What is AIDS and HIV (symptoms, how it is transmitted, diagnosis, treatment). HIV - why is this virus dangerous? AIDS affects which cells? AIDS prevention The immunodeficiency virus primarily affects

Good day, dear readers!

In today's article, we will consider with you such a serious disease as HIV infection, and everything that is connected with it - the reasons, how it is transmitted, the first signs, symptoms, stages of development, types, analyzes, tests, diagnostics, treatment, medications, prevention and other useful information. So…

What does HIV mean?

HIV infection in children

HIV infection in children in many cases is accompanied by developmental delay (physical and psychomotor), frequent infectious diseases, pneumonitis, encephalopathy, hyperplasia of pulmonary lymphatic catches, hemorrhagic syndrome. Moreover, HIV infection in children, which they acquired from infected mothers, is characterized by a more rapid course and progression.

The main cause of HIV infection is infection with the human immunodeficiency virus. AIDS is also caused by the same virus, because AIDS is the last stage in the development of HIV infection.

Is a slowly developing virus belonging to the Retroviridae family and the Lentivirus genus. It is the word “lente” in Latin that means “slow”, which partly characterizes this infection, which develops from the moment it enters the body and to the last stage rather slowly.

The size of the human immunodeficiency virus is only about 100-120 nanometers, which is almost 60 times smaller than the diameter of a blood particle - an erythrocyte.

The complexity of HIV lies in its frequent genetic changes in the process of self-reproduction - almost every virus differs from its predecessor by at least 1 nucleotide.

In nature, as of 2017, 4 types of virus are known - HIV-1 (HIV-1), HIV-2 (HIV-2), HIV-3 (HIV-3) and HIV-4 (HIV-4), each of which differs in genome structure and other properties.

It is HIV-1 infection that plays a role at the heart of the disease of most HIV-infected people, therefore, when the number of the subtype is not indicated, the default is exactly 1.

The source of HIV is people infected with the virus.

The main routes of infection are: injection (especially injection drugs), transfusion (blood, plasma, erythrocyte mass) or organ transplantation, unprotected sexual contact with a stranger, unnatural sex (anal, oral), trauma during childbirth, breastfeeding of the baby (if the mother is infected), trauma during childbirth, the use of non-disinfected medical or cosmetic items (scalpel, needles, scissors, tattoo machines, dental and other instruments).

For HIV infection and its further spread throughout the body and development, it is necessary that the infected blood, mucus, sperm and other biomaterials of the patient get into the bloodstream or the human lymphatic system.

An interesting fact is that some people have innate protection against the human immunodeficiency virus in their bodies, so they are resistant to HIV. The following elements have such protective properties - CCR5 protein, TRIM5a protein, calcium-modulated cyclophilin ligand (CAML) protein, and interferon-induced transmembrane protein CD317 / BST-2 ("tetherin").

By the way, the CD317 protein, in addition to retroviruses, also actively counteracts arenaviruses, filoviruses and herpes viruses. The CD317 cofactor is the cellular protein BCA2.

Groups at risk of HIV infection

• Drug addicts, mainly injecting drug users;
• Sex partners of drug addicts;
• Persons with promiscuous sex life, as well as those who have unnatural sex;
• Prostitutes and their clients;
• Donors and people in need of blood transfusion or organ transplantation;
• People with venereal diseases;
• Doctors.

The classification of HIV infection is as follows:

Classification by clinical manifestations (in the Russian Federation and some CIS countries):

1. Stage of incubation.

2. The stage of primary manifestations, which, according to the flow options, can be:

• no clinical manifestations (asymptomatic);
• acute course without secondary diseases;
• acute course with secondary diseases;

3. Subclinical stage.

4. Stage of secondary diseases caused by the defeat of the body by viruses, bacteria, fungus and other types of infection developing against the background of a weakened immune system. Downstream is divided into:

A) body weight is reduced by less than 10%, as well as frequently recurring infectious diseases of the skin and mucous membranes - pharyngitis, otitis media, shingles, angular cheilitis ();

B) body weight decreases by more than 10%, as well as persistent and often recurring infectious diseases of the skin, mucous membranes and internal organs - sinusitis, pharyngitis, shingles, or diarrhea (diarrhea) within a month, localized Kaposi's sarcoma;

C) body weight is significantly reduced (cachexia), as well as persistent generalized infectious diseases of the respiratory, digestive, nervous and other systems - candidiasis (trachea, bronchi, lungs, esophagus), pneumocystis pneumonia, extrapulmonary tuberculosis, herpes, encephalopathy, meningitis, cancerous tumors (disseminated Kaposi's sarcoma).

All variants of the course of the 4th stage have the following phases:

• progression of pathology in the absence of highly active antiretroviral therapy (HAART);
• the progression of pathology on the background of HAART;
• remission during or after HAART.

5. Terminal stage (AIDS).

The above classification is largely the same as the classification approved by the World Health Organization (WHO).

