Treatment of HIV infection (antiretroviral therapy). HIV - is it treated in the early stages? Is HIV completely curable? Can HIV be infected?

Developments

Two weeks after a child was first cured of HIV, scientists say similar treatment can help adults.

The most important thing is to start treatment early, although this does not guarantee success.

Professor Azie Saez-Siriona(Asier Sáez-Cirion) from Pasteur Institute in Paris analyzed 70 people with HIV who were treated with antiretrovirals between days 35 and 10 weeks after infection. This is much earlier than HIV patients are usually treated.

The medication regimen of all participants was interrupted for various reasons. For example, some people have made the decision to stop taking their medications themselves, while others have tried other drugs.

In most volunteers, the disease returned after stopping treatment, and the virus recurred to the level it was before treatment. But 14 patients, including 4 women and 10 men, had no recurrence of the virus after stopping treatment conducted over a period of 3 years on average.

Although 14 patients had traces of HIV in their blood, their levels were so low that their bodies could control it without medication.

Treatment of HIV infection

Average 14 participants stopped taking medication 7 years ago, and one of them coped without drugs for 10.5 years.

More recently, a baby was declared "functionally cured" of HIV after being prescribed three antiretroviral drugs almost immediately after birth: zidovudine, lamivudine And nevirapine. However, experts have warned that quick treatment is not for everyone, but it is important to start as early as possible.

"There are three benefits of early treatment," Sáez-Siriona explained. "It limits the HIV reservoir, the diversity of the virus, and keeps the immune response to the virus in check."

However, none of the 14 patients was the so-called "super-controller", that is, 1 percent of people who are naturally resistant to HIV and quickly suppress the infection. In addition, most had severe symptoms that led to early treatment.

"As paradoxical as it may sound, the worse they were at the beginning, the better they felt afterwards", the scientists said.

How long does it take for HIV to show up?

A month or two (2-4 weeks at the earliest) after HIV has entered the body, the first signs of infection may appear. But sometimes symptoms of HIV may not appear for years or even a dozen years after infection. That's why it's important to get tested for HIV to help detect the presence of the virus.

The first signs of HIV

During the first 2-4 weeks after HIV exposure (and up to 3 months), 40-90 percent of people may develop acute flu-like symptoms. It is called " acute retroviral syndrome" and is a natural response to an HIV infection. At this time, the level of the virus in the blood is high, and a person can more easily pass it on to others.

Symptoms may be present such as:

Heat

night sweats

Sore throat

Muscle pain

Headache

Fatigue

Enlarged lymph nodes

After the early symptoms of HIV disappear, the virus becomes less active, although it is still present in the body. During this time, the person may not experience any symptoms. It is called latent phase, which can last up to 10 years and longer.

After HIV turns into AIDS, symptoms of fatigue, diarrhea, nausea, fever, chills, and others appear.

The likelihood of contracting HIV

The risk of HIV infection depends on various factors.

Transfusion of infected blood - about 90 percent

Pregnancy and childbirth - 30-50 percent

Breastfeeding - about 14 percent

Intravenous injection - 0.5 -1 percent

Accidental needle stick with HIV - 0.3 percent

Unprotected anal sex - 3 percent

Unprotected vaginal sex - about 1 percent

Socially significant infections of the 21st century can be considered one of the notable infections of the century - viral hepatitis (B and C, primarily) and HIV infection. These are infections with one of the possible ways of transmission - sexual, remaining in the human body in the vast majority of cases for life, and also having the most unfavorable outcome in their dynamic development - death.

There is such a thing as "social adaptation" of patients with socially significant infections. It includes independent awareness of one's diagnosis, the realization that one can live with it further, the acceptance and adaptation of such patients in society, as well as in the patient's family and close circle, and the absence of fear of infection. All these moments are extremely important for the patient himself, since the quality of his future life depends on it. Often in society there are certain barriers for such patients. Until now, there is a problem of making the diagnosis public in families due to fear of a break, fear of misunderstanding and unfounded claims. At the same time, these diseases are not as highly contagious as is commonly believed, and knowledge of preventive measures will ensure a completely comfortable existence for patients with their loved ones, which will certainly affect the course of the disease for the better.

Possible routes of infection

Let us recall together the main mechanisms of infection with such infections, not so much for the patients themselves, but for their close circle, so that it would be easier to understand the measures to prevent infection.

Getting infected in everyday life is not as easy as it seems at first glance. These infections are classified as blood-borne (that is, infection is possible only through the blood). So, there are two broad groups of transmission paths:

1) Medical (transfusion of blood and its preparations, medical manipulations with violation of the integrity of the skin).
2) Non-medical (in / venous administration of narcotic substances, sexual transmission, tattoos and other cosmetic procedures in unsanitary conditions - no special treatment of instruments).

We must not forget that the structure of socially significant infections of the 21st century has undergone changes in terms of the well-being of patients: if diseases were previously recorded among socially disadvantaged categories of citizens, now there are also quite well-off patients in social terms, infected by accident.

In everyday life, such patients do not need to have personal dishes. It is recommended to have individual personal hygiene items (washcloth, toothbrush, manicure and shaving accessories, towel). The sexual route of transmission is more relevant for hepatitis B and HIV infection than for hepatitis C. The recommendations of experts are reduced to the use of barrier protective equipment for spouses.

Which doctor should be contacted if an infection is suspected, who conducts dispensary observation?

