Explanations for the clinical classification of HIV infection. Clinical picture (Symptoms) of HIV infection 4 clinical stage of HIV

In 2001, under the leadership of Academician of the Russian Academy of Medical Sciences V.I. Pokrovsky, a new edition of the domestic clinical classification HIV infections.

Clinical classification of HIV infection:

Stage 1– “incubation stage” – the period from the moment of infection to the appearance of the body’s reaction in the form of clinical manifestations acute infection and/or antibody production. Its duration usually ranges from 3 weeks to 3 months, but in isolated cases it can last up to a year. During this period, HIV actively multiplies, but there are no clinical manifestations of the disease and antibodies to HIV have not yet been detected. Therefore, the diagnosis of HIV infection at this stage is traditional laboratory method cannot be installed. It can only be suspected on the basis of epidemiological data and confirmed by laboratory research detection of human immunodeficiency virus, its antigens, and nucleic acids in the patient’s serum.
Stage 2– “stage of primary manifestations”, is associated with the manifestation of the body’s primary response to the introduction and replication of HIV in the form of clinical manifestations and/or the production of antibodies. The stage of primary manifestations of HIV infection can have several course options:
2A – “asymptomatic”, characterized by the absence of any clinical manifestations of HIV infection. The body's response to the introduction of HIV is manifested only by the production of antibodies.
2B – “acute infection without secondary diseases”, manifested by a variety of clinical symptoms. The most frequently recorded are fever, rashes on the skin and mucous membranes (urticarial, papular, petechial), increased lymph nodes, pharyngitis. An enlarged liver, spleen, and diarrhea may occur.
Sometimes aseptic meningitis develops, manifested by meningeal syndrome. In this case, lumbar puncture usually produces unchanged cerebrospinal fluid flowing under high blood pressure, occasionally there is slight lymphocytosis. Similar clinical symptoms can be observed in many infectious diseases, especially with so-called childhood infections.
Sometimes this variant of the course is called mononucleosis-like or rubella-like syndrome. In the blood of patients during this period, wide-plasma lymphocytes - mononuclear cells - can be detected, which further enhances the similarity of this variant of the course of HIV infection with infectious mononucleosis.
Vivid mononucleosis-like or rubella-like symptoms are observed in 15-30% of patients. The rest have 1-2 of the above symptoms in any combination. Some patients may experience lesions of an autoimmune nature. With this course of the stage of primary manifestations, a transient decrease in the level of CD4 lymphocytes is often observed.
2B – “acute infection with secondary diseases”, characterized by a significant decrease in the level of CD4 lymphocytes. As a result, against the background of immunodeficiency, secondary diseases of various etiologies appear (candidiasis, herpetic infection, etc.). Their manifestations, as a rule, are mild, short-term, respond well to therapy, but can be severe (candidal esophagitis, Pneumocystis pneumonia) and in rare cases, even death is possible.
In general, the stage of primary manifestations, which occurs in the form of acute infection (2B and 2C), is recorded in 50-90% of patients with HIV infection. The onset of the stage of primary manifestations, which occurs in the form of an acute infection, is usually noted in the first 3 months after infection. It can precede seroconversion, that is, the appearance of antibodies to HIV. Therefore, at the first clinical symptoms, antibodies to HIV proteins and glycoproteins may not be detected in the patient’s serum.
The duration of clinical manifestations in the second stage can vary from several days to several months, but they are usually recorded within 2-3 weeks. Clinical symptoms of the stage of primary manifestations of HIV infection can recur.
In general, the duration of the stage of primary manifestations of HIV infection is one year from the onset of symptoms of acute infection or seroconversion. In prognostic terms, the asymptomatic course of the stage of primary manifestations of HIV infection is more favorable. The more severe and longer (more than 14 days) this stage proceeded, the greater the likelihood of rapid progression of HIV infection.
The stage of primary manifestations of HIV infection in the vast majority of patients becomes subclinical, but in some patients it can immediately pass into the stage of secondary diseases.
Stage 3– “subclinical stage” is characterized by a slow increase in immunodeficiency, which is associated with compensation of the immune response due to modification and excessive reproduction of CD4 cells. The rate of HIV reproduction during this period, compared to the stage of primary manifestations, slows down.
The main clinical manifestation of the subclinical stage is persistent generalized lymphadenopathy (PGL). It is characterized by an enlargement of at least two lymph nodes, in at least two unrelated groups (not counting the inguinal ones), in adults to a size in diameter of more than 1 cm, in children - more than 0.5 cm, persisting for at least 3 years. -x months. Upon examination, usually the lymph nodes are elastic, painless, not fused with the surrounding tissue, and the skin over them is not changed.
Enlarged lymph nodes at this stage may not meet the criteria for PGL or may not be registered at all. On the other hand, such changes in the lymph nodes can be observed even more late stages HIV infections, in some cases, they occur throughout the entire disease, but in the subclinical stage, enlarged lymph nodes are the only clinical manifestation.
The duration of the subclinical stage ranges from 2-3 to 20 or more years, but on average it lasts 6-7 years. The rate of decrease in the level of CD4 lymphocytes during this period averages 0.05-0.07x10 9 /l per year.
Stage 4– “stage of secondary diseases”, is associated with depletion of the CD4 cell population due to ongoing HIV replication. As a result, against the background of significant immunodeficiency, infectious and/or oncological secondary diseases develop. Their presence determines the clinical picture of the stage of secondary diseases.
Depending on the severity of secondary diseases, stages 4A, 4B, 4B are distinguished:
4A usually develops 6-10 years after infection. It is characterized by bacterial, fungal and viral lesions of the mucous membranes and skin, inflammatory diseases of the upper respiratory tract. Typically, stage 4A develops in patients with a CD4 lymphocyte count of 0.5-0.35x10 9 /L (in healthy individuals, the CD4 lymphocyte count ranges from 0.6-1.9x10 9 /L).
4B most often occurs 7-10 years after infection. Skin lesions during this period are deeper in nature and tend to be protracted. Lesions begin to develop internal organs. Weight loss, fever, localized Kaposi's sarcoma, peripheral nervous system. Typically, stage 4B develops in patients with a CD4 lymphocyte count of 0.35-0.2x10 9 /L.
4B is predominantly detected 10-12 years after infection. It is characterized by the development of severe, life-threatening secondary diseases, their generalized nature, and damage to the central nervous system. Typically, stage 4B occurs when the CD4 count is less than 0.2x10 9 /L. Despite the fact that the transition of HIV infection to the stage of secondary diseases is a manifestation of the depletion of the protective reserves of the body of an infected person, this process is reversible (at least for some time). Spontaneously or as a result of ongoing therapy clinical manifestations secondary diseases may disappear. Therefore, in the stage of secondary diseases, phases of progression (in the absence of antiretroviral therapy or against the background of antiretroviral therapy) and remission (spontaneous, after previously conducted antiretroviral therapy or against the background of antiretroviral therapy) are distinguished.
Stage 5– “terminal stage”, manifested by the irreversible course of secondary diseases. Even adequately administered antiretroviral therapy and treatment of secondary diseases are ineffective. As a result, the patient dies within a few months. At this stage, the CD4 cell count is usually below 0.05x10 9 /L.
It should be noted that clinical course HIV infections are very diverse. The given data on the duration of individual stages of the disease are averaged and may have significant fluctuations. The sequence of progression of HIV infection through all stages of the disease is not necessary. For example, the latent stage can, when a patient develops Pneumocystis pneumonia, go directly to stage 4B, bypassing stages 4A and 4B. There are cases when the latent stage directly passed into the terminal stage.
The duration of HIV infection varies widely. Average duration disease from the moment of HIV infection to the development of the final stage of HIV infection (AIDS itself) ranges from 5-8 to 10-12 years, although some patients live 15 years or more.
The fastest progression of the disease from the moment of infection to death is described, which was 28 weeks.
The duration of the disease depends on the type of virus and the individual characteristics of the human body (the body’s susceptibility to the virus, the presence of concomitant diseases, habitual intoxications, etc.). Thus, when infected with HIV type 2, the disease progresses somewhat more slowly. The older you are when you become infected with HIV, the faster the disease usually progresses.
Intravenous administration of psychoactive substances is often accompanied by the development of severe bacterial infections(abscesses, phlegmons, pneumonia, endocarditis, sepsis, tuberculosis, etc.), which can also occur with a normal content of CD4 lymphocytes. At the same time, the presence of these lesions contributes to a more rapid progression of HIV infection.
The use of modern antiretroviral therapy regimens can significantly increase the duration and improve the quality of life of patients with HIV infection.
Belyaeva Valentina Vladimirovna,