Clinical classification (CDC - US Centers for Disease Control and Prevention):

The CDC classification includes not only the clinical manifestations of the disease, but also the indicator of the number of CD4 + T-lymphocytes in 1 μl of blood. It is based on the division of HIV infection into only 2 categories: the disease itself and AIDS. If the parameters below meet criteria A3, B3, C1, C2 and C3, the patient is counted as an AIDS patient.

Symptoms by CDC Category:

A (acute retroviral syndrome) - characterized by an asymptomatic course or generalized lymphadenopathy (HLAP).

B (AIDS-associated complex syndromes) - may be accompanied by oral candidiasis, herpes zoster, cervical dysplasia, peripheral neuropathy, organic lesions, idiopathic thrombocytopenia, leukoplakia or listeriosis.

C (AIDS) - may be accompanied by candidiasis of the respiratory tract (from the oropharynx to the lungs) and / or esophagus, pneumocystosis, pneumonia, herpetic esophagitis, HIV encephalopathy, isosporosis, histoplasmosis, mycobacteriosis, cytomegalovirus infection, cryptosporicomidiosis Kaposi, lymphoma, salmonellosis and other diseases.

Diagnosis of HIV infection

Diagnosis of HIV infection includes the following examination methods:

• Anamnesis;
• Visual examination of the patient;
• Screening test (detection of blood antibodies to infection by enzyme-linked immunosorbent assay - ELISA);
• A test that confirms the presence of antibodies in the blood (blood test by the method of immune blotting (blot)), which is performed only if the screening test is positive;
• Polymerase chain reaction (PCR);
• Tests for immune status (counting CD4 + lymphocytes - performed using automatic analyzers (flow cytometry method) or manually, using microscopes);
• Viral load analysis (counting the number of copies of HIV RNA in a milliliter of blood plasma);
• Rapid HIV tests - diagnostics is performed using ELISA on test strips, agglutination test, immunochromatography or immunological filtration analysis.

Tests alone are not enough to make a diagnosis of AIDS. Confirmation occurs only with the additional presence of 2 or more opportunistic diseases associated with this syndrome.

HIV infection - treatment

Treatment of HIV infection is possible only after a thorough diagnosis. However, unfortunately, as of 2017, officially, adequate therapy and drugs that would completely eliminate the human immunodeficiency virus and cure the patient have not been established.

The only modern method of treating HIV infection today is highly active antiretroviral therapy (HAART), which is aimed at slowing the progression of the disease and stopping its transition to the AIDS stage. Thanks to HAART, a person's life can last for several decades, the only condition is the lifelong intake of appropriate drugs.

The insidiousness of the human immunodeficiency virus is also its mutation. So, if drugs against HIV are not changed after a while, which is determined on the basis of constant monitoring of the disease, the virus adapts, and the prescribed treatment regimen becomes ineffective. Therefore, at different intervals, the doctor changes the treatment regimen, and with it the drugs. The reason for changing the drug can also be its individual intolerance to the patient.

Modern drug development is aimed not only at achieving the goal of effectiveness against HIV, but also at reducing the side effects from them.

The effectiveness of treatment also increases with a change in a person's lifestyle, an improvement in its quality - healthy sleep, proper nutrition, stress avoidance, an active lifestyle, positive emotions, etc.

Thus, the following points can be highlighted in the treatment of HIV infection:

• Medication for HIV infection;
• Diet;
• Preventive actions.

Important! Before using medications, be sure to consult your doctor for advice!

1. Medical treatment of HIV infection

At the beginning, you need to immediately remind once again that AIDS is the last stage in the development of HIV infection, and it is at this stage that a person usually has very little time to live. Therefore, it is very important to prevent the development of AIDS, and in many respects it depends on the timely diagnosis and adequate therapy of HIV infection. We also noted that the only method of HIV treatment today is considered to be highly active antiretroviral therapy, which, according to statistics, reduces the risk of AIDS formation by almost 1-2%.

Highly active antiretroviral therapy (HAART) - a method of treating HIV infection, based on the simultaneous administration of three or four drugs (tritotherapy). The number of drugs is associated with the mutagenicity of the virus, and in order to bind it at this stage as long as possible, the doctor selects exactly the set of drugs. Each of the drugs, depending on the principle of action, is included in a separate group - reverse transcriptase inhibitors (nucleoside and non-nucleoside), integrase inhibitors, protease inhibitors, receptor inhibitors and fusion inhibitors (fusion inhibitors).

HAART has the following goals:

• Virological - aimed at stopping the reproduction and spread of HIV, an indicator of which is a decrease in viral load by a factor of 10 or more in just 30 days, to 20-50 copies / ml or less in 16-24 weeks, as well as maintaining these indicators as long as possible;
• Immunological - aimed at restoring the normal functioning and health of the immune system, which is due to the restoration of the number of CD4 lymphocytes and an adequate immune response to infection;
• Clinical - aimed at preventing the formation of secondary infectious diseases and AIDS, it makes it possible to conceive a child.

