have to resort to a kind of trick - to combined antiretroviral therapy. The essence of this therapy is the selection of the optimal combination of several antiviral drugs at once, resistance to which the human immunodeficiency virus is almost impossible to develop.

However, please note that there is no universal scheme for anti-retroviral therapy - in each case it is selected individually for each specific initiated person. This takes into account many factors, such as the number of antibodies, clinical manifestations, and many others.

Rarely enough, but still there are cases when the immunodeficiency virus may experience some decrease in susceptibility to this method of therapy. Doctors monitor a sick person throughout the entire period of treatment, therefore, at the first signs of a decrease in the effectiveness of drug therapy, the regimen for taking pharmacological drugs is immediately modified.

• Prevention of opportunistic infections.

As the disease progresses, the human immunodeficiency virus infects the cells of the immune system more and more, thereby disrupting its full functioning. As a result, there is a very high risk of developing various infections. Due to the specific nature of this disease, the treatment of almost any infection becomes very problematic.

It is because of this feature that doctors prefer to prescribe HIV-infected people to prescribe prophylactic treatment aimed at preventing the occurrence of infectious diseases. For this, various antimicrobial pharmacological preparations are used.

This therapy is effective only to prevent various secondary diseases that develop as a result of impaired functioning of the human immune system. In relation to the human immunodeficiency virus itself, such a treatment tactic is absolutely ineffective - these pharmacological preparations do no harm to the virus.

• Vaccination of a sick person

In addition to diseases that are based on one or another inflammatory process, people with HIV infection are also threatened by all kinds of viral diseases. In order to prevent a possible disease, doctors offer HIV-infected people several ways. The first method is the simplest - during the outbreak of epidemics - usually in the autumn - spring period, a sick person should try to refuse to visit crowded places, up to complete isolation, up to a strict home regimen.

The second way is to vaccinate against various diseases. Pay special attention - vaccination really helps to protect an HIV-initiated person from a huge number of infectious diseases. However, there is one small but very significant nuance - vaccination can be done only at the initial stage of the disease, when the cells of the human immune system are slightly damaged, which means that they are still able to properly produce antibodies to a particular disease.

Vaccination of a person with AIDS, at best, will be absolutely useless, and at worst, it will only provoke the development of the disease, depending on what type of vaccine and for which disease it was used. Therefore, it is very important to make all injections in a timely manner, while there is still time. Which vaccines are needed should be decided by the attending physician of an HIV-infected person.

If we summarize all the information, we get the following picture. The goal of therapy for both HIV infection and AIDS is to suppress the reproduction of viruses and their vital activity, thereby reducing their number in the body of a sick person. In addition, if a person has HIV infection, treatment should be comprehensive. For the normal functioning of the human body, it is very important to preserve the remaining functions of the immune system and try to restore as much as possible those already lost.

Many years have passed since the invention of the first version of antiretroviral therapy (zidovudine monodrug) in 1985. Scientists had high hopes for this drug, but the results were not as good as we would like. Many years have passed since then, and modern scientists have been able to reach such a level in the treatment of the immunodeficiency virus that, with proper therapy, the life expectancy of an HIV-positive person does not differ in any way from any person with a negative HIV status.

But despite all the successes, a way has not yet been found to completely rid the body of this virus. Modern antiretroviral therapy is similar to the principles of treating any chronic disease, such as diabetes - the patient must take drugs for life to control the level of viral load.

Basic principles of modern treatment of HIV infection

Due to the fact that there are no means to completely rid patients of HIV infection, all treatment is based on preventing or slowing down the progression of the disease. There are three components of the fight against the virus:

• antiretroviral therapy;
• Prevention and treatment of opportunistic infections;
• Pathogenetic treatment of some syndromes.

Thus, for successful treatment of patients with HIV infection, it is required:

Among the main principles of the use of antiretroviral therapy are:

• The need to prescribe treatment before the development of immunodeficiency, followed by lifelong use of drugs aimed at suppressing HIV replication.
• Combination administration of three to four antiretroviral drugs. This method is called highly active antiretroviral therapy (HAART for short).

We hope that very soon scientists will find a way to completely rid the human body of HIV infection and then another terrible disease will remain in the past.

Recall that you can read the history of the development of antiretroviral drugs in.

Treatment of HIV infection is currently an important problem in modern medicine. The number of HIV-infected people around the world is steadily increasing. Current treatment for HIV/AIDS slows the progression of the disease, but does not cure patients completely. Today, the search for drugs is intensively conducted in many countries of the world. New treatment regimens are being developed. A search is underway for drugs that restore immunity, and issues of combating the development of infectious complications and tumors in AIDS patients are being studied.