Pokrovsky Vadim Valentinovich,
Professor, Academician of the Russian Academy of Medical Sciences, Head of the Russian Federal Scientific and Methodological Center for the Prevention and Control of AIDS
Kravchenko Alexey Viktorovich,
Doctor of Medical Sciences, leading researcher at the Russian Federal Scientific and Methodological Center for the Prevention and Control of AIDS

After the immunodeficiency virus enters the human blood, the disease goes through several stages until the infection finally destroys the natural defenses and the body becomes defenseless against attack. various diseases. HIV itself is not fatal, but what it does to the human body is dangerous.

Few patients survive to stage 4b, which occurs approximately fifteen years after contracting HIV infection. During this period, the patient develops infectious or oncological diseases that lead to death. The human body is no longer able to resist viruses. The majority of patients die from deterioration of nerve cells and brain diseases.

How much a person is given after infection depends on many factors; the disease does not always develop gradually. Passing one stage after another, it is possible to observe both the rapidly developing disease and the stages of its spontaneous remission and retreat. Determining the stages of development of immunodeficiency is based on determining the titer of HIV or the amount of antibodies to the virus, but in the last stages of the disease the method is less accurate.

The first stage of the development of the disease is direct infection with the virus and its active reproduction. In the second stage, HIV begins to gain a foothold in the blood, causing symptoms similar to those of a cold. The total duration of development is up to 24 months.

At the third stage, the body is still able to withstand the attacks of the virus (the lymph nodes are affected). The duration of the stage is determined by the individual resistance of the body and can last from 24 months to 20 years (it all depends on how quickly the virus deals with CD4 lymphocytes).