HIV medications

Nucleoside reverse transcriptase inhibitors - the mechanism of action is based on the competitive suppression of the HIV enzyme, which ensures the creation of DNA, which is based on the RNA of the virus. It is the first group of drugs against retroviruses. They are well tolerated. Side effects include -, lactic acidosis, bone marrow suppression, polyneuropathy and lipoatrophy. The substance is excreted from the body through the kidneys.

Among the nucleoside reverse transcriptase inhibitors are abacavir (Ziagen), zidovudine (Azidothymidine, Zidovirin, Retrovir, Timazid), lamivudine (Virolam, Heptavir-150, Lamivudin-3TC "," Epivir "), stavudine (" Aktastav "," Zerit "," Stavudine "), tenofovir (" Viread "," Tenvir "), phosphazide (" Nikavir "), emtricitabine (" Emtriva "), as well as complexes abacavir + lamivudine (Kivexa, Epsicom), zidovudine + lamivudine (Combivir), tenofovir + emtricitabine (Truvada), and zidovudine + lamivudine + abacavir (Trizivir).

Non-nucleoside reverse transcriptase inhibitors - delavirdine (Rescriptor), nevirapine (Viramune), rilpivirine (Edurant), efavirenz (Regast, Sustiva), etravirine (Intelens).

Integrase inhibitors - the mechanism of action is based on blocking the viral enzyme, which is involved in the integration of viral DNA into the genome of the target cell, after which a provirus is formed.

Integrase inhibitors include dolutegravir (Tivikay), raltegravir (Isentress), elvitegravir (Vitecta).

Protease inhibitors - the mechanism of action is based on blocking the viral protease enzyme (retropepsin), which is directly involved in the cleavage of Gag-Pol polyproteins into individual proteins, after which the mature proteins of the human immunodeficiency virus virion are actually formed.

Protease inhibitors include amprenavir (Ageneraza), darunavir (Prezista), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir, Ritonavir), saquinavir-INV ( Invirase "), tipranavir (" Aptivus "), fosamprenavir (" Lexiva "," Telzir "), as well as the combined drug lopinavir + ritonavir (" Kaletra ").

Receptor inhibitors - the mechanism of action is based on blocking the penetration of HIV into the target cell, which is due to the effect of the substance on the coreceptors CXCR4 and CCR5.

Among the receptor inhibitors can be distinguished - maravirok ("Celsentri").

Fusion inhibitors (fusion inhibitors) - the mechanism of action is based on blocking the last stage for the introduction of the virus into the target cell.

Among the fusion inhibitors can be distinguished - enfuvirtide ("Fuzeon").

The use of HAART during pregnancy reduces the risk of transmission from an infected mother to her baby by up to 1%, although without this therapy, the percentage of infection of the baby is about 20%.

Among the side effects from the use of HAART drugs are pancreatitis, anemia, skin rashes, kidney stones, peripheral neuropathy, lactic acidosis, hyperlipidemia, lipodystrophy, as well as Fanconi syndrome, Stevens-Johnson syndrome and others.

A diet for HIV infection is aimed at preventing the patient from losing weight, as well as providing the body's cells with the necessary energy and, of course, stimulating and maintaining the normal functioning of not only the immune system, but also other systems.

It is also necessary to pay attention to the certain vulnerability of the immunity weakened by the infection, therefore, to keep yourself from infection with other types of infection - be sure to follow the rules of personal hygiene and the rules of cooking.

Nutrition for HIV / AIDS should:

2. Be high in calories, which is why it is recommended to add butter, mayonnaise, cheese, sour cream to food.

3. Include plenty of drinking, it is especially useful to drink decoctions and freshly squeezed juices with a large amount of vitamin C, which stimulates the immune system - decoction, juices (apple, grape, cherry).

4. Be frequent, 5-6 times a day, but in small portions.

5. Water for drinking and cooking must be purified. Avoid expired foods, undercooked meat, raw eggs, and unpasteurized milk.

What can you eat with HIV infection:

• Soups - vegetable, on cereals, with noodles, in meat broth, it is possible with the addition of butter;
• Meat - beef, turkey, chicken, lungs, liver, lean fish (preferably sea);
• Groats - buckwheat, pearl barley, rice, millet and oat;
• Porridge - with the addition of dried fruits, honey, jam;
• Bread;
• Fats - sunflower oil, butter, margarine;
• Vegetable food (vegetables, fruits, berries) - carrots, potatoes, cabbage, squash, pumpkin, legumes, peas, apples, grapes, plums and others;
• Sweet - honey, jam, jam, jam, marmalade, marshmallow, sugar, sweet pastries (no more than 1 time per month).

Also, with HIV infection and AIDS, there is a shortage of such and

3. Preventive measures

Preventive measures for HIV infection that must be followed during treatment include:

• Avoiding repeated contact with the infection;
• Healthy sleep;
• Compliance with the rules of personal hygiene;
• Avoiding the possibility of infection with other types of infection - and others;
• Avoiding stress;
• Timely wet cleaning at the place of residence;
• Refusal from prolonged exposure to sunlight;
• Complete rejection of alcoholic beverages, smoking;
• Good nutrition;
• Active lifestyle;
• Rest on the sea, in the mountains, i.e. in the most environmentally friendly places.

