AIDS, or Acquired Immune Deficiency Syndrome (AIDS), is an immune deficiency caused by human infection with Human Immunodeficiency Virus (HIV), which leads to a series of opportunistic infections and tumors, and in severe cases can lead to It is a syndrome that can lead to death. Currently, AIDS has changed from a lethal disease to a manageable chronic disease.
I. Epidemiology
1. Epidemiological overview: WHO reported that in 2010, there were 34 million living HIV carriers and AIDS patients worldwide, 2.7 million new infections and 1.8 million deaths. There are more than 7,000 new infections every day, and the epidemic is prevalent in all regions of the world, but more than 97% are in middle and low-income countries, especially in Africa. China’s CDC estimates that by the end of 2011, about 780,000 people were living with HIV and AIDS in China, with 48,000 new infections and 28,000 deaths for the year. The epidemic has covered all provinces, autonomous regions and municipalities directly under the central government, and China is now facing the peak of AIDS incidence and death, and has started to spread from high-risk groups such as drug addicts and clandestine prostitutes to the general population.
Yang Huai, Department of Male Medicine, Guangzhou General Hospital, Guangzhou Military Region
2, the source of infection: HIV-infected people and AIDS patients are the only source of infection of the disease.
3, the transmission route: HIV mainly exists in the blood, semen, vaginal secretions, breast milk of infected people and patients. ①Sex: unprotected sex with an infected partner, including homosexual, heterosexual and bisexual sexual contact.
②Intravenous drug use: Sharing unsterile injection tools used by an infected person with others is a very important route of HIV transmission.
③Mother-to-child transmission: During pregnancy, delivery and breastfeeding, HIV-infected mothers may transmit to their fetuses and infants.
④Blood and blood products (including artificial insemination, skin grafts and organ transplants).
Handshakes, hugs, courtesy kisses, eating and drinking together, sharing toilets and bathrooms, sharing offices, public transportation, recreational facilities and other daily life contacts will not transmit HIV.
4.Susceptible people: The population is generally susceptible. High-risk groups include: male homosexuals, intravenous drug users, frequent sexual contacts with HIV carriers, frequent transfusion of blood and blood products, and babies born to HIV-infected mothers.
Second, the harm of AIDS
1.Harm to patients themselves: At present, AIDS has become a chronic disease that can be controlled. However, there are still a considerable number of patients who die or become disabled due to untimely diagnosis and treatment, virus resistance or side effects of drugs. At the same time, due to social discrimination against infected people, it often brings heavy mental pressure to infected people.
2. Hazards to others: unprotected sex, multiple sexual partners, sharing of needles and intravenous drug use, and mother-to-child transmission of the virus to others.
3. Harm to family and society: Although China has long implemented the policy of “four free and one care” for HIV-infected patients, the treatment of advanced complications may still bring heavy economic burden and social problems to the family and society.
Clinical manifestations
In China, HIV infection is divided into acute phase, asymptomatic phase and AIDS phase.
(I) Acute stage
Usually occurs about 2-4 weeks after the initial HIV infection. The main clinical manifestations are fever, sore throat, night sweats, nausea, vomiting, diarrhea, rash, arthralgia, swollen lymph nodes and neurological symptoms. Most patients have mild clinical symptoms that last 1-3 weeks and then resolve.
(II) Asymptomatic phase
This phase can be entered from the acute phase or directly without obvious symptoms of the acute phase.
The duration of this period is usually 6-8 years. However, there are also those who progress rapidly and those who do not progress for a long time. The length of this period depends on the number and type of viruses infected, the route of infection, the immune status of the body and other factors.
(C) AIDS stage
It is the final stage after HIV infection. The patient’s CD4+
T-lymphocyte count decreases significantly, mostly <200/mm3, and HIV plasma viral load increases significantly. The main clinical manifestations in this stage are HIV-related symptoms, various opportunistic infections and tumors.
HIV-related symptoms: The main manifestations are fever, night sweats, diarrhea that last for more than one month; weight loss of 10% or more. Some patients show neuropsychiatric symptoms, such as memory loss, apathy, personality change, headache, epilepsy and dementia. In addition, persistent generalized lymph node enlargement may occur, which is characterized by ①. Lymph node enlargement in two or more areas other than the groin; ②. Lymph node diameter ≥1 cm, no pressure pain, no adhesions; ③ Duration of more than 3 months.
Common symptoms of HIV-related opportunistic infections and tumors: fever, night sweats, swollen lymph nodes, cough, sputum and blood, dyspnea, headache, vomiting, abdominal pain and diarrhea, gastrointestinal bleeding, dysphagia, decreased appetite, oral white spots and ulcers, various rashes, decreased vision, blindness, dementia, epilepsy, limb paralysis, emaciation, anemia, diarrhea, urinary retention, intestinal obstruction, etc.
IV. Diagnosis
Diagnosis of HIV infection: ①Epidemiological history: history of unsafe living, history of intravenous drug injection, input of blood or blood products without anti-HIV antibody test, children born to HIV-positive persons or history of occupational exposure, etc. ② Clinical manifestations: different manifestations in each stage. ③Laboratory tests: HIV infection must be diagnosed with positive HIV antibodies confirmed by confirmatory tests, and HIV-RNA and P24 antigen testing can help in the diagnosis of HIV/AIDS, especially in shortening the antibody “window period” and helping in the early diagnosis of HIV infection in newborns.
V. Treatment
(A) Anti-HIV treatment
Highly Active Antiretroviral Therapy (HAART) is a treatment for HIV/AIDS.
Therapy (HAART) is the most fundamental treatment for AIDS. And it requires lifelong medication. Treatment goals: maximize the inhibition of viral replication, preserve and restore immune function, reduce morbidity and mortality and the incidence of HIV-associated diseases, improve the quality of life of patients, and reduce the transmission of AIDS.
(II) Treatment of complications
Anti-infective treatment against various pathogens is performed for all kinds of infections.
(iii) For concurrent tumors.
Cervical cancer: radical surgery, radiotherapy and chemotherapy are required depending on the stage. Lymphoma requires combined chemotherapy. Kaposi’s sarcoma: only anti-HIV therapy is required for those with limited, and chemotherapy is required for those with disseminated.
VI. Prognosis of the disease
1. Asymptomatic long-term stability: It is seen in those who have timely antiviral treatment, good compliance with medication, and no viral resistance and serious adverse drug reactions. It is also seen in those who do not progress for a long time after infection.
2.Disability: Some patients may suffer from blindness or other organ dysfunction due to untreated complications.
3. Death: It is seen in patients with advanced disease who do not receive timely antiviral treatment and often die from complications or side effects of drugs.
VII. Prevention of disease
1. Management of infectious sources: High-risk groups should be tested regularly for HIV antibodies, and infected persons found by medical and health departments should be reported promptly, and HIV-related knowledge should be disseminated to infected persons to avoid transmission to others. The blood, body fluids and secretions of the infected person should be disinfected.
2. Cut off the transmission route: avoid unsafe sexual behavior, prohibit sexual promiscuity, and outlaw prostitution. Strictly screen blood supply personnel, strictly inspect blood products, and promote the use of disposable syringes. Strictly prohibit injection of drugs, especially the sharing of needles for drug injection. Do not share dental tools or razors. Do not go to informal hospitals for examination and treatment.
3. Protect susceptible people: advocate pre-marital and pre-pregnancy medical check-ups. HIV-positive pregnant women should be blocked from mother to child. Including obstetric intervention (termination of pregnancy, cesarean delivery) + antiviral drugs + artificial feeding. Medical staff should strictly follow medical procedures and avoid occupational exposure. If medication is required, it should be administered prophylactically in the shortest possible time (within 2 hours if possible) after the occurrence of occupational exposure, preferably no longer than 24 hours, but even if it is longer than 24 hours, it is recommended to implement prophylactic medication. Post-occupational exposure counseling and monitoring are also required.