When the disease reaches the fourth stage, the person’s immunity is so destroyed that it can no longer stop the development of the virus - and loses the fight for life. The minimum level of CD4 cells, macrophages and other defense cells is determined in human blood. The human body gradually loses the battle to HIV and the virus completely occupies the body, provoking the development of neoplasms and severe infections.

It is at the fourth stage that the body becomes defenseless against infection, which a normal person can quickly and easily cope with.

These diseases are called opportunistic (from the Latin benefit, opportunity) infections or HIV-related diseases, that is, those that take advantage of the state of practical absence of immunity. For the development of one of these pathologies, the presence of HIV is necessary; some, combined with immunodeficiency, take on an unusually severe form.

Pre-AIDS according to the classification accepted in Russia, which was developed by V.I. Pokrovsky, has three stages of gradual development:

• 4A with determination of the level of CD4 lymphocytes up to 500 per cubic meter. mm;
• 4B with a gradual drop in CD4 level to 200 per cubic meter. mm;
• 4B, characterized by a drop in CD4 count to less than 200 per cubic meter. mm.

If in phase 4A concomitant infections are treatable, but require a longer time, then in stage 4B they are practically incurable. The stage is determined based on symptoms of concomitant diseases and an analytical study of the number of CD4 cells in the blood.

In some cases, remission of pre-AIDS is observed, but it is not possible to determine whether the cause is a spontaneous process or highly active antiretroviral therapy.

Stage 4 Pre-AIDS

Stage 4 Pre-AIDS shows a critically low level of body defense and the maximum load of HIV on the immune system. A person practically loses the ability to resist the disease, but the use of HAART and treatment of concomitant diseases in many cases makes it possible to stop the development of pathology.

The onset of stage 4B indicates that the virus has found a way to cope with the drugs that block it, and the transition to the next phase becomes faster. Changing the medicine used allows you to stop the development of the virus and bypass its protection.

HIV infection can stop, and stage 4B will not occur. The stopped development of the virus shows that a balance has been achieved between the state of the body and the course of the pathogen. This “falling asleep” of the virus also occurs at stage 4B - this means that with sufficient medical support, the patient can live indefinitely.

Symptoms

Many people experience chest pain, coughing accompanied by the release of bloody sputum.

Signs:

• Pain in the head area;
• Severe dizziness;
• Nausea that occurs immediately after eating;
• Increased sweating;
• Anxiety and suspiciousness;
• Sleep problems.

The patient's skin condition also worsens. Quite often, a person develops ulcers on the palms and in the armpits. The wounds bleed and pus accumulates in them. This phenomenon is temporary, the ulcers usually disappear after the initiation of appropriate therapy. The patient may have a sharp rise in body temperature and develop bronchitis or flu. The danger of the situation is that influenza, which develops at stage 4B of HIV infection, can be fatal.

A patient suffering from HIV infection often experiences anemia. With this disease, the level of hemoglobin in the blood decreases and the risk of heart failure increases. The patient complains of loss of appetite and weight loss.

Regular consumption of alcoholic beverages, smoking and drug addiction doubles the aggressiveness of the human immunodeficiency virus. At this stage, additional infection of a person with sexually transmitted diseases, hepatitis C, which accelerates the destruction of the body and the patient’s refusal of a rational way of life: an established daily routine, diet, feasible physical activity.

Late treatment, non-compliance with doctor’s prescriptions, or refusal to treat HIV and related infections accelerates the transition of the disease to the terminal stage. At this stage of the disease, patients are extremely exhausted, they have no appetite, there is constant fatigue, and patients spend almost all their time in bed.

The accompanying pathology in this phase of the lesion is Pneumocystis pneumonia (characteristic only for this stage of HIV and is considered one of its symptoms). The patient suffers from the herpes virus, which causes permanent ulcers and lesions on the mucous membranes.

The intestines experience attacks from protozoan microorganisms (protozoa), diseases from which are considered characteristics of the onset of stage 4B.

Often there is total damage by the tuberculosis bacillus to the bones, membranes of the brain, intestines, and skin of the human body; characterized by infection with mycobacteria (protozoa similar to the tuberculosis bacillus) that attack the skin, digestive system, lungs, central nervous system. Mycobacteria normally very rarely infect humans, although the causative agent of leprosy belongs to this group.

Cryptococcal meningitis, which is typical for HIV-infected people, also does not occur in healthy people (the causative agent is the yeast fungus cryptococcus, which lives in the soil). Characteristic of the last stage of HIV and various malignant neoplasms, occurring anywhere in the body, heart and kidney failure.

Characteristic of stage 4B of HIV is damage to the central nervous system, classified as HIV (AIDS) dementia. It manifests itself in a decrease in intellectual abilities, memory and personality disorders, and coordination problems.

Accompanying disorders are depression and anxiety, psychosis, insomnia, and leaving home. The patient is constantly in a state of deep depression caused by the presence of a complex of diseases and suffering.

Against the background of emotional depression, pathologies of the central nervous system and heart rapidly develop. At this stage HIV patients refuse the help of a psychologist, although professional consultations and the patient’s desire to fight for life often significantly improve the condition.