We will look at additional HIV prevention measures at the end of the article.

Important! Before using folk remedies for HIV infection, be sure to consult with your doctor!

St. John's wort. Pour well-dried chopped grass into an enamel pan and pour 1 liter of soft purified water over it, then put the container on fire. After the product boils, cook the product for another 1 hour over low heat, then remove, cool, strain and pour the broth into a jar. Add 50 g of sea buckthorn oil to the broth, mix thoroughly and set aside in a cold place for infusion, for 2 days. You need to take the product 50 g 3-4 times a day.

Licorice. Pour 50 g of chopped into an enamel pan, pour 1 liter of purified water into it and put on the stove, over high heat. After bringing to a boil, reduce heat to low and simmer for about 1 hour. Then remove the broth from the stove, cool it, strain, pour into a glass container, add 3 tbsp. tablespoons of natural, mix. You need to drink the broth in 1 glass in the morning, on an empty stomach.

Propolis. Pour 10 g of crushed half a glass of water and put the product in a water bath to simmer for 1 hour. Then cool the product and take it 1-3 times a day, 50 g each.

Syrup made from berries, apples and nuts. Mix together in an enamel saucepan 500 g of fresh red berries, 500 g of lingonberries, 1 kg of chopped green apples, 2 cups of chopped, 2 kg of sugar and 300 ml of purified water. Set aside for a while until the sugar dissolves, then put the agent on a low heat for 30 minutes and boil the syrup from it. After the syrup must be cooled, poured into a jar and taken in the morning, on an empty stomach, 1 tbsp. spoon, which can be washed down with a sip of boiled water.

HIV prevention includes:

• Compliance;
• Blood and organ donor examinations;
• Examination of all pregnant women for the presence of antibodies to HIV;
• Birth control of HIV-positive women and prevention from breastfeeding;
• Conducting lessons on informing young people about the consequences of certain sexual relations;
• There are drug addiction movements with the aim of providing psychological assistance, teaching about safe injections and exchanging needles and syringes;
• Reducing the incidence of drug addiction and prostitution;
• Opening of rehabilitation centers for drug addicts;
• Promotion of safe sex;
• Refusal from unnatural sexual relations (anal, oral sex);
• Compliance by medical workers with all safety rules for working with biomaterials of infected people, incl. diseases such as;
• If a health worker has contact of mucous membrane or blood (cut, puncture of the skin) with an infected biomaterial, the wound must be treated with alcohol, then washed with soap and again treated with alcohol, and after that, in the first 3-4 hours, take drugs from the HAART group ( for example - "Azidothymidine"), which minimizes the possibility of developing HIV infection, and be monitored by an infectious disease specialist for 1 year;
• Compulsory treatment of sexually transmitted diseases (STDs) so that they do not become chronic;
• Refusal of tattooing, as well as visiting unverified beauty salons, cosmetology masters at home, little-known dental clinics with a dubious reputation;
• As of 2017, a vaccine against HIV and AIDS has not yet been formally developed, at least some drugs are still undergoing preclinical trials.

An expression such as “People living with HIV” (PLHIV) is used to refer to a person or group of people who are HIV-positive. This term was coined in connection with the fact that PLHIV can live in society for several decades, and die not from the infection itself, but from the natural aging of the body. PLHIV should never be a stigma to be avoided and kept in isolation. Also, PLHIV have the same rights as an HIV-negative person - to medical care, education, work, and childbirth.

Which doctor should I go to for HIV infection?

HIV infection - video

21-02-2017

I used to think so too, like Antal Makk, but it turns out I was terribly wrong.

Hungarian doctor Antal Makk said in an interview, as they say, not in the eyebrow, but in the eye: “Most AIDS diagnoses are not based on the isolation of the virus, but on the decision of the World Health Organization to classify such clinical symptoms as weight loss, chronic diarrhea and constant high temperature ".

It is good to talk about this in the abstract. I would like to see these "smart guys" if it happened to them personally.

But what should a person do when he has an 11-year-old child with HIV in his arms, with hives covering 90% of his body? And this food atopic dermatitis, having arisen at the age of 10, was repeated after half a year. And then more and more. And when we took the child to Kiev OKHMATDET in the fall of 2015, we received a conclusion.

The main diagnosis: At 23.8, II clinical stage, severe immunosuppression. And the CD4 cell count is two. Yes, and during this period he had a weight loss of 20%, very frequent diarrhea, a constantly elevated temperature of 37.2 ° C. In fact, if during this period the child contracted any opportunistic illness, it could be fatal. But more on that in order.

I first encountered the problem of HIV infection in 2003. A guy and a girl, each separately from each other, turned to our phytoclinic and asked for help in treating HIV infection. But both had complaints of liver with hepatitis. We prescribed drugs for the treatment of hepatitis, they took the drugs and I never saw them again.