Each patient with suspected HIV or hepatitis should know that there is a specialist doctor to whom he can contact and get qualified advice completely free of charge. This specialist is called infectious disease specialist. Infectious disease doctors are accepted in all polyclinics at the place of residence. If some polyclinic does not have them, that is, in the district center. The infectious disease specialist is your “trusted doctor”. It is here that you can fearlessly talk about all the complaints, the duration of the disease, as well as ask all possible questions. In addition to the initial consultation with this specialist, your dispensary observation will be carried out.

Patients with HIV infection, in addition to the infectious disease specialists of the local polyclinic, have "trusted doctors" in regional AIDS Centers throughout Russia. There are also anonymous reception rooms for infectious disease specialists. For HIV patients, primary counseling is provided in such centers.

Legislative rights: Article 23 of the Constitution of the Russian Federation establishes the right of any citizen to the inviolability of private property, personal and family secrets. Medical secrecy (mystery of diagnosis) is a personal secret. Non-disclosure of medical confidentiality is guaranteed by art. 30 Fundamentals of the legislation of the Russian Federation on the protection of public health and is ensured by the legal responsibility of the doctor.

Why go to the doctor? Purpose and objectives of the visit.

The main purpose of a visit to an infectious disease specialist is to improve the quality and duration of life. This goal is achieved by solving certain tasks:

1) Make the first visit to the infectious disease specialist of your clinic.
2) Pass a complete examination in order to make a final diagnosis.
3) Get registered with the dispensary and receive medical recommendations.

Many patients are stopped by one of the frequent questions: “Why should I walk? Nothing
doesn't bother, doesn't hurt. After all, "the less you know, the better you sleep." The answer is quite obvious: "This is a profound mistaken delusion." Any disease, and even more infectious, has its own development, that is, it is cyclical. In chronic processes, over the years, one stage passes into another. Therefore, you need to visit a doctor not for his “tick in the journal”, but for your own health and for the prevention of complications.

What are the consequences of chronic hepatitis? an increase in the viral load in the blood due to increased reproduction of the virus in the liver and other systems, the development of fibrosis, the formation of liver cirrhosis, hepatocellular carcinoma (cancer). All these consequences can and should be prevented in a timely manner, and it is for this that dispensary dynamic observation by a doctor is necessary.

It is desirable that this be one doctor who knows your entire history, comorbidities and the dynamics of the underlying disease. Dispensary observation is regulated by certain documents (Order No. 408 "On measures to reduce the incidence of viral hepatitis in the country" dated 12.07.89, SanPin 3.1.1.2341-08 "Prevention of viral hepatitis B") and is carried out 1 time in 6 months, and with presence of active infection quarterly. Patients on therapy are invited to the infectious disease specialist monthly.

Consequences of HIV infection obvious to many. In the absence of medical care for such patients, the virus begins to actively multiply, significantly affecting the human immune system. The observation of such patients has one goal - the prevention of infectious complications against the background of a persistent decrease in immunity, namely, the prevention of the onset of the AIDS stage. Clinical examination and assistance is also regulated by documents (SP 3.1.5.2826-10 "Prevention of HIV infection"). Medical examination of patients with HIV infection is carried out at least once every 6 months, sometimes the patient is invited for examination more often.

What you need to be prepared for at the reception of an infectious disease specialist:

- questioning complaints;
- collecting an epidemiological history, which is important for making a diagnosis and preliminary determining the duration of infection (the doctor can ask about all possible manipulations, sexual relations, procedures, operations, lifestyle) - you need to be prepared for this;
- clinical examination (skin, lymph nodes, pharynx, eyes, lungs and heart, abdomen - liver, spleen, intestines);
- referral for additional examination (blood, urine, feces, instrumental examinations).

What complaints can lead to an infectious diseases patient with chronic hepatitis.

More often, such patients discover positive tests in themselves quite by accident - during a routine examination for surgical treatment, during inpatient treatment, during medical examinations. Consequently, the vast majority of the initially diagnosed patients do not feel any changes in health. However, despite this, there is no need to postpone your visit to a specialist. Patients with suspected chronic hepatitis may complain of weakness, fatigue, sweating, decreased appetite, discomfort in the liver from heaviness to aching pain, periodically dark urine in the morning, stool disorders, marginal yellowing of the sclera of the eyes.

Symptoms of chronic hepatitis requiring urgent medical attention are the development of jaundice, constant pain in the liver (right hypochondrium), dark urine in the morning, a hemorrhagic rash on the skin of the trunk and extremities.

What symptoms that are suspicious of HIV require consultation with an infectious disease specialist and examination for this infection:

What examinations will patients need to undergo?

During the initial consultation with an infectious disease specialist, the doctor determines the volume (quantity) of the necessary examination to make a final diagnosis, to assess the degree of your health disorder, and also determines further tactics of treatment and dispensary observation.

For the initial diagnosis of viral hepatitis, you will need:

General blood test, general urinalysis, blood biochemistry (bilirulin single and direct, alanine aminotransferase-ALT, aspartate aminotransferase-AST, gamma-glutamyltransferase-GGTP, alkaline phosphatase-AP, thymol test), and according to indications prothrombin index-PTI, serum amylase and others; tumor marker - alphafetoprotein - AFP (for CVH B);
- specific diagnosis of hepatitis B: by ELISA (blood for HBsAg, HBeAg, IgG to HBeAg, IgM and G to HBcorAg); PCR method (blood for DNA-HBV qualitatively and quantitatively);
- specific diagnosis of hepatitis C: by ELISA (blood for IgM to HCV, IgG (NS3,4,5Ag) to HCV); PCR method (blood for RNA-HCV quantitatively, qualitatively, genotype).
- Ultrasound of the abdominal organs (liver, spleen, pancreas, gallbladder)
- Evaluation of the degree of fibrosis: laboratory studies (fibro/aktitest, fibromax); research by the apparatus "Fibroscan", puncture biopsy of the liver according to indications.