Pregnancy at stage 4B

Pregnancy does not accelerate the development of immunodeficiency, but you should not have a child at stage 4B of HIV infection. The probability of infection of the baby in the womb is quite high. In addition, the virus may develop resistance to drugs.

During pregnancy, a woman’s body is especially vulnerable; her immune system is aimed, first of all, at protecting the unborn child from contracting HIV infection. On initial stage the patient can become a mother only if there are no other contraindications to bearing a baby.

Pre-AIDS therapy

Medicine does not know a medicine that could completely stop the infection of the human immunodeficiency virus, but modern methods of treating HIV make it possible to block the replication process of the pathogen and prolong the life of patients. The effectiveness of the drugs is very high - if you follow the doctor’s prescriptions and take the medicine correctly, the process of growth of CD4 leukocytes and massive suppression of HIV is possible.

Treatment is aimed at suppressing HIV and preventing the development of concomitant infections, long-term preservation of the patient’s acceptable condition, psychological and emotional supervision and support for patients.

The doctor, using HAART and symptomatic treatment, tries to ensure that the stage of secondary diseases does not progress to AIDS. At stage 4B, the last stage of HIV, HAART is always prescribed.

HAART is carried out:

• HIV transcriptase inhibitors (nucleoside) Didanosine, Lamivudine, Abacovir, Stavudine;
• Non-nucleoside inhibitors Nevirapine, Delavirdine;
• Inhibitor of viral fragments Saquinavir, Indinavir, Ritonavir.

The drugs are prescribed to the patient in combination, periodically changing combinations.

If a patient has HIV dementia, therapy with Zidovudine and Didanosine is prescribed simultaneously, a course of treatment of at least 4 months. When mental disorders manifest themselves, appropriate drug treatment is used.

HIV-related infections can be controlled with symptomatic therapy: antibiotics, antiviral and antimycotic agents. IN complex treatment includes general strengthening medications (vitamins and supplements), and, if possible, physiotherapy is used.

Is the forecast optimistic?

The prognosis for AIDS is not very optimistic. The average life expectancy of a patient is 1-3 years.

The rate of transition of HIV infection to the stage of acquired immunodeficiency syndrome is influenced by the following factors:

• State of human health;
• Bad habits. The body of people who regularly drink alcoholic beverages and psychotropic substances, noticeably weakened. In this case, the likelihood of developing AIDS increases significantly;
• Infection with various infectious diseases. Diseases transmitted through intimate intimacy place additional stress on the body;
• Lifestyle of an HIV-positive person. If you refuse a strict diet, heavy physical work, or failure to comply with basic hygiene standards, the risk of adverse consequences of HIV infection increases;
• Compliance with medical orders. If antiviral therapy is not started in a timely manner, the patient's life expectancy is significantly reduced.

Modern medicines are able to stop the development of the disease at stage 4B. Therefore, there is no need to despair and give up!

Stage 1 - “Incubation stage” - the period from the moment of infection until the body’s reaction appears in the form of clinical manifestations of “acute infection” and/or the production of antibodies. Its duration usually ranges from 3 weeks to 3 months, but in isolated cases it can last up to a year. During this period, HIV actively multiplies, but there are no clinical manifestations of the disease and antibodies to HIV have not yet been detected. Consequently, at this stage, the diagnosis of HIV infection, suspected on the basis of epidemiological data, cannot be confirmed by the traditional laboratory method (detection of antibodies to HIV). To do this, it is necessary to use methods that can detect the human immunodeficiency virus or its fragments (antigens, nucleic acids) in serum.

Stage 2 - “Primary manifestation stage” is the body’s primary response to the introduction and replication of HIV in the form of clinical manifestations and/or antibody production. This stage can have several course options:

2A - “Asymptomatic”, characterized by the absence of any clinical manifestations of HIV infection. The body's response to the introduction of HIV is manifested only by the production of antibodies (seroconversion);

2B - “Acute infection without secondary diseases”, manifested by a variety of clinical symptoms. The most commonly recorded symptoms are fever, rashes on the skin and mucous membranes (urticarial, papular, petechial), enlarged lymph nodes, and pharyngitis. There may be an enlarged liver, spleen, and diarrhea. Sometimes “aseptic meningitis” develops, manifested by meningeal syndrome. In this case, lumbar puncture usually results in unchanged cerebrospinal fluid flowing out under increased pressure, and occasionally there is slight lymphocytosis in it. Similar clinical symptoms can be observed in many infectious diseases, especially the so-called “childhood infections”. Sometimes this variant of the course is called “mononucleosis-like” or “rubella-like” syndrome. In the blood of patients during this period, wide-plasma lymphocytes - mononuclear cells - can be detected, which further enhances the similarity of this variant of the course of HIV infection with infectious mononucleosis. Vivid mononucleosis-like or rubella-like symptoms are detected in 15 - 30% of patients, the rest have 1 - 2 of the above symptoms in any combination. Some patients may experience lesions of an autoimmune nature. With this course of the stage of primary manifestations, a transient decrease in the level of CD4 lymphocytes is often recorded;

2B - “Acute infection with secondary diseases”, characterized by a significant decrease in the level of CD4 lymphocytes. As a result, against the background of immunodeficiency, secondary diseases of various etiologies appear (candidiasis, herpetic infection, etc.). Their manifestations, as a rule, are mild, short-term, respond well to therapy, but can be severe (candidal esophagitis, Pneumocystis pneumonia), in rare cases, even death is possible.

