The document discusses AIDS/HIV, including its definition, etiology, epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment, and prevention. It describes HIV's target cells (CD4+ T lymphocytes), its various stages from initial infection to AIDS, common opportunistic infections associated with AIDS like Pneumocystis carinii pneumonia treated with pentamidine, and combination antiretroviral therapy.

1. AIDS (Acquired Immune Deficiency Syndrome)

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5. Definition Sever & often fatal chronic disease HIV (Human immunodeficiency Virus) CD4+T lymphocyte Opportunistic infection & malignant tumor Sexual contact &injection transmission

6. Etiology Causative organism: HIV HIV-1 & HIV-2 Single-strand RNA, retroviridae, genome9.7kb 3 structural gene env gene: envelope Pro.-- gp120, gp41 gag gene: core pro. --P24 & medium P pol gene: polymerase, retrotranscriptase. gene homologous of HIV-2 40-50% comparing with HIV-1

9. Etiology Resistance: sensitive to heat: 56 o C30 min >25% alcohol Isolation: blood cell, plasma, lymph nodes, semen, saliva, tears, breast milk. Target cell: CD4+T, M, B cell,Nerve cell

11. Epidemiology Source of infection: patients asymptomatic carriers Route of transmission: sexual contact transmission: homosexual or bisexual: Western world heterosexual: Africa injection transmission: intravenous drug abusers blood or its components transfusion

12. Epidemiology Route of transmission: vertical spread: placenta: from mother to infant breast milk other route: organ transplants, artificial insemination needle-stick, hospital staff

13. Epidemiology Susceptibility of population: at-risk groups male homosexual or bisexual intravenous drug abusers blood transfusion > 40 yrs. male

15. Pathogenesis HIV is a cytotoxic virus HIV interfer with CD4 function & reduce its number

16. 动态演示 HIV 病毒的感染过程

17. Clinical manifestation Incubation period: 2 to 10 yrs. First period-Illness of infection Symptoms: fever, headache, anorexia, nausea, enlargement of lymph nodes HIV +, P24 Ag +, CD4/CD8 inverted ratio Last 2 weeks

18. Clinical manifestation Second period- Asymptomatic contact Initial HIV inf. or after illness of inf. No symptoms HIV +, Anti- core Ag +, anti-envelope Ag + Last 2 to 10 yrs.

19. Clinical manifestation Third period- PGL (Persistent Generalized Lymphoadenopathy) Enlargement of lymph nodes outside the inguinal area more than 2 areas more that 3 months

20. Clinical manifestation Fourth period- Manifest AIDS ARC(AIDS-related complex): fever, loss of weight, anorexia, diarrhea plu PGL nervous system symptoms: headach, convulsion, paralysis, progress dementia Rare opportunistic infection Unusual malignant tumors Pneumonia

21. Clinical manifestation Clinical Classification: Class A: illness of infection, asymptomatic infection, PGL Class B: pneumonia, ski infection Class C: Nervous system symptoms, opportunistic inf. unusual malignant tumors

22. Clinical manifestation Grade according to CD4+T cell count Grade A: CD4 > 0.5  10 9 /L, Total lymphacyte >2.0  10 9 /L, CD4+>29% Grade B: CD4 2.0-.04  10 9 /L, Total lymphacyte 1.0-1.9  10 9 /L, CD4+14~28% Grade C: CD4< 2.0  10 9 /L, Total lymphacyte <1.0  10 9 /L, CD4+<14%

23. Clinical manifestation Common manifestation of AIDS Lung infection: P. Carinii pneumonia Gastrointestinal infection: candidiasis of mouth or oesophagus Central nervous system infection: Ski infection: Kaposi’s sarcoma - red or violet macules or papules

24. Kaposi’s sarcoma

26. candidiasis of mouth

27. Laboratory Findings Blood picture: WBC and RBC decrease Immunologic test: CD4+T decrease, CD4/CD8 <1 Serological test: anti-HIV pos., Ag(gp120, p24), anti-gp120, anti-p24. HIV isolation

28. Clinical Diagnosis High risk population: >2 pos loss of weight >10% chronic cough or diarrhea > 1 mon intermittent or persistent fever >1 mon PGL herps infection candidias infection in month

29. Laboratory Diagnosis Anti-p24 or gp120 pos twice, WB or SRIP definite P24 Ag pos HIV isolation from blood, PBMS, cfs, or HIV RNA by Northern blot or HIV pre-DNA by PCR

30. Treatment There is no cure for AIDS at this time. However, a variety of treatments are available that can help keep symptoms at bay and improve the quality of life of those who have already developed symptoms.

31. Treatment Anti-virus AZT(antiretrovirals ): CD4<0.5 109/L AZT plu IFN(Kaposi’s sarcoma) Pentamidine( pneumocystis carinii pneumnia) Immune therapy complication therapy

32. complication therapy also called Cocktail therapy Taking two or more antiretroviral drugs at a time is called combination therapy. Taking a combination of three or more anti-HIV drugs is sometimes referred to as Highly Active Antiretroviral Therapy (HAART). If only one drug was taken, HIV would quickly become resistant to it and the drug would stop working. Taking two or more antiretrovirals at the same time vastly reduces the rate at which resistance would develop, making treatment more effective in the long term.

33. Prevention Control source of infection isolation sterilization international quarantine Cut the route of transmission Vaccination?(gp120)

34. HIV infecfion is mainly located in ： a.Thailand b.U.S.A c.Africa d.Japan e.Europe

35. Which cell is the target cell of HIV? a.CD8+ cells b.Mononuclear cells c.CTL e.NK cells f.CD4+ cells

36. How many years may the asymptomatic infecfion last After the infection of HIV ? a.1year b.20years c.2~10years d.2~10years or more e.1~20years

37. The most main route of transmission for AIDS is: Sexual contace Receiving blood and blood products Abuser of intravenous drug Receiving organs or tissues Eating uncooked food

38. Which drug is used for the treatment of pneumocystis carinii pneumnia. pentamidine Bleomycin spiromycin clindamycin Gancyclovir