The primary diagnosis of HIV infection requires:

- A blood test for antibodies to HIV by ELISA, followed by (with a 2-fold positive result) an immunoblot study. Further, the viral load is determined quantitatively by PCR (already in a specialized laboratory of the AIDS Center).

When HIV antibodies are detected, a complete examination of the patient is carried out: general blood tests, urine tests, biochemistry, blood for antibodies to infections (herpetic, cytomegalovirus, toxoplasmosis), specialist consultations (neurologist, ENT, ophthalmologist, therapist, surgeon, urologist), ultrasound examination internal organs, ECG.

All the results of the studies carried out are stored in individual patient records in the office of infectious diseases, in case of HIV infection - in a safe. That is, only a trusted infectious disease specialist has access to the cards.

Outcomes of socially significant infections without observation and during dispensary observation by a doctor.

Many patients often ask themselves: “Well, what will happen if you don’t go to the doctor? After all, there is a lot of information on the Internet, even more comments, can you take tests without a doctor's referral in any paid laboratories? Why waste time and show up at the clinic, where the queues are mostly elderly people? I recall a case from practice when one patient with chronic hepatitis could not find time once every six months to take care of his health (“Work, work, I am an indispensable employee, everything will fall apart without me!” Do you know this?). He appeared already with jaundice, the examination revealed significant signs of liver fibrosis. It required inpatient therapy, which took 2 weeks of sick leave and serious parenteral treatment.

There is an unspoken rule: "The less often you appear at the doctor, the more powerful the surprise of your illness will be." The consequences of hepatitis are liver cirrhosis (proliferation of connective tissue in the liver tissue, that is, its replacement with connective tissue), and at a certain stage this process is already irreversible. Another terrible consequence of hepatitis is liver cancer (more often with chronic hepatitis B), for the diagnosis of which a tumor marker, alphafetoprotein, AFP, is regularly (annually) checked in the blood.

The degree of consciousness of an HIV-infected patient also depends on his awareness of the diagnosis, its manifestations and outcomes. The progression of HIV infection with the development of severe immunodeficiency, the appearance of frequent purulent-inflammatory, fungal, viral diseases in the patient, and even more so, the development of the AIDS stage, when the body is unable to fight the infection, should discipline the patient. Regular meetings with the doctor, dynamic monitoring of the viral load, timely administration of antiviral therapy has a good effect on the prognosis of the disease.

Social adaptation in society

In the West, adaptation in society of patients with socially significant infections (mainly
this applies to HIV infection) is currently at a high level - patients get a job, lead an active lifestyle that is accessible to their state of health, public opinion is not so categorical in relation to such patients. In our country, the majority prefers to hide not only their diagnosis, but in general the need for regular visits to the doctor. Employment is carried out on an individual basis and mainly for positions that do not require a medical book. And you can understand patients.

Patients with chronic hepatitis adapt to society somewhat easier. Employed in working order. When applying for a job in preschool institutions (kindergartens, schools), they can be refused only if there are markers of viral hepatitis A and E, which are transmitted by the fecal-oral route, they cannot be other hepatitis. In other situations, employment should not be impeded (if the patient himself does not have a health problem).

Prevention of socially significant infections

In family foci of socially significant infections, all family members are examined (blood is taken for specific examinations). Patients should have individual personal hygiene items (manicure and shaving accessories, toothbrushes, washcloths, combs, towels and bedding). They must be disinfected individually. Avoid any contact in everyday life with infected blood of the patient (with paresis, abrasions, wounds). Prevention of sexual infection (barrier methods of protection).

With viral hepatitis B, there is a specific prophylaxis (vaccination) that all members of the patient's family must undergo.

When markers of hepatitis B and C are detected in medical workers, only gynecologists, surgeons, dentists, urologists, operating and procedural nurses with violations of the integrity of the skin are temporarily suspended from work. In other cases, medical workers work in compliance with the rules of personal hygiene (all manipulations are carried out by them in rubber gloves). More details in the regulatory documents ((Order No. 408 "On measures to reduce the incidence of viral hepatitis in the country" dated 12.07.89, SanPin 3.1.1.2341-08 "Prevention of viral hepatitis B")). When professionally infected with HIV, medical workers are transferred to positions that do not have direct contact with blood.

Infectious disease specialist Bykova N.I.

It is a disease caused by the human immunodeficiency virus, characterized by acquired immunodeficiency syndrome, which contributes to the occurrence of secondary infections and malignant tumors due to a deep inhibition of the protective properties of the body. HIV infection has a variety of course options. The disease can last only a few months or stretch up to 20 years. The main method for diagnosing HIV infection remains the detection of specific antiviral antibodies, as well as viral RNA. Currently, patients with HIV are treated with antiretroviral drugs that can reduce the reproduction of the virus.