In general, the stage of primary manifestations, which occurs in the form of acute infection (2B and 2C), is recorded in 50 - 90% of patients with HIV infection. The onset of the stage of primary manifestations, which occurs in the form of an acute infection, is usually noted in the first 3 months after infection. It can precede seroconversion, that is, the appearance of antibodies to HIV. Therefore, at the first clinical symptoms, antibodies to HIV proteins and glycoproteins may not be detected in the patient’s serum.

The duration of clinical manifestations in the second stage can vary from several days to several months, but they are usually recorded within 2 to 3 weeks. Clinical symptoms of the stage of primary manifestations of HIV infection can recur.

In general, the duration of the stage of primary manifestations of HIV infection is one year from the onset of symptoms of acute infection or seroconversion.

In prognostic terms, the asymptomatic course of the stage of primary manifestations of HIV infection is more favorable. The more severe and longer (more than 14 days) this stage proceeds, the greater the likelihood of rapid progression of HIV infection.

The stage of primary manifestations of HIV infection in the vast majority of patients becomes subclinical, but in some, bypassing it, the stage of secondary diseases immediately develops.

Stage 3 - “Subclinical stage”, is characterized by a slow increase in immunodeficiency, which is associated with compensation of the immune response due to modification and excessive reproduction of CD4 cells. The rate of HIV replication during this period slows down compared to the stage of primary manifestations.

The main clinical manifestation of the subclinical stage is “persistent generalized lymphadenopathy” (PGL). It is characterized by an enlargement of at least two lymph nodes in at least two unrelated groups (not counting the inguinal ones), in adults - to a size in diameter of more than 1 cm, in children - more than 0.5 cm, persisting for at least 3 -x months. Upon examination, the lymph nodes are usually elastic, painless, not fused with the surrounding tissue, and the skin over them is not changed.

Enlarged lymph nodes at this stage may not meet the criteria for persistent generalized lymphadenopathy (PGL) or may not be recorded at all. On the other hand, such changes in the lymph nodes can also be observed in later stages of HIV infection. In some cases, they occur throughout the entire disease, but in the subclinical stage, enlarged lymph nodes are the only clinical manifestation.

The duration of the subclinical stage varies from 2 - 3 to 20 or more years, but on average it lasts 6 - 7 years.

Stage 4 - "Secondary disease stage" - is associated with depletion of the CD4 cell population due to ongoing HIV replication. As a result, against the background of significant immunodeficiency, infectious and/or oncological secondary diseases develop. Their presence determines the clinical picture of the stage of secondary diseases.

Depending on the severity of secondary diseases, stages 4A, 4B, 4C are distinguished.

Stage 4A usually develops 6 to 10 years after infection. It is characterized by bacterial, fungal and viral lesions of the mucous membranes and skin, and inflammatory diseases of the upper respiratory tract.

Stage 4B most often occurs 7 to 10 years after infection. Skin lesions during this period are deeper in nature and tend to be protracted. Damage to internal organs and the peripheral nervous system, localized Kaposi's sarcoma, begins to develop.

Stage 4B primarily occurs 10 to 12 years after infection. It is characterized by the development of severe, life-threatening secondary diseases, their generalized nature, and damage to the central nervous system.

Despite the fact that the transition of HIV infection to the stage of secondary diseases is associated with the depletion of the protective reserves of the macroorganism, this process is reversible (at least for some time). Spontaneously or as a result of therapy, the clinical manifestations of secondary diseases may disappear. Therefore, this stage is divided into phases of progression (in the absence of antiretroviral therapy or against the background of antiretroviral therapy) and remission (spontaneous, after previous antiretroviral therapy or against the background of antiretroviral therapy).

Stage 5 - "Terminal stage", is manifested by the irreversible course of secondary diseases. As a result, the patient dies within a few months.

When making a diagnosis, the nosological unit according to ICD-10 is indicated - HIV infection, then - the stage of HIV infection, phase, secondary disease. If, against the background of HIV infection, at least one of the secondary diseases has a degree of manifestation that meets the criteria for acquired immunodeficiency syndrome, after the disease phase, AIDS is indicated.

Below is a list of conditions (28 in total) that indicate the development of AIDS in a patient (defined by WHO recommendations). It is used primarily for epidemiological surveillance of the spread of HIV in the world, since cases of HIV infection are not registered in all countries.

Which is characterized by a critical decrease in the level of CD4 lymphocytes, in which various secondary infectious and oncological diseases become irreversible, that is, specific treatment is ineffective. AIDS inevitably leads to unfortunate death.

In 2012, more than 69 thousand “fresh” cases of HIV infection were identified in Russia, among which 20 thousand had a registered HIV infection, and the rest had an asymptomatic HIV-positive status. More than 800 children under 17 years old were registered among the new cases. Data for 2012 is 12% more than the previous year. The number of deaths from AIDS continues to rise. In 2012, their number was 20,511 people, which is 11.5% more than in 2011.

Causes of AIDS in humans

This syndrome, like HIV infection, is caused by the human immunodeficiency virus (several types), which can be read in more detail in the article: “HIV infection”. HIV is an RNA virus. A feature of the pathogenic effect of HIV is the ability to infect immune cells that have certain receptors on their surface (CD4) - these are T-lymphocytes, macrophages, and dendritic cells. By infecting a cell, HIV causes its death. The natural result of HIV multiplication is the development of severe immunodeficiency - AIDS.

The source of AIDS is a person who becomes infectious already in incubation period(the period from the moment of infection until the appearance clinical symptoms), the infectious period continues into the febrile stage of HIV infection, the latent stage, and the stage of secondary diseases. Largest quantity The patient excretes the virus along with all biological media precisely during the AIDS stage (terminal stage).

HIV infection is a blood-contact disease, that is, infection occurs through the blood, but the virus can also be isolated from the secretions of the cervix, seminal fluid, cerebrospinal fluid, urine, saliva, tears, etc. The content of HIV in secretions depends on the degree of viral load in the patient’s body .

There are three main transmission mechanisms:

1) Sexual (0.1% of infection with a single vaginal contact and 1% with anal contact, but if there is regular contact, the percentage of infection increases significantly). Uninhibited sexual behavior without the use of barrier protection (condoms) poses a significant risk of infection.
2) Parenteral (intravenous, intramuscular) injections and transfusions infected blood(risk of infection with intravenous use narcotic substances about 30%, with transfusion of infected blood - up to 90%).
3) Transplacental (from mother to fetus), in which the risk of infecting the child reaches up to 30%. It is also possible to transmit HIV during childbirth and breastfeeding.

Susceptibility to HIV is quite high. In the female population, the risk was previously thought to be high among women who provide sexual services. Currently, HIV is detected with a certain frequency among wives of patients with HIV and drug users who neglect protection during sexual relations.

Video about what HIV tests you need to take and why:

Changes in the human immune system during the AIDS stage

This syndrome develops when the number of CD4 lymphocytes decreases to less than 200 cells in 1 μl (or less than 0.2 per 109/l). The course of the disease becomes irreversible when it drops below 50 cells in 1 µl. These are profound disorders of the human body’s immunity, in which there is no ability to resist secondary diseases. That is, the main barrier of protection has been destroyed.

Dependence of HIV stages on CD4 lymphocytes

Symptoms of AIDS in humans

Manifestations of the AIDS stage are usually preceded by signs of the development of HIV infection and, like the first symptoms of HIV, they are very diverse. These can be various infectious bacterial, viral, fungal infections, malignant neoplasms. Their distinctive feature– rapid progression with the development of generalized forms (that is, with damage to many organs and systems), as well as low effectiveness of the treatment.

There are certain opportunistic diseases characteristic of AIDS:

1) Candidiasis of the esophagus, trachea, bronchi, lungs (caused by fungi of the genus Candida - representatives of the normal flora of the mucous membranes, but which acquire an aggressive course during AIDS)
2) Extrapulmonary cryptococcosis (caused by yeast-like capsular fungi cryptococci that are not capable of infecting healthy person, and in AIDS – observed severe forms damage to the nervous system, skin, lungs).
3) Cryptosporidiosis (protozoal disease with damage to the digestive tract and the development of severe diarrhea).
4) Cytomegalovirus infection with damage to the liver, spleen, lymphatic system, central nervous system (type 4 herpesvirus in an immunologically strong organism causes a latent form - asymptomatic; in AIDS, the changes are of an aggressive generalized nature).
5) Herpes infection caused by a virus herpes simplex in the form of a common form and damage to internal organs (bronchitis, pneumonia, esovagitis).
6) Kaposi's sarcoma (systemic malignant tumor, caused by herpesvirus type 8, appearing on the skin and internal organs - bone, gastrointestinal tract, nervous system and others).
7) Primary brain lymphoma
8) Lymphoid interstitial pneumonia
9) Mycobacteriosis (including tuberculosis), acquiring the character of disseminated or widespread forms with damage to internal organs (lungs, skin, lymphatic system, bone)
10) Pneumocystis pneumonia (caused by pneumocystis and characterized by severe lung damage with a persistent course)
11) Toxoplasmosis of the central nervous system (toxoplasma - intracellular microorganisms - causes latent or asymptomatic forms in healthy people; in AIDS, this is damage to the central nervous system with the development of meningoencephalitis and other manifestations).
12) Progressive multifocal leukoencephalopathy.

The manifestations of this stage of HIV infection are diverse and depend on the complex of diseases that develop at a particular point in time in a particular patient. These can be mixed viral infections (for example, cytomegalovirus and herpes caused by the herpes simplex virus), the development of a systemic fungal infection against the background of severe mycobacteriosis is possible, it can be the occurrence of Kaposi's Sarcoma in a young man against the background of chronic hepatitis and pneumonia of various etiologies.

Features of the stage of AIDS are, of course, the severity of secondary diseases that have arisen, persistent course (that is, the lack of effect on the specific treatment being carried out), progression of the disease (that is, the addition of new symptoms, which aggravates the patient’s condition) and, ultimately, the irreversibility of symptoms.

Non-infectious manifestations of AIDS

1) Exhaustion or cachexia of patients (critical decrease in body weight by more than 10-15% of the original). Typically, weight loss is accompanied by chronic disorder stool up to 2-3 or more times a day. The cause of exhaustion is persistent opportunistic infections that cause loss of appetite and impaired absorption in the intestine.

Cachexia

2) Peripheral polyneuropathy ( severe pain in the limbs, aggravated by standing, walking, and other movements).
3) Dementia (cause – neurotoxic effect of the virus). It is manifested by the patient's slowness, inattention, memory impairment, slow response, apathy, difficulty concentrating, passivity, and aloofness. Develops in 10-15% of cases.
4) Cardiomyopathy (cause of focal myocardial damage) - weakness of cardiac activity, shortness of breath during physical activity, pain, rhythm disturbances.
5) Myelopathy (defeat spinal cord) is manifested by spastic paraparesis of the limbs, which is manifested by gait disturbances, weakness in the limbs, the inability to perform normal movements, and possible dysfunction of urination.
6) Non-Hodgin lymphoma (painless enlargement of lymph nodes of different groups).

Lethal outcome can occur in case of severe damage to vital important organs
(lungs, brain, etc.), circulatory disorders and complications. The AIDS stage lasts from 1 to 3 years.

Diagnosis of the AIDS stage in HIV infection

1) Clinical and epidemiological diagnosis. Almost all patients who reach the stage of AIDS are registered with regional AIDS Centers and undergo regular medical examinations. Epidemiological data on HIV infection have already been collected. The appearance of various opportunistic infections with a severe course allows us to suspect this stage and further examine the patient.
2) Laboratory diagnostics.
- specific – decrease in the level of CD4 lymphocytes to 50 cells per μl; increase in viral load;
- specific laboratory criteria for a particular infection (blood and other biological fluids for antigens and antibodies, PCR diagnostics);
- general laboratory data (blood, urine, biochemical tests).
- instrumental diagnostics lesions of certain organs and systems (ultrasound, X-ray, MRI).

A. Organizational and routine measures– creation of a protective regime. All patients in the AIDS stage are subject to mandatory hospitalization in special hospitals at AIDS Centers or in infectious diseases hospitals. Bed rest and proper nutrition are indicated.

B. Drug treatment . Includes:

1) Antiretroviral therapy - ART (aimed at suppressing the replication of HIV) Examples of drugs: azidothymidine, zidovudine, zalcitabine, didanosine, saquinavir, nevirapine, lamivudine and many others. Drugs can be prescribed in combinations that are determined only by a doctor based on the patient’s viral load and the severity of immunodeficiency. Indication for ART is a decrease in CD4 lymphocytes below 350 cells per μl. When their number approaches 50 cells/µl, therapy is carried out continuously.

2) Chemoprevention of secondary opportunistic diseases
For candidiasis and cryptococcosis are prescribed antifungal drugs(nystatin,
fluconazole, amphotericin B, isoconazole, ketoconazole). For toxoplasmosis, a combined regimen of pyrimethamine, sulfadimezine and calcium folinate is prescribed. At herpetic infection antiviral drugs are used (acyclovir, famciclovir, valacyclovir). Cytomegalovirus infection in AIDS requires the administration of a parenteral form of ganciclovir - cymevene or foscarnet if there are contraindications to ganciclovir. The occurrence of Kaposi's sarcoma requires the inclusion of specific drugs in the treatment regimen (prospidin, vincristine, vinblastine, etoposide). For tuberculosis, drugs from the standard treatment regimen are added to ART of this disease(isonioside and others).
For pneumocystosis, Biseptol and Bactrim are prescribed.
3) Syndromic therapy (depending on the severity and manifestations of disease syndromes)

Prevention of AIDS stage in HIV infection

Prevention of the onset of AIDS largely depends on the consciousness of the patient himself. A timely visit to a trusted doctor at the AIDS Center with regular blood donation for viral load and immunogram, as well as timely diagnosis of opportunistic diseases greatly facilitates this task. A decrease in CD4 lymphocyte count below 350 cells/μl is an indication for highly active antiretroviral therapy (HAART). At the same time, the attending doctor prescribes preventive courses of specific drugs to prevent secondary opportunistic infections.

Infectious disease doctor N.I. Bykova

The fourth stage of HIV is the penultimate stage. It is during this period that cancer and infectious diseases that lead to human death. Stage 4 HIV infection is accompanied by serious illnesses, which are quite difficult to cure due to the lack of immunity.

The stage of secondary diseases is associated with a decrease in CD4, that is, an increase in the viral load. The result of this indicator is the body’s inability to resist viruses. This process is easily reversible with the help of antiviral therapy, which helps reduce the viral load for a long time and slow down the stages of HIV development. If you seek help in a timely manner and start taking medications, you can slow down the development of immunodeficiency. This is only possible with complete or partial relief from concomitant diseases, since the patient’s immunity is not able to cope with the ailments on its own.

Clinical forms of HIV infection

HIV AIDS has 4 periods, divided into several phases. To make a correct diagnosis, it is necessary to donate blood for viral load. This stage is determined not only by symptoms, but also by taking into account the number of CD4 cells.

HIV 4A - occurs 8-10 years after infection. Accompanied by fungal, viral, bacterial lesions of the skin and mucous membranes, as well as inflammatory diseases genitals and respiratory tract, often severe and moderate pneumonia. People who reach stage 4a of HIV live for a long time, since it is a reversible process and is easily treatable.

HIV 4B is achieved 9-12 years after infection with a retrovirus. At this stage, dermatitis and diseases of the mucous membranes develop. Irreversible weight loss can reach 15%, which is associated with prolonged diarrhea and an increase in body temperature to 38-39 degrees. Such symptoms can last from three weeks to two months. Often HIV (stage 4b) is accompanied by tuberculosis and sexually transmitted diseases such as syphilis and genital herpes. For women, exacerbation of vaginitis and thrush is also common. There are many cases where it was possible to slow down or stop the progression of the disease during this period and increase the life of a patient with stage 4b ​​HIV.

HIV 4B - few infected people reach this stage; in general, it occurs no earlier than 15 years after infection. How long patients with HIV stage 4b ​​live is a controversial issue, since it is this group of people who die not from the disease itself or secondary manifestations of AIDS, but from brain damage. This is due to the fact that with HIV (stage 4c), nerve cells and the brain are primarily affected, which can also lead to partial or complete paralysis.

The forms mentioned above can manifest themselves in different ways. Some people start having minor symptoms and develop gradually. In such cases, it is possible to recognize the onset of the fourth stage of HIV in time and begin treatment in a timely manner. Minor symptoms, such as a severe cough accompanied by chest pain or bloody discharge, may indicate the onset of stage 4 HIV infection.

HIV stage 4b, what does this mean? With the development of AIDS, the virus is gradually rehabilitated in the blood and finds ways to avoid damage from the therapy being taken. Every year, the development of a certain stage becomes faster by 0.5 - 3% of the results of the previous year. In connection with these data, scientists say that it is necessary to separate antiviral drugs, not only referring to the stage of immunodeficiency, but also taking into account what therapy the patient took at previous stages of the disease. This approach will prevent the virus from producing cells that protect it from the drugs taken.

If the retrovirus is in a “dormant” state, the fourth stage may not occur at all. A “dormant state” is when the virus does not develop inside a person, that is, the body itself has found a way to interact with the pathogen. This condition may not be initial, but may occur at any stage of immunodeficiency except the last. This means that a person with stage 4 HIV infection in the progression phase can live for a long time.

In most people, with a mild course of the disease, smoothly transitioning into a new stage, symptoms may appear: additional symptoms, and they cannot be ignored. These signs include:

• headache, especially in the morning;
• frequent dizziness;
• nausea or diarrhea immediately after eating;
• heavy sweating at night;
• unjustified anxiety and insomnia.

It is important to correctly identify all these signs to prevent misdiagnosis.

Changes in the structure of the skin and mucous membranes are the most obvious and severe sign of HIV infection at the stage of secondary diseases. Skin lesions may indicate the presence or exacerbation of severe oncological diseases, which complicates treatment. Small ulcers also sometimes appear on the palms, feet, and armpits. They often break out, bleed and fester. This is just a temporary phenomenon that goes away after an exacerbation or with the start of therapy. This period is always accompanied by high fever and illnesses such as pneumonia, influenza or bronchitis. At stage 4 of HIV, these diseases can be fatal.

With the onset of HIV stage four, a disease such as anemia appears. A decrease in hemoglobin in the blood leads to heart failure, frequent fainting, loss of appetite and, consequently, serious weight loss.

Depression is one of the common conditions associated with AIDS; it not only causes weight loss, but also a symptom of other diseases. Against the background of depression, the infected person may develop heart and nervous system diseases. Very often patients bring themselves to this state. The reason for this is self-pity and the doctor’s inability to positively influence the patient.

The fourth stage of HIV infection can last for years if timely treatment is started. Don’t be afraid of it; this process can not only be slowed down, but also reversed. Signs of the fourth stage of HIV should never be ignored. If they are detected, you should immediately contact the AIDS center. There, viral load tests are taken, and only after this a diagnosis is made and treatment is prescribed.

Pregnancy in the fourth stage of HIV development

Although pregnancy does not affect the development of immunodeficiency, you should not have children at this stage, as the risk of infection of the child and the development of secondary diseases in the mother increases. After childbirth, therapy may not have the desired effect. Such a consequence can not only fail in treatment, but also cause the virus to become resistant to antiviral drugs. This may be due to the use of therapy during pregnancy, since at this time it is aimed primarily at protecting the fetus from the virus and the mother’s body is especially vulnerable. If the therapy has given the desired result, the development of the disease has slowed down and there are no other contraindications to bearing a fetus, pregnancy is still possible with HIV at stage 4A.

It is worth paying attention to the symptoms and signs that the body gives, especially with regard to changes in body temperature and changes in the skin. If you take medications in a timely manner, you can significantly slow down the progression of the disease. Even if you can’t get rid of it, you can stop its development and live for many years, despite the presence of a retrovirus in the body.