First of all, what is AIDS?
AIDS, also known as Acquired Immune Deficiency Syndrome (AIDS), is a syndrome in which the human immunodeficiency virus (HIV) invades the immune system and causes a progressive decline in immune function, leading to various opportunistic infections and malignancies, thus endangering the life of the patient.
Since the discovery of the disease in 1981, human beings have been fighting hard against it, from the isolation of the virus in 1983 to the introduction of the cocktail therapy, Highly Active Antiretroviral Therapy (HAART), by Chinese American Professor Da-Yi Ho in 1996, which transformed AIDS from a “super plague” to a chronic infectious disease that can be treated with drugs. In 2011, a study introduced a new concept of “treatment as prevention”, thus upgrading HAART to epidemiological prevention.
It is clear that AIDS is not as scary as previously thought, and that it is a preventable and manageable disease.
So how should AIDS be diagnosed?
1.The diagnosis of HIV infection is mainly based on epidemiological history, clinical manifestations and laboratory tests.
(1) Epidemiological history
Including history of unsafe sex, history of intravenous drug use, history of importation of untested blood or blood products, history of children born to HIV-positive persons or history of occupational exposure, etc;
(2) Clinical presentation
HIV infection can be divided into acute stage, asymptomatic stage and AIDS stage according to its natural history, and the clinical manifestations of different infection stages are different.
The clinical manifestations of acute infection are non-specific, mainly fever, swollen lymph nodes, pharyngitis, rash, oral ulcers, arthralgia, etc., which occur in 80% to 90% of infected patients and last about 2-4 weeks after infection.
Patients with asymptomatic infection have no clinical manifestations and resemble normal immune populations.
In the AIDS phase, when the disease reaches its onset, the main manifestations are various opportunistic infections and clinical manifestations of AIDS-related tumors, such as Pneumocystis pneumonia, fungal esophagitis, CMV esophagitis, CMV retinitis, cryptococcal meningitis, Penicillium equi, pulmonary tuberculosis, extrapulmonary tuberculosis, tuberculous meningitis, non-Hodgkin’s lymphoma, cervical cancer, Kapozi’s sarcoma, toxoplasmic encephalopathy, etc. .
(3) Laboratory tests
Positive anti-HIV antibody (confirmed by confirmatory test) is the gold standard for the diagnosis of HIV/AIDS. HIV-RNA and P-24 antigen testing can help to shorten the window period and diagnose HIV infection in children at an early stage.
2. Key points of AIDS diagnosis in different periods
(1) Acute stage: Patients with recent epidemiological history and clinical manifestations, combined with laboratory HIV antibody change from negative to positive can be diagnosed, or only laboratory test HIV antibody change from negative to positive can be diagnosed.
(2) Asymptomatic infection stage: Diagnosis can be made with an epidemiological history, no clinical manifestations, and positive laboratory tests for HIV antibody, or with positive laboratory tests for HIV antibody only.
(3) AIDS stage.
Positive anti-HIV antibody with CD4+ T lymphocyte count <200/μl; or positive anti-HIV antibody plus any one of the following.
Persistent irregular fever of unknown origin of 38°C or more for >1 month; diarrhea (stools more than 3 times/day) for >1 month; weight loss of 10% or more within 6 months; recurrent oral candidiasis; recurrent herpes simplex virus infection or herpes zoster virus infection; pneumocystis pneumonia (PCP); recurrent bacterial pneumonia; active tuberculosis or non-tuberculous Mycobacterium bovis; deep fungal infections; central nervous system lesions; dementia in young and middle-aged adults; active cytomegalovirus infections; toxoplasma encephalopathy; Penicillium infection; recurrent sepsis; Kaposi’s sarcoma, lymphoma of the skin mucosa or viscera.
Treatment of AIDS
It includes two aspects: treatment of opportunistic infections and malignancies and highly effective antiretroviral therapy.
1. The first aspect
(1) Principles of treatment for opportunistic infections
Search for the causative agent through various examination means and provide effective treatment as well as symptomatic support treatment for the agent.
(2) Treatment principles for malignant tumors
Start antiviral treatment as soon as possible, and at the same time adopt different chemotherapy regimens for different types of tumors, and strengthen supportive treatment during chemotherapy.
2. Second aspect
Highly effective antiretroviral therapy
The combination of three or more antiretroviral drugs can maximally suppress and maintain the virus to undetectable levels, restore or rebuild the immune function, reduce the morbidity and mortality of AIDS patients, thus prolonging the life of patients, improving their quality of life, reducing the transmission of the virus, reducing the occurrence of immune reconstitution inflammatory response syndrome and non-AIDS related events, which is the most effective treatment at present. It is the most effective treatment method to maximize the benefits to patients.
The first-line antiretroviral regimen is two nucleoside antiretroviral drugs combined with non-nucleoside antiretroviral drugs, with pre-treatment evaluation and compliance education, virological, immunological and clinical efficacy monitoring during treatment, observation and symptomatic management of drug toxicities, determination of treatment failure, and timely change of treatment regimen. and timely change of treatment regimen, etc.
Precautions
Although AIDS is a preventable and controllable disease, early diagnosis and early treatment are still key.
During the acute infection period, the problem of window period is involved, which refers to the period between HIV invasion and positive anti-HIV antibody, which is easy to cause missed detection and requires high vigilance. It can shorten the window period to 14-21 days. If necessary, the HIV-RNA test can be combined with the HIV test to further shorten the interval of diagnosis of HIV infection.
It is also important for public health to reduce the further transmission of the virus, and this is why we need to strengthen the promotion of HIV-related knowledge.
A good clinical and psychological assessment and compliance assessment prior to effective antiretroviral therapy is essential to ensure the success of antiretroviral therapy, which is also important for early initiation of antiretroviral therapy.
In clinical practice, patients often fail to understand the disease correctly, are not prepared for long-term treatment, and miss the best time to start treatment because they are afraid of the side effects of various antiviral drugs, thus increasing the difficulty of antiviral treatment and the failure of treatment, and some patients even lose the time to start antiviral treatment and lose their lives due to various opportunistic infections or malignant tumors.
Therefore, proper understanding of AIDS, active patient education, early detection and diagnosis of the disease, and timely initiation of antiretroviral therapy at the best time are of great clinical importance to improve the prognosis of patients, reduce the morbidity and mortality rate, and reduce the spread of the disease.