Rice. 1. The photo shows the moment of budding of the release of new virions from the target cell.

Main goals of antiretroviral therapy in HIV patients

Timely prescription of antiretroviral therapy, the use of optimal treatment regimens and the creation of a protective psychological regimen can prolong and improve the quality of life of the patient, delay the development of life-threatening complications, and achieve longer remissions. The main goal of antiretroviral therapy is to reduce the viral load to a level where it cannot be detected by a laboratory test and increase the number of CD4 lymphocytes.

Rice. 2. For the first time, AIDS has been widely discussed since the mid-1980s.

Basic principles of treatment of HIV patients

The main principles of treatment of HIV patients are:

• creation of a protective psychological regime;
• timely initiation of highly active antiretroviral therapy (HAART);
• prevention, early detection and treatment of secondary diseases.

HIV/AIDS treatment should be combined and include antiviral therapy, pathogenetic and symptomatic treatment. Treatment of patients at the stage of AIDS, when the development of opportunistic diseases is noted, is of the same importance as the use of HAART.

Antiretroviral therapy slows down the progression of the disease and its transition to the stage of AIDS for 10-20 years. It is necessary to take into account the fact that any treatment regimen after 6-12 months may become ineffective due to virus mutations and the acquisition of resistance (resistance) to antiviral drugs. In addition, in some cases, individual intolerance to HIV drugs is recorded. Neutropenia and anemia develop in 40% of patients in the late stages of HIV infection as a result of taking antiretroviral drugs.

Taking antiretroviral drugs should only be carried out under the direction of a physician. The need for daily intake is dictated by the course of the disease itself and is a great test for the patient. In the trial phase are antiviral drugs that can be injected 2 times a month, but for now, antiviral drugs must be taken daily and at the same time. The indication for taking antiviral drugs is a high viral load and a significant decrease in the number of CD4 lymphocytes.

Antiretroviral drugs are taken in combination. The doctor takes into account the general condition of the patient, viral load, concomitant diseases and a number of other factors. The HIV/AIDS treatment regimen includes 3 or more drugs.

Use of immunomodulators may open new perspectives in the treatment of HIV infection.

Primary prevention involves preventing the development of opportunistic diseases that develop when the level of CD4-lymphocytes is below the critical level - 200 in 1 mm 3.

Secondary prevention involves the appointment of AIDS patients with chemotherapy drugs to prevent recurrence of the disease.

Supporting the health of people living with HIV is an important factor in the treatment process. Proper nutrition, avoiding stress, healthy sleep and a healthy lifestyle, regular visits to the doctor are the main components of maintaining health.

Psychosocial assistance to a person with HIV infection is an integral part of the comprehensive treatment of the disease.

Rice. 3. With HIV infection, herpetic lesions of the mucous membranes acquire a severe course.

Features of the course of HIV/AIDS against the background of HAART

When using HAART, the viral load in patients decreases (in 50-70% of them it decreases to 50 or less RNA copies/ml) and the number of CD4-lymphocytes increases. Against the background of improving the immune status, the development of opportunistic diseases and oncopathology is prevented, the duration and quality of life of patients increases. You should be aware that in some patients with HIV / AIDS on the background of HAART, for a number of reasons, disease progression is possible.

• HIV-1 is the most pathogenic, virulent and widespread among all. Minor changes in its genome lead to the emergence of a large number of new strains, which allows the pathogen to elude the patient's immune system and acquire drug resistance to antiviral drugs.
• Some HIV/AIDS patients develop intolerance to antiretroviral drugs.

Preventing and delaying the development of life-threatening conditions is the main goal of HIV therapy.

Rice. 4. Shingles. A severe relapsing course of the disease is noted in HIV infection.

Indications for prescribing antiretroviral drugs

The World Health Organization recommends treating all infected patients. The situation in Russia is somewhat different. Treatment of patients begins only with a decrease in the immune status, which is determined by the number of CD4-lymphocytes. In HIV-negative individuals, their amount in the blood is from 500 to 1200 in 1 mm 3.

Any newly initiated antiretroviral therapy must be potent and aggressive to ensure maximum suppression of HIV replication.

Rice. 5. Candidiasis of the esophagus (photo on the left) and genital candidiasis in women with AIDS. (photo on the right).

Antiretrovirals are the main drugs for HIV/AIDS

Today, there is no cure for HIV that can completely cure the patient. Treatment of HIV infection is carried out with antiviral drugs, with which you can slow down the progression of the disease, and significantly (by 10-20 years) prolong the life of the patient. In the absence of HAART, the death of the patient occurs after 9-10 years from the moment of infection.

The effect of antiviral treatment in patients with HIV/AIDS is achieved by suppressing HIV replication in target cells. It is necessary to take such drugs for a long time, preferably constantly.

1 group represented by nucleoside reverse transcriptase inhibitors (NRTIs). These include: Azidothymidine (Zidovudine, Retrovir, Timazid), Didanosine, Zalcitabine, Lamivudine (Epivir), Stavudine, Abakovir, Adefovir, Zalcitabine. Combined drugs Combivir (Azidothymidine + Lamivudine), Trizivid (Azidothymidine + Lamivudine + Abacovir).

2 group includes non-nucleoside reverse transcriptase inhibitors (NNRTIs). These include: Nevirapine (Viramune), Delavirdine (Rescriptor), Ifavirenz (Stacrine), Emicitabine, Loviridine.

3 group represented by protease inhibitors (PIs). These include: Saquinavir (Fortovase), Indinavir (Crixivan), Nelfinavir (Viracept), Ritonavir (Kaletra), Indinavir, Amprenavir, Lopinavir and Tipranavir.

4 group represented by receptor inhibitors. This includes the drug maraviroc(Celzentry).

5 group represented by fusion inhibitors. This includes enfuvirtide (fuzeon).

Rice. 6. Lamivudine and Zidovudine are HIV/AIDS medications.

Treatment regimens for HIV infection

Initial therapy with antiviral drugs for HIV/AIDS patients should be combined. The most optimal are the following schemes:

• Scheme 1: 2 drugs from the NRTI group + 1 from the PI group.
• Scheme 2: 2 drugs from the NRTI group + 1 from the NNRTI group.
• Scheme 3: 3 drugs of the NRTI group.

The first scheme is the most optimal. Regimen 2 is an alternative to its replacement. The regimen, which includes only 2 NRTI drugs, is inferior in efficiency to the regimen, which includes 3 NRTI drugs. Monotherapy with any of the drugs is ineffective. The exceptions are cases of pregnancy and the impossibility of using alternative treatment regimens.

It is better to use drugs in HIV/AIDS treatment regimens of different groups, at maximum doses and simultaneously, which significantly reduces the likelihood of developing HIV drug resistance, allows you to reduce drug doses, affect many parts of the infectious process at once, and penetrate into different tissues and organs. This method of using HAART makes it possible to reduce the concentration of HIV to values ​​that cannot be determined using modern test systems.

It is necessary to continue antiretroviral therapy for a long time (possibly lifelong). Termination of treatment leads to the resumption of HIV replication.

Combination therapy according to the rules of HAART increases the effectiveness of treatment up to 80 - 90%, monotherapy - up to 20 - 30%.

Rice. 7. AIDS patients in the stage of development of opportunistic diseases: lymphoma (photo on the left) and Kaposi's sarcoma (photo on the right).

Interruption of antiretroviral therapy and change of regimen

There is an opinion of experts that if it is necessary to interrupt therapy for a long time, it is better to cancel all drugs than to switch to monotherapy or therapy with 2 drugs. This will reduce the development of HIV resistance.

The reason for prescribing a new treatment regimen is insufficient virological and immunological effect, intercurrent infection or vaccination, side effects and intolerance to antiretroviral drugs.

An increase in the viral load indicates the ineffectiveness of the treatment of HIV / AIDS patients, and the number of CD4-lymphocytes in this case is not taken into account.

• With a pronounced side effect of the drug, it must be replaced with another of the same group with a different profile of intolerance and toxicity.
• If inadequate therapy is prescribed (eg, only 2 NRTIs), but an adequate response (suppression of HIV replication) is obtained, other drugs should be added. Inadequate therapy will still lead to an inadequate response.
• It is recommended to completely replace an inadequate initial treatment regimen.
• The high probability of developing cross-resistance dictates the condition for prescribing 2 drugs of the same group. This is especially true for protease inhibitors.

There are side effects from antiretroviral drugs, but there are more positive aspects of antiretroviral therapy.

Great importance in the treatment of a patient with HIV infection is given to the prevention and treatment of opportunistic infections and malignant tumors. Facilitates the course of the disease and prolongs the life of the patient immunocorrective and immunoreplacement therapy. For many years, a number of countries around the world have been searching for new antiretroviral drugs and vaccines. Of the 10 anti-HIV drugs recommended by the WHO, 8 generics will be produced in the Russian Federation in 2017 and 2 more in 2018.

Rice. 8. Antiretroviral therapy slows down the progression of HIV infection and the transition to the stage of AIDS up to 10-20 years.

The difficulty in obtaining effective drugs for HIV infection is complicated by the high variability of immunodeficiency viruses, which, under the influence of external factors, quickly develop resistance and previously effective drugs and become ineffective.