In 2003, a pregnant woman approached our phytoclinic with a request to help her recover from HIV. Which she, and then her husband, was found during, prenatal blood donation for analysis.

In the spring of 2004, this woman gave birth to a child. For obvious reasons, I will not name either his gender or the time of birth, since he was born infected with HIV. And from the age of two, he began to receive antiretroviral therapy. Kaletra was discharged, strictly by the hour, as well as a number of medications.

The child grew up healthy, did not go to kindergarten, and practically did not get sick. But the parents died and the child remained in the care of the grandparents. Therefore, my grandmother and grandfather came to me for advice about whether to take the kaletra in the future, for some reason, they did not trust her.

When they gave it to a child, they complained of pain in the stomach. Then the child was 4.5 years old. And the strongest campaign against antiretroviral theropia was raised on the Internet at that time. Therefore, the guardians stopped giving it to the child. And they wrote a statement to the AIDS center about the refusal of therapy.

They had a good opportunity to provide, at that time, good food, and to monitor the health of their child. In addition, follow diets as needed. They also tried to stick to a healthy diet. During all this time, the child was checked once every three months for various viruses and fungi by specialists in foul points. And he almost constantly took various herbal remedies.

Therefore, when the child got to OKHMATDET, he did not have any oportunestic diseases, except for atopic dermatitis. At the same time, children with a CD4 cell count from 20 to 80 and with malignant diseases, syphilis, tuberulosis, hepatitis, etc. were admitted there.

Thank God there are excellent specialists in OKHMATDET and they stabilized the child's condition in one month.

We put a person in the clinic, fully examine. Based on the results of the examinations, the drug that is suitable for him is selected. Depending on what kind of dreams he has, what tests, whether he is a drug addict, how his psyche is, etc. And for a period of treatment for 1 year they give anti-tuberculosis drugs to avoid accidental tuberculosis. While the immune system is weak.

Our child was assigned:

1. Continue HAART with TDF / FTC / EFV regimen (regimen 2 from 30/11/15)

Atripla. 1 tablet X1r / day. (Reception time 22h 30min) - Very strict on the minutes of the reception.

2. Continue prevention of opportunistic infections

Biseptol (480 mg) 1 tablet X2 r / day three times a week (Mon-Wed-Fri) prevention of PCP
Azithromycin 800 mgX1 times a week Prevention of MAC.

3. Continue the prevention of tuberculosis infection - Isoniazid 300 mgX1r / day for 6 months.

The child's weight at the time of discharge was 41 kg.

In the hospital he was given many droppers: Human immunoglobulin 8 vial. (20 g) at the rate of 0.5 g / kg due to severe immunosuppression. Infused Nystatin 500 thousand X2 r / day, magnesium B6 1 tablet X 3 r / day. And Sodium Chlorine and other drugs were dripping.

2 weeks after the start of treatment, the child's cervical lymph node under the right jaw became inflamed. Handed over and nalizi for Paratite (Pig), thank God everything was in order.

More than a year has passed. Now for February 2017, it has 234 cells. She continues to take medications 2015-2016-2017. As we can see, they grow very slowly. Experts from OKHMATDET say that a healthy person should have 1000-1500 CD4 cells. And if there are less than 500 of them, then antiretroviral treatment should be started in the presence of HIV infection.

IT IS NECESSARY TO FIGHT FOR THE PRESERVATION OF THE LYMPHOID TISSUE OF THE INTESTINAL TISSUE, WHILE TAKING ANTIRETROVIRAL THERAPY.

HIV - it turns out to be dangerous, but not fatal if measures are taken in time

In the Wikipedia articles, everything related to HIV infection is presented quite fully and competently. Therefore, I took some excerpts from these articles, which, I believe, partly explain the evil to the human immune system that HIV infection does to it.

I am constantly torn apart by controversies about HIV infection. And the questions about this virus do not become less, the more you learn about it.

In my opinion, with what can this "Virus" be compared? With Judas. This is when a person who calls himself a friend came to your house, and when all members of your large family are the owner, mistress, children, cats and dogs, in general, everything. Everyone recognized him as a "Friend" and did not even suspect treason. Having dined together at the same table, having played with children and animals, this "friend" went to sleep in a bed prepared especially for him. But in the place of sleep, he stuck a knife in the back at the beginning of the cat and the dog. Then the children, then the hostess. And finally to the owner himself.

But he does it not in one or two days or months. And with the process stretching for 11 years. And why at eleven?

The human immune system seems to be perfect! T-hellers and T-killers, they are like superbly trained born ninja, ready to sacrifice themselves for the sake of saving the owner, when meeting with the "enemy - HIV" they stretch out their hand to greet him like a friend. And passing by him, they then receive a stab in the back and die.

And they have more than enough strength to cope with the relatively "weak" HIV. But they do not attack him without seeing him as an enemy. And he attacks them using their own strength, and tears them apart, but not immediately, but growing into them. The "invisible" and insidious enemy of "Judas" in general.