General information

Exciter characteristic

The human immunodeficiency virus is a DNA-containing virus that belongs to the Lentivirus genus of the Retroviridae family. There are two types: HIV-1 is the main causative agent of HIV infection, the cause of the pandemic, the development of AIDS. HIV-2 is a rare type found mainly in West Africa. HIV is an unstable virus, it dies quickly outside the carrier's body, is sensitive to temperature (reduces infectious properties at a temperature of 56 ° C, dies after 10 minutes when heated to 70-80 ° C). It is well preserved in the blood and its preparations prepared for transfusion. The antigenic structure of the virus is highly variable.

The reservoir and source of HIV infection is a person: suffering from AIDS and a carrier. Natural reservoirs of HIV-1 have not been identified, it is believed that wild chimpanzees are the natural host in nature. HIV-2 is carried by African monkeys. Susceptibility to HIV in other animal species has not been noted. The virus is found in high concentrations in blood, semen, vaginal secretions, and menstrual fluids. It can be isolated from women's milk, saliva, lacrimal secretion and cerebrospinal fluid, but these biological fluids pose a lesser epidemiological hazard.

The probability of transmission of HIV infection increases in the presence of damage to the skin and mucous membranes (trauma, abrasions, cervical erosion, stomatitis, periodontitis, etc.) HIV is transmitted using the blood-contact and biocontact mechanism in a natural way (during sexual contact and vertically: child) and artificial (mainly implemented with a hemopercutaneous transmission mechanism: with transfusions, parenteral administration of substances, traumatic medical procedures).

The risk of HIV infection with a single contact with a carrier is low, regular sexual contact with an infected person significantly increases it. Vertical transmission of infection from a sick mother to a child is possible both in the prenatal period (through defects in the placental barrier) and during childbirth, when the child comes into contact with the mother's blood. In rare cases, postnatal transmission with breast milk is recorded. The incidence among children of infected mothers reaches 25-30%.

Parenteral infection occurs by injection with needles contaminated with the blood of HIV-infected persons, with blood transfusions of infected blood, non-sterile medical procedures (piercing, tattoos, medical and dental procedures performed with instruments without proper processing). HIV is not transmitted by contact-household way. Human susceptibility to HIV infection is high. The development of AIDS in people over 35 years of age, as a rule, occurs in a shorter time from the moment of infection. In some cases, resistance to HIV is noted, which is associated with specific immunoglobulins A present on the mucous membranes of the genital organs.

The pathogenesis of HIV infection

The human immunodeficiency virus, when it enters the blood, invades macrophages, microglia and lymphocytes, which are important in the formation of the body's immune responses. The virus destroys the ability of immune bodies to recognize their antigens as foreign, populates the cell and proceeds to reproduction. After the multiplied virus enters the bloodstream, the host cell dies, and the viruses are introduced into healthy macrophages. The syndrome develops slowly (for years), in waves.

At first, the body compensates for the massive death of immune cells by producing new ones, over time, compensation becomes insufficient, the number of lymphocytes and macrophages in the blood decreases significantly, the immune system collapses, the body becomes defenseless both against exogenous infection and bacteria that inhabit organs and tissues normal (which leads to the development of opportunistic infections). In addition, the mechanism of protection against the reproduction of defective blastocytes - malignant cells - is disrupted.

The colonization of immune cells by the virus often provokes various autoimmune conditions, in particular, neurological disorders are characteristic as a result of autoimmune damage to neurocytes, which can develop even earlier than the immunodeficiency clinic manifests itself.

Classification

In the clinical course of HIV infection, 5 stages are distinguished: incubation, primary manifestations, latent, secondary diseases and terminal. The stage of primary manifestations can be asymptomatic, in the form of primary HIV infection, and can also be combined with secondary diseases. The fourth stage, depending on the severity, is divided into periods: 4A, 4B, 4C. The periods go through phases of progression and remission, differing depending on the antiretroviral therapy taking place or its absence.

Symptoms of HIV Infection

Incubation stage (1)- can be from 3 weeks to 3 months, in rare cases it can be extended up to a year. At this time, the virus is actively multiplying, but there is no immune response to it yet. The incubation period of HIV ends either with a clinic of acute HIV infection or with the appearance of HIV antibodies in the blood. At this stage, the basis for the diagnosis of HIV infection is the detection of the virus (antigens or DNA particles) in the blood serum.

Stage of primary manifestations (2) characterized by the manifestation of the body's reaction to the active replication of the virus in the form of a clinic of acute infection and an immune response (production of specific antibodies). The second stage may be asymptomatic, the only sign of developing HIV infection will be a positive serological diagnosis for antibodies to the virus.

Clinical manifestations of the second stage proceed according to the type of acute HIV infection. The onset is acute, observed in 50-90% of patients three months after the moment of infection, often preceding the formation of HIV antibodies. Acute infection without secondary pathologies has a rather diverse course: fever, a variety of polymorphic rashes on the skin and visible mucous membranes, polylymphadenitis, pharyngitis, lienal syndrome, and diarrhea may occur.

In 10-15% of patients, acute HIV infection occurs with the addition of secondary diseases, which is associated with a decrease in immunity. These can be tonsillitis, pneumonia of various origins, fungal infections, herpes, etc.

Acute HIV infection usually lasts from several days to several months, averaging 2-3 weeks, after which, in the vast majority of cases, it passes into a latent stage.

Latent stage (3) characterized by a gradual increase in immunodeficiency. The death of immune cells at this stage is compensated by their increased production. At this time, HIV can be diagnosed using serological tests (antibodies to HIV are present in the blood). The clinical sign may be enlargement of several lymph nodes from different, unrelated groups, excluding inguinal lymph nodes. At the same time, there are no other pathological changes in enlarged lymph nodes (soreness, changes in surrounding tissues). The latent stage can last from 2-3 years, up to 20 or more. On average, it lasts 6-7 years.

Stage of secondary diseases (4) characterized by the occurrence of concomitant (opportunistic) infections of viral, bacterial, fungal, protozoal genesis, malignant tumors against the background of severe immunodeficiency. Depending on the severity of secondary diseases, 3 periods of the course are distinguished.

4A - weight loss does not exceed 10%, infectious (bacterial, viral and fungal) lesions of integumentary tissues (skin and mucous membranes) are noted. The performance is reduced.
4B - weight loss of more than 10% of the total body weight, prolonged temperature reaction, prolonged diarrhea that does not have an organic cause is possible, pulmonary tuberculosis may join, infectious diseases recur and progress, localized Kaposi's sarcoma, hairy leukoplakia is detected.
4B - general cachexia is noted, secondary infections acquire generalized forms, candidiasis of the esophagus, respiratory tract, pneumocystis pneumonia, tuberculosis of extrapulmonary forms, disseminated Kaposi's sarcoma, neurological disorders are noted.

Substages of secondary diseases go through phases of progression and remission, which differ depending on the presence of antiretroviral therapy or its absence. In the terminal stage of HIV infection, secondary diseases that have developed in a patient become irreversible, treatment measures lose their effectiveness, and death occurs after a few months.

The course of HIV infection is quite diverse, not always all stages take place, certain clinical signs may be absent. Depending on the individual clinical course, the duration of the disease can range from several months to 15-20 years.

Clinical features of HIV infection in children

HIV in early childhood contributes to delayed physical and psychomotor development. Recurrence of bacterial infections in children is noted more often than in adults, lymphoid pneumonitis, an increase in pulmonary lymph nodes, various encephalopathies, and anemia are not uncommon. A common cause of childhood death in HIV infections is hemorrhagic syndrome, which is a consequence of severe thrombocytopenia.

The most common clinical manifestation of HIV infection in children is a delay in the pace of psychomotor and physical development. HIV infection received by children from mothers ante- and perinatally proceeds much more severely and progresses faster, in contrast to that in children infected after a year.

Diagnostics

Currently, the main diagnostic method for HIV infection is the detection of antibodies to the virus, which is carried out mainly using the ELISA technique. In the case of a positive result, the blood serum is examined using the immune blotting technique. This makes it possible to identify antibodies to specific HIV antigens, which is a sufficient criterion for the final diagnosis. Failure to blot detect antibodies of a characteristic molecular weight, however, does not rule out HIV. During the incubation period, the immune response to the introduction of the virus has not yet been formed, and in the terminal stage, as a result of severe immunodeficiency, antibodies cease to be produced.

When HIV is suspected and no positive immune blotting results are available, PCR is an effective method for detecting viral RNA particles. HIV infection diagnosed by serological and virological methods is an indication for dynamic monitoring of the state of the immune status.

Treatment of HIV infection

Therapy of HIV-infected persons implies constant monitoring of the body's immune status, prevention and treatment of emerging secondary infections, and control over the development of neoplasms. Often, HIV-infected persons require psychological assistance and social adaptation. Currently, due to the significant spread and high social significance of the disease on a national and global scale, support and rehabilitation of patients is being carried out, access to social programs is expanding that provides patients with medical care that facilitates the course and improves the quality of life of patients.

To date, the predominant etiotropic treatment is the appointment of drugs that reduce the reproductive ability of the virus. Antiretroviral drugs include:

NRTIs (nucleoside transcriptase inhibitors) of various groups: zidovudine, stavudine, zalcitabine, didanosine, abacavir, combination drugs;
NTRTs (nucleotide reverse transcriptase inhibitors): nevirapine, efavirenz;
protease inhibitors: ritonavir, saquinavir, darunavir, nelfinavir and others;
fusion inhibitors.

When deciding to start antiviral therapy, patients should remember that the use of drugs is carried out for many years, almost for life. The success of therapy directly depends on strict adherence to the recommendations: timely regular intake of drugs in the required dosages, adherence to the prescribed diet and strict adherence to the regimen.

Occurring opportunistic infections are treated in accordance with the rules of effective therapy against the pathogen that caused them (antibacterial, antifungal, antiviral agents). Immunostimulating therapy for HIV infection is not used, since it contributes to its progression, cytostatics prescribed for malignant tumors depress the immune system.

Treatment of HIV-infected people includes general strengthening and supporting the body means (vitamins and biologically active substances) and methods of physiotherapeutic prevention of secondary diseases. Patients suffering from drug addiction are recommended to be treated in appropriate dispensaries. Due to significant psychological discomfort, many patients undergo long-term psychological adaptation.

Forecast

HIV infection is completely incurable, in many cases antiviral therapy gives little result. Today, on average, HIV-infected people live 11-12 years, but careful therapy and modern medications will significantly lengthen the life of patients. The main role in curbing the developing AIDS is played by the psychological state of the patient and his efforts to comply with the prescribed regimen.

Prevention

Currently, the World Health Organization is conducting general preventive measures to reduce the incidence of HIV infection in four main areas:

education on the safety of sexual relations, distribution of condoms, treatment of sexually transmitted diseases, promotion of a culture of sexual relations;
control over the manufacture of drugs from donor blood;
managing the pregnancy of HIV-infected women, providing them with medical care and providing them with chemoprophylaxis (in the last trimester of pregnancy and during childbirth, women receive antiretroviral drugs, which are also prescribed for newborn children for the first three months of life);
organization of psychological and social assistance and support for HIV-infected citizens, counseling.

Currently, in world practice, special attention is paid to such epidemiologically important factors in relation to the incidence of HIV infection as drug addiction, promiscuity. As a preventive measure, many countries provide free distribution of disposable syringes and methadone substitution therapy. As a measure to reduce sexual illiteracy, courses on sexual hygiene are being introduced into curricula.

Despite advances in the study of infectious diseases, HIV treatment does not yet completely eliminate immunodeficiency, so for most patients such a diagnosis sounds like a death sentence. But it is important to note that with HIV therapy with modern antiretroviral drugs can delay severe complications and AIDS. Subject to the prescribed regimen and the rejection of bad habits, it provides a person with a long and fulfilling life.

The only effective treatment for HIV is highly active antiretroviral therapy (HAART), which is aimed at suppressing the activity of the HIV pathogen and slowing down the transition to the terminal stage.

There are three main goals in HIV therapy:

virological - to eliminate the reproduction of the infectious agent;
immunological - to resume the work of immunity;
clinical - to improve the quality of life and the patient's condition.

HIV treatment should be started as soon as possible after diagnosis to be effective. After all, the sooner you start acting on the virus, the less it will have time to harm the immune system.

When immunodeficiency is detected in the later stages, especially with AIDS, antiretroviral therapy has practically no effect on the course of the disease. Life expectancy is reduced to 10-12 months. And according to a study by American scientists, against the background of timely treatment and when the disease is detected at an early stage, a patient with HIV lives quietly up to 70 years. The only important condition is lifelong medication.

During treatment, medical supervision and laboratory diagnostics are important - the retrovirus is able to adapt to adverse conditions caused by treatment. The drugs used cease to act on the causative agent of the infection, which is immediately displayed on blood tests (antibody titer). The HIV clinic begins to progress, then a change in treatment tactics and a combination of drugs is necessary.

Currently, the so-called tritherapy is used - a combination of three (rarely four) drugs, each of which acts on a certain stage of pathogen reproduction. Such a scheme makes it possible to suppress not only the existing type of retrovirus in the patient's body, but also mutated forms that arise in the process of its adaptation to the action of the drug. When HIV is detected at an early stage, when the CD4-lymphocyte titer is above 350 cells, immunodeficiency is treated as with a lower level of T-cells, but with the help of two drugs from different pharmacological groups.

How to treat HIV in women and HIV in men largely depends on comorbidities, because in addition to HAART, drugs are needed due to the etiology of secondary diseases. In women, inflammatory processes of the reproductive organs, cycle disorders, and fungal infections of the internal organs more often occur. There is also a more pronounced manifestation of HIV with a vivid clinical picture. Men have a rash, diarrhea, swollen lymph nodes throughout the body, and joint pain. Thus, HAART is the same for any gender and age, differences in treatment are determined by the presence of concomitant diagnoses.

Can HIV infection be cured?

According to statistics for 2017, there is not a single patient who has been able to completely cure HIV. It is impossible to destroy the virus, only suppression of its activity and reproduction is possible, and as long as there is a pathogen, a complete cure for HIV is impossible. That is why HIV is treated throughout life - if you stop taking prescribed medications, the virus becomes active, and immunodeficiency begins to progress. Immunity, adapted to a low-active virus, does not have time to restrain its reproduction, the production of antibodies is very slow, the virus multiplies rapidly and leads to irreversible consequences.

Modern drugs for the treatment of HIV and AIDS

Treatment of HIV using modern methods of antiretroviral therapy is based on the suppression of virus replication (reproduction of copies of the maternal DNA of the virus) inside T cells at different stages. Depending on the suppressed process, the following groups of drugs are distinguished:

inhibit reverse transcriptase, an enzyme that is responsible for creating HIV DNA based on virus RNA (Zidovudine, Stavudine, Phosphazid, Abacavir);
block protease - an enzyme that breaks down complex molecules into proteins necessary for DNA synthesis (Ritonavir, Amprenavir, Saquinavir);
inhibit integrase, an enzyme that inserts viral DNA into the target cell of the human body (Raltegravir, Dolutegravir);
act on the receptors of the target cell, as a result of which they do not allow the virus to pass through the cell membrane (Maraviroc);
block the process of penetration of the virus into the target cell (Enfuvirtide).

All antiretroviral drugs have side effects that complicate the treatment of HIV infection, especially in the presence of comorbidities:

cirrhosis of the liver, pancreatitis, renal failure, gastrointestinal disorders;
allergic reactions with a malignant course;
metabolic disease;
oppression of the bone marrow and hematopoiesis;
polyneuropathy;
toxic effect on the nervous system.

Many side effects can cause conditions that threaten the life of the patient, so the therapy requires medical supervision and dynamic monitoring.

Restoration of the immune system during treatment

Antiviral therapy for HIV infection allows you to control immunodeficiency. But in almost 20% of patients there is such a side condition as the immune recovery inflammatory syndrome (IRS). The essence of this syndrome lies in the fact that when immunity is restored, it becomes able to respond to some infectious disease, the causative agent of which was in the body. For example, a patient before active therapy was infected with cytomegalovirus, but the immunity due to HIV was so weak that there was no response to the invasion of the pathogen. After the start of HAART, the level of lymphocytes and macrophages increased, they began to actively fight against cytomegalovirus, the patient immediately began to have clinical manifestations and deterioration of his condition. According to the same scheme, in the first few months from the start of treatment, any infectious disease may worsen or reappear. This effect on the body greatly complicates antiretroviral therapy. A patient with HIV may even refuse further treatment, because before the start of therapy, the state of health was much better, despite immunodeficiency.

There are enough options for infectious diseases in VISV, but the most common are mycobacterial, cytomegalovirus, cryptococcal, pneumocystis, and herpetic infections.

VISV is treated symptomatically, depending on the infection. Interruption of antiretroviral therapy in this case is not recommended, since the patient's condition usually stabilizes after 2-3 months. And if you interrupt the therapy, and then start again, then VSIV will arise with renewed vigor.

In general, despite the negative aspects of this syndrome, in general, this is a good sign! If the immune system began to work and respond to external stimuli, then the treatment is effective and immunodeficiency is amenable to therapy.

Victory over HIV is possible only with the patient's discipline and the fulfillment of all medical prescriptions. If the patient is drug addicted and does not give up addiction, then treatment for HIV infection will not bring any results. In addition to treatment, diet, adequate physical activity, vitamin therapy, giving up bad habits, and avoiding contact with infectious patients are necessary.

For those at risk, it is important to know if HIV is being treated. Of course, such an infection is not considered fatal, but, nevertheless, it gives the patient a lot of trouble. In addition, AIDS often develops against the background of HIV, which only aggravates the general health of a person.

The number of people infected with the human immunodeficiency virus (HIV) is increasing every year, but the number of people who have recovered, unfortunately, is not increasing. If we do not start the fight against such a dangerous disease now, in 2-3 decades it can become an epidemic. Can HIV infection be cured or is it impossible?

With such a disease, the virus suppresses its own immunity, the destruction of leukocytes in the blood - cells that recognize any infection and participate in the fight against it. Losing the natural volume of such blood cells, the body can no longer independently fight even the most primitive viruses, fungi, bacteria and other pathogenic microorganisms. If earlier, before infection, the human body easily defeated a cold, then during the development of HIV, such a disease can cause death.

Whether the early-stage immunodeficiency virus (HIV) is treated is a question for both the infected themselves and many researchers. There are two ways to answer it: no and yes. First of all, patients are given a blood test taken from a vein for the presence of antibodies to HIV1 and HIV2 antigens. If the diagnosis is confirmed, appropriate therapy is prescribed.

Treatment of an infection is the adoption by people of measures that contribute to the restoration of the body in the development of a specific disease (in our case, HIV infection). The cure of a disease is the complete elimination of the pathology. Given these two terms, we can say with accuracy: HIV is treated. The infection is treated with strong drugs (antiretrovirals) that can suppress the activity of the pathogenic microorganism.

What is HIV: it is like a chronic disease that will accompany a person throughout his life. Of course, various studies are currently underway that are aimed at finding ways to stop the global epidemic, but now the disease is still classified as incurable. A patient with AIDS, just like HIV, cannot be completely cured, unfortunately. It is possible for a person to conduct only maintenance therapy, which will help smooth out clinical manifestations.

Since HIV is treated well only at the initial stage of its development, it is necessary to be attentive to your health and consult a doctor at the first alarming symptoms. The first signs and symptoms of AIDS and HIV infection are mostly similar:

Increased general temperature, the indicators of which reach 38 degrees for several days.
General malaise, which can be both short-term and long-term.
Lymphadenitis - an increase in the size of the lymph nodes. This symptom of the disease is the main one, which is taken into account in the diagnosis.

This disease (HIV) can begin to develop without any manifestations at all, which is typical for the initial stage. Nevertheless, there is a slow attack on the immune system, which can subsequently cause dangerous consequences (in our case, the development of acquired immunodeficiency syndrome).

The incubation stage is the time from the moment the virus enters the body until the first symptoms and (or) antigens in the blood to the virus cells appear. HIV at an early stage lasts from 3 weeks to 3 months, and sometimes drags on for up to 12 months. It is important to identify the disease at this stage, because the prognosis in this case is the most favorable. In the case of a positive analysis, the person must contact the AIDS center and begin appropriate therapy.
The second stage is subdivided into 2a, 2b and 2c. The first of these (2a) is considered asymptomatic. The second (2b) occurs with pronounced symptoms: febrile syndrome, rash on the dermis and mucous membranes, lymphadenitis, pharyngitis, etc. The third (2c) is characterized by the addition of secondary diseases: tonsillitis, bacterial and pneumocystis pneumonia, candidiasis, herpes, etc.
The third stage is called "latent" and proceeds with a slow progression of immunodeficiency. The only symptom is lymphadenitis, which covers 2 or more nodes in different groups (except inguinal ones). The duration of this period is from 2-20 years or more, moreover, being completely asymptomatic.
The fourth stage is characterized by the addition of secondary pathologies. Healing and the transition of the disease into a latent course at this stage is no longer possible. It can be both secondary infectious and oncological diseases with corresponding symptoms.
At the fifth (terminal) stage, secondary pathologies have an irreversible course, and antiviral drugs are no longer effective. Death occurs in 2-3 months.

In any case, each organism is individual and reacts differently to the development of a viral infection. Even if a blood test confirmed the presence of antibodies in the body, and there are no clearly expressed symptoms, do not despair, because, perhaps, such a result is a false positive. This can happen for many reasons: if an acute respiratory infection develops at the time of blood donation, allergies, or others. The doctor can make an incorrect diagnosis, which can be confirmed or refuted only with the help of a repeated test.

Ways of transmission of HIV infection

There are many ways to transmit HIV infection, the main ones are:

Sexual intercourse with an infected person without the use of contraceptive methods.
Drawing blood or injecting with a syringe that has previously been used on an infected person.
Immunodeficiency, that is, HIV infection, can be transmitted from a sick mother to a child during childbirth, breastfeeding (the initial symptoms after infection with the virus may occur many years later).

Other modes of transmission are rare. These include the transfusion of infected blood to a healthy person, which was not tested before use for HIV infection. Even less common is the transmission of infected material to open wounds or mucous membranes. The disease is not transmitted by household means.

The risk of transmission is reduced for people who have sex with people who are on antiretroviral treatment.

To avoid dangerous consequences, after unprotected sexual intercourse, it is worthwhile to conduct an ELISA blood test if there is a suspicion of HIV infection in a partner. It is better to detect HIV in the early stages than to deal with its negative consequences later.

HIV is curable: myth or reality

Scientists around the world are fighting in the hope that someday the virus can be permanently cured, but these are just assumptions. What methods really work, while it is impossible to say. Some try to treat the disease with folk remedies, but they are completely ineffective. The most common way to suppress the activity of the virus is only with special drugs that a doctor prescribes to infected people.

In the 90s, when antiretroviral therapy was invented, researchers suggested that, after all, HIV is curable. To date, there are many refutations to this, because a viral infection, like AIDS, is not treated. Even the timely start of therapy does not guarantee that it is possible to completely cure the disease and get rid of the terrible diagnosis.

Leading researchers conducted relevant tests, with the help of which they wanted to find out why the virus continues to be present in the body and does not respond to any therapy. And, so, in 1996, there were suggestions that a cure for AIDS and HIV is possible. To this end, even stronger drugs began to be developed. It was believed that someday the virus cells would still end up in the body, die completely or become sensitive to antiviral drugs. According to the mathematical models of researchers, this will take more than 60 years.

Each person's body reacts differently to these drugs. Some treat HIV infection and see a positive trend, while for others it does not bring positive results and soon a fatal outcome occurs.

Treatment of HIV infection

Whether it is possible to cure HIV (the first type and the second) or not, the question is relative. For many years, only therapy has been used that is aimed at improving the quality of life of the patient, preventing and slowing down the progression of the disease. The latest antiviral treatment is in the form of drugs that can prolong a person's life (for example, it can be Loverid and Deloverdin). Also prescribe means that help prevent the blocking of healthy cells by the virus (For example, Indinavir, etc.), and reduce the viability of the pathogen (for example, Epevir, Zerit, etc.). Timely and complete therapy is based on the fact that the patient can live to a ripe old age.

Additional treatment for AIDS and HIV is to use:

During the use of each method of treating a disease, it is necessary to adhere to some rules, following which, you can improve the effectiveness of therapy:

Continuous treatment.
If possible, start using drugs as early as possible, at the initial stage of the disease.
In the complex, several drugs with antiretroviral action are used.

How to cure HIV if unsatisfactory results are observed after the course of therapy? In this case, chemotherapy is corrected.

HIV prevention

Of course, it is easier to prevent the disease than to get rid of it, because even in the early stages it is completely impossible to cure HIV, including by using powerful antiretroviral therapy. By following these simple recommendations, you can significantly reduce the risk of infection:

It is recommended to conduct sexual life with a permanent partner, avoiding casual relationships. It is necessary to protect yourself by using contraceptives - condoms.
Drugs - to exclude from life. Under their influence, a person often loses control, including for using the same syringe with other drug addicts. After contact with someone else's infected blood, there is a 100% guarantee that a person will become infected with the immunodeficiency virus.
Prevention of acquired HIV in a child is more concerned with his mother, who during pregnancy must follow all the recommendations of the leading doctor. Breastfeeding in this case is not carried out.

AIDS prevention

The answer to the question: can AIDS be cured is the same as for HIV infection. Both pathologies are considered incurable, and there is no specific cure for them. Prevention of AIDS is reduced to the following:

Prohibition of promiscuous sexual activity.
Use of condoms during intercourse.
Compliance with personal hygiene: a toothbrush, syringes for injection, a razor must be strictly individual.
Bad habits must be excluded, especially drugs.
Dental and surgical instruments must be properly cleaned before use.

AIDS against the background of HIV is an even more dangerous disease, which after a short amount of time leads to death.

Healing from HIV

Although there is no cure for HIV, there are examples that show otherwise. The first case is a Berlin patient who contracted the pathology at the age of 30. For 10 years he was treated with special drugs, after which he was diagnosed with acute leukemia. Traditional medicine did not bring the desired recovery, which became the reason for a bone marrow transplant. Only 2 operations were needed so that the cured person could live for many years without relapses.

Other cases of getting rid of an infectious disease have been reported in Africa: children were infected from a mother who did not receive the necessary treatment. For 30 days, the babies took medications, and after this period, a noticeable decrease in the activity of the virus was observed.

The immunity of each person is individual and no one knows what will be the reaction and sensitivity to the antiviral drugs taken. If a person is not treated at all, the average life expectancy does not exceed 11 years. In most cases, the cause of death is concomitant secondary diseases (it can be tuberculosis, cancer, pneumonia, etc.). In the case of timely start of treatment for AIDS and HIV, one can hope for a fairly favorable prognosis. The average life expectancy in this case is up to 70 years.