本科艾滋病英文版

AIDSDepartment of Infectious Diseases，The Yongchuan Hospital of Chongqing medical Universityliwei,Summary,AIDS = Acquired Immuno- Deficiency SyndromeHIV = Human Immunodeficiency VirusAIDS ,which features a progressive depletion of CD4+ T lymphocytes, leading to life-threatening opportunistic infections, was first recognized in 1981 in the united states。,HIV病毒模式图,Etiology,the structure of HIV,包膜蛋白,跨膜蛋白,逆转录酶,核心蛋白,蛋白酶,外 膜,P17蛋白,Epidemiology,As of 2012, approximately 35.3million people are living with HIV globally.,the domestic situation,as of 2012 ,more than 380,000 people are living with HIV.,source of infection,Patients with HIVAsymptomatic HIV carriers HIV in blood、semen、vaginal fluid、breast milk。,HIV in Body Fluids,Route of transmission,Sexual contact（the predominant mode） homosex heterosexBlood to blood contactVertical transmission others,同之恋毒之祸血之灾,susceptible population,Most of people are susceptible to HIVThe change has made the virus spreading from drug users and sex workers to general population.,pathogenesis,HIV can infect those cells that express CD4 on the surface.During the cycle of HIV life, CD4+ T cells have been directly and indirectly damaged,HIV LIFE CYCLE,HIV 生长周期,HIV can damage those cells that express CD4 on the surface,CD4+ T cellsCD8+ T cells B cells Langerhans cells monocytes/macrophages follicular dendritic cells,Clinical Manifestations,Period of latent infection：2 10yearsstage: primary infectionstage: asymptomatic infection stage: AIDS,0,100,200,300,400,500,600,700,800,900,1000,0 1 2 3 4 5 1 2 3 4 5 6 7 8 9 10 11,CD4+ cell Count,Asymptomatic,HZV,OHL,OC,PPE,PCP,CM,CMV, MAC,TB,Months,Years After HIV Infection,Common Natural Course of HIV Infection Complications,Acute HIVinfection syndrome,Relative level of Plasma HIV-RNA,CD4+ T cells,Manifestations at last period,AIDS-related syndrome Respiratory manifestationsNeurological and ocular manifestationsGastrointestinal manifestationsOther systematic manifestations,Respiratory manifestations,Recurrent respiratory tract infectionsPneumocystis pneumoniaTuberculosisMACfungus,Neurological and ocular manifestations,cryptococcal meningitistubercular meningitistoxoplasmic encephalitisHIV encephalopathyCMV Retinitis,Toxoplasmic encephalitis,Gastrointestinal manifestations,Thrushhairy leukoplakia,Thrush,Hairy leukoplakia,Other,Kaposi sarcomaLymphomaShingles,Kaposis sarcoma,Shingles,laboratory examinations,Serologyplasma HIV viral loadImmunologic laboratory tests,Plasma laboratory marker,diagnosis,two criteria must be met.1、Positive test for HIV infection by confirmatory test2、 one of the following criteria,Weight loss of 10% body weight within 6 months.Chronic diarrhea of more than 1 month duration.Unknown persistent fever Opportunistic infection Kaposi sarcoma/Lymphoma.Neurological impairment restricting daily activities,treatment,HAART: highly active anti-retroviral therapy,Treatment goals,Eradication of HIV infection cannot be achieved with available antiretroviral regimensSo the primary goals of them are to: reduce HIV-related morbidity, mortality, improve the quality of life，restore and preserve immunologic function，and maximally and durably suppress viral load,Preparation before treatment,Each patient initially entering care should have complete medical history，physical exam，and laboratory tests。,When to treat,Main point: treating patients earlier.,The reason for starting medications earlier,Some studies suggest those with lower CD4 cell counts at greater risk of heart disease, cancers and dementiaNo study shows more harm with early start of HIV medicationsBad things are generally rarer among those with more normal CD4 cell countsTherapy is easier and better toleratedTreatment can also reduce infectiousness,Selection of combination regimen,EFV/TDF/3TC is recommended for initial therapy.,Pretty easy to be an HIV doctor,Long-term side effects,Kidneys/bones (tenofovir) Liver (NNTRIs, PIs) Anemia (AZT) Nerves (ddI, d4T),Prophylaxis,At the present ,there is no effective ADIS vaccine.Currently ,prevention is the best and most feasible approach to reverse and halt HIV epidemic.it is possible to protect yourself and others from infection by following 5 simple rules,Regardless of what they are used for injecting(注射) drugs, steroids(类固醇), vitamins, for tattooing(纹身) or body piercing they should not be shared. Also, do not share equipment (or works) used to prepare drugs for injection.,Rule #1 - Do not share needles or syringes (注射器).,A surefire way to avoid getting sexually transmitted diseases(性传播疾病) is to be in a long term, monogamous(一夫一妻) relationship with a healthy partner. For people whose sexual behaviors put them at risk for STDs, always using a male latex condom(乳胶避孕套) correctly can reduce the risk. Remember: no form of protection works 100% of the time.,Rule #2 Do not have unprotected sex,Sharing either of these creates the possibility of contact with blood.,Rule #3 - Do not share razors or toothbrushes.,If you must come in contact with someone elses blood for instance, to help someone who has an injury you should wear rubber gloves.,Rule #4 - Avoid contact with other peoples blood.,If you are pregnant or think y