Who created this virus, nature, or a man in a secret laboratory, today we do not know. But his actions are ruthless and inevitable, but slow like a boa constrictor, do not give a chance to avoid retroviral therapy. Which fully enables a person to survive.

And maybe there is no "VIRUS - HIV" at all, but there is only a holographic program embedded in the form of a holographic soliton into the energy-informational structure of the human aura. Which orders human cells to obey an alien (encoded) program. And these are the questions I asked myself.

Therefore, in 2004 - 2007 I was engaged in the study, very sensible in my opinion, the work of L. G. Puchko "Multidimensional Medicine" (see). As a result, he got rid of kidney stones quite successfully.

HIV infection - a slowly progressive disease caused by the human immunodeficiency virus (HIV). The virus infects cells of the immune system that have CD4 receptors on their surface: T-helpers, monocytes, macrophages, Langerhans cells, dendritic cells, microglia cells.

As a result, the immune system is suppressed, acquired immune deficiency syndrome (AIDS) develops, the patient's body loses its ability to defend itself against infections and tumors, and secondary opportunistic diseases arise that are not characteristic of people with normal immune status.

Without medical intervention, opportunistic diseases cause death of the patient on average 9-11 years after infection (depending on the subtype of the virus). The average life expectancy at the AIDS stage is about nine months. With antiretroviral therapy, the patient's life expectancy is 70-80 years.

The rate of development of HIV infection depends on many factors, including the status of the immune system, age (older people have an increased risk of rapid development of the disease in comparison with younger people), virus strain, coinfection with other viruses, good nutrition, and therapy.

Insufficient level of medical care and the presence of concomitant infectious diseases, e.g. tuberculosis, causes a predisposition to the rapid development of the disease.

Replication of human immunodeficiency virus in a cell

HIV infection is caused by the human immunodeficiency virus, which belongs to the family of retroviruses, the genus of lentiviruses. The genome of HIV is represented by ribonucleic acid and undergoes reverse transcription in the infected cell.

HIV infects human blood cells that have on their surface CD4 receptors: T lymphocytes, macrophages and dendritic cells. Virus-infected T lymphocytes die due to destruction by the virus, apoptosis, or destruction by cytotoxic T lymphocytes. After the number of CD4 + T lymphocytes falls below 200 in one microliter of blood, the cellular immunity system ceases to defend the body.

The viral envelope consists of a bilayer lipid membrane in which a number of proteins are embedded, for example, the transmembrane glycoprotein gp41 and the surface glycoprotein gp120. Inside the "core" of the virus, which consists of the matrix protein p17 and the capsid protein p24, there are two single-stranded molecules of genomic RNA and a number of enzymes: reverse transcriptase, integrase, and protease.

Changes in the immune system

Immature and mature forms of HIV

In the acute phase of HIV infection, at the stage of viremia, there is a sharp decrease in CD4 + T-lymphocytes due to the direct lyzing action of the virus and an increase in the number of copies of viral RNA in the blood. After that, the stabilization of the process is noted with a slight increase in the number of CD4 cells, which, however, does not reach normal values.

The positive dynamics is due to an increase in the number of cytotoxic CD8 + T-lymphocytes. These lymphocytes are able to destroy HIV-infected cells directly by cytolysis without restriction on human leukocyte antigen class I (English Human leukocyte antigen-HLA). In addition, they secrete inhibitory factors (chemokines), such as RANTES, MIP-1alpha, MIP-1beta, MDC, which prevent the virus from multiplying by blocking coreceptors.

HIV specific CD8 + lymphocytes play a major role in the control of the acute phase of HIV infection, however, in the chronic course of infection, it does not correlate with viremia, since the proliferation and activation of CD8 + lymphocytes depends on antigen-specific CD4 T-helper cells, while, HIV also infects CD8 + lymphocytes, which can lead to a decrease in their number.

Acquired immunodeficiency syndrome is the terminal stage of HIV infection and develops in most patients with a decrease in the number CD4 + T-lymphocytes, blood below 200 cells / ml (norm of CD4 + T-lymphocytes 1200 cells / ml).

CD4 + cell depression has been attributed to the following theories:

Death of CD4 + T-lymphocytes as a result of the direct cytopathic action of HIV. The virus primarily infects activated CD4 lymphocytes, and since HIV-specific lymphocytes are among the first cells to be activated during HIV infection, they are among the first to suffer.

The virus changes the cell membrane of CD4 + T-lymphocytes, which leads them to fusion with each other to form giant syncytia, which is regulated by LFA-1. Defeat CD4 cell antibodies, as a result of ADCC-antibody-dependent cellular cytotoxicity.

Natural killer cell activation

Autoimmune damage
Virus protein binding gp120 with CD4 receptor (CD4 receptor masking) and as a result - the inability to recognize the antigen, the inability to interact with HLA class II CD4.
Programmed cell death
Lack of immune response (anergy)
B-lymphocytes in HIV-infections undergo polyclonal activation and release a large amount immunoglobulins, TNFα, interleukin-6 and lectin DC-SIGNwhich promotes penetration HIV into T lymphocytes. In addition, there is a significant decrease in interleukin-2 produced CD4 helper type 1 and critical in the activation of cytotoxic T-lymphocytes (CD8 +, CTL) and suppression by the virus of the secretion of interleukin-12 by macrophages - a key cytokine in the formation and activation Type 1 T helper cells and NK lymphocytes (English Natural killer cells).

One of the main factors in the pathogenesis of HIV is the hyperactivation of the immune system in response to infection. One of the features of the pathogenesis is the death of CD4 + T-helpers, the concentration of which is slowly but steadily declining. Especially significant negative consequences have the death of infected HIV CD4 + central memory T lymphocytes and dendritic cells... The main cause of death T cell death in HIV infection is programmed cell death (apoptosis).

Even on stage AIDS infection rate of CD4 + peripheral blood cells is 1: 1000, which suggests that the virus itself is not able to kill the number of cells that die with HIV infection... Also, such a massive death of T cells and the cytotoxic effect of other cells cannot be explained. At the same time, the main place where replication takes place HIV at all stages of HIV infection is secondary lymphoid tissue... The most intense HIV replication occurs in the intestinal-associated lymphoid tissue (en: Gut-associated lymphoid tissue). Infected Memory T cells in this tissue are found 10-100, and sometimes almost 1000 times more often.than in peripheral blood. This is primarily due to the high content of CD4 + CCR5 + T cells in this tissuewhich are good targets for HIV infection. For comparison: in peripheral blood such cells are only 11.7%, lymph node tissue 7.9%, while in the lymphoid tissue associated with the intestine - 69.4%.

Severe depletion of CD4 + cells caused by HIV replication in intestinal lymphoid tissue occurs several weeks after infection and persists at all stages of HIV infection. HIV infection interferes with the permeability of the mucosa to microbial substances, such as the lipopolysaccharides of gram-negative bacteria. These substances, entering the bloodstream, are the cause of chronic nonspecific hyperactivation of innate and adaptive immunity. Thus, HIV infection is mainly a disease of the intestinal mucosa, and the gastrointestinal tract is the main site of HIV replication.

A fundamentally important role in reducing the number of naive lymphocytes is the change in the structure of the lymphoid tissue of the lymph nodes caused by chronic immune activation. After emigration from the thymus, naive T-lymphocytes form a supply of long-lived cells that circulate between tissues and secondary lymphoid organs. Some of them die due to apoptosis, and some divide from time to time, replenishing the supply of dead cells. In all periods of life, the number of cells that appear as a result of division exceeds the export from the thymus. To prevent apoptosis of these cells at each stage of their development, they need certain signals of survival. Such a signal is realized when, during contact T cell receptor (TCR) with its own antigen complex - MHC I, the naive lymphocyte receives stimulation with interleukin-7. The entry of naive T cells into lymphoid tissue and interaction with the microenvironmental cells that synthesize IL-7 (eg, lymph node stromal cells, dendritic cells) are critical for maintaining the naive T cell population.

The highly organized structure of the secondary lymphoid tissue is extremely important for the survival of T cells and the provision of an immune response through the interaction of T-lymphocytes and antigen-presenting cells. Chronic immune activation and replication of HIV in lymphoid tissue leads to the destruction of this structure and excessive accumulation of collagen, and ultimately to lymph node fibrosis. Overproduction of collagen is a side effect of trying to counteract regulatory T cells (Treg) against the negative effects of immune activation. Fibroblasts stimulated by cytokines (such as TGF-β1) of regulatory T cells produce collagen, the accumulation of which destroys the structure of lymphoid tissue, and deprives naive T cells of access to the IL-7 source. This leads to the depletion of their stock, as well as to the limitation of the possibility of its recovery when HIV replication is suppressed on HAART.

The main reservoir of HIV in the body is macrophages and monocytes... Explosive reproduction does not occur in these cells; virions are released through the Golgi complex. Also, it should be noted that the innate immune system is not capable of effectively recognizing the virus during acute HIV infection and stimulating a timely adequate specific T-cell response.

The immune system can poorly recognize HIV since up to 45% of the human genome consists of endogenous retroviruses and retrotransposons. Antibodies arising from the reaction to the gp-120 protein only contribute to the intensification of the "infection", but not its suppression. Thus, the human immune system by its response only contributes to the multiplication of the virus, therefore the creation of an HIV vaccine similar to the vaccine against smallpox virus is impossible. It should be noted that this point of view is not supported by many HIV researchers. In addition, it contradicts the fact that the fundamental possibility of creating a vaccine against HIV has been proven. In 2009, a trial of the RV144 vaccine in Thailand was shown to be effective in preventing infections.

The Big Oddity in HIV Treatment

It turns out that when using antiretroviral therapy, it is not recommended to take simultaneously drugs that include the following herbs: Yarrow, Echinacea, Marigold (calendula), St. John's wort. Garlic should not be overused either.

And what is most interesting is that all these herbs are natural drugs that increase human immunity, when taken. This was also noted in our practice, since Echinocea is included in the Imod preparation. Therefore, it cannot be used. One of our patients complained that while taking antiretroviral therapy he took St. John's wort and for several months in a row his CD4 cell count did not grow at all.

Of course, these "quirks" are contrary to common sense about increasing immunity in a natural way. And naturally it begins to seem that after taking antiretroviral therapy, a person develops "Artificial" immunity, and not natural. But maybe this is out of my imagination?

What we can do?

How can herbal medicine help a person in the treatment of HIV infection? From the above material, it is clear that it is necessary to fight HIV while keeping the lymph nodes of the peritoneum and, in general, the entire lymphatic system of the human body in working condition. By preventing calagen from clogging up the lymphatic system, especially the lymph nodes. HIV infects human blood cells that have CD4 receptors on their surface: T-lymphocytes, macrophages and dendritic cells. Virus-infected T lymphocytes die due to destruction by the virus, apoptosis, or destruction by cytotoxic T lymphocytes. After the number of CD4 + T lymphocytes falls below 200 in one microliter of blood, the cellular immunity system ceases to defend the body.

And a person dies not because the disease destroys his vital organs, but because the immune system becomes helpless to save him, not only from complex viruses, but also from the simplest ones. It turns out that a person "Master of the Earth" appears on it without immunity, as if an alien who had never lived in Earth conditions.
And like HG Wells in "The War of the Worlds" The highly developed civilization of the alien invaders, the Martians, died on our Earth, from ordinary simple earth viruses, to which they had no immunity. So a person becomes an "Outcast" in his environment. Therefore, for now, antiretroviral therapy will restore T cells and other components of the "shelf" of the army of the immune system. Our task is to keep all parts of the immune system intact. And prevent opportunistic viruses, fungi and other pathogenic microorganisms from seizing the unprotected organs of our body.
We have at our disposal very effective natural preparations that help preserve the lymphatic system.

It is hard to believe

But it has been repeatedly established using examples that of all existing diseases it is impossible to reliably link them with the fact that they arose as a result of HIV.

They very often appear, as it were, at the same time..
HIV kills, with the help of some kind of self-destruction program, immune cells. MAKES THE CELLS COMMIT SUICIDE!
What diseases are most feared by antiretroviral therapy doctors?
Hepatitis.
Tuberculosis.
Herpes.
Syphilis.
And therefore the question at the beginning of our article, "What Human Immunodeficiency Virus Infects and How to Escape" remains unanswered.
And why?
If a person got HIV infection in adulthood, then by this time he has accumulated during the previous life, a bunch of his ordinary diseases, which gradually with the development of HIV only aggravate. And NOBODY will be able to prove that this happened due to the influence of the external environment - HIV. And what exactly this led to the development of a malignant tumor from, for example, the eighth herpes.
But rather the opposite: the 8th herpes led to (kaposi sarcoma) and received its development in the body without resistance from the human immune system.

The protocol system for HIV diagnostics was adopted even earlier.

In addition to donating blood, it is not possible to determine the presence of the disease!

To diagnose lesions of the oral mucosa in HIV-infected patients, a working classification was adopted, approved in London, in September 1992. All lesions are divided into 3 groups, the most interesting and the most common are lesions belonging to group 1.

Group 1 - lesions clearly associated with HIV infection. This group includes the following nosological forms:

candidiasis (erythematous, pseudomembranous, hyperplastic, atrophic);
hairy leukoplakia;
marginal gingivitis;
ulcerative necrotizing gingivitis;
destructive periodontitis;
kaposi's sarcoma;
non-Hodgkin's lymphoma.
Group 2 - lesions less clearly associated with HIV infection:
bacterial infections;
diseases of the salivary glands;
viral infections;
thrombocytopenic purpura.
Group 3 - lesions that can occur with HIV infection, but are not associated with it.

Practicing doctors use the ICD-10 classification.

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In 1983, a group of scientists from the University of Paris, and then their American colleagues, isolated the human immunodeficiency virus (HIV) from the blood of AIDS patients. It attacks the human immune system, rendering it unable to protect the body from disease. For the third decade, there has been a fight against dangerous pathogenic protozoa, but we have not yet fully figured out HIV. It still remains a mystery how the AIDS virus affects the defense system and why some patients infected with this infection remain perfectly healthy for a long time.

Features of cell infection

Only HIV can infect and then kill the cellular tissue of the human immune system. At the initial entry of the virus into the blood or mucous membranes, immune cells begin to fight against it, but they always lose. HIV can infect only macromeres (cells) that contain special proteins (CD4 receptors) on their surface. A number of human cellular tissues contain everything necessary for the virus to penetrate into them.

What cells does the AIDS virus attack? Helper T cells are the main target for HIV. But CD4 receptors are also found on the outer surface of other cells (for example, thymocytes, macrophages, intestinal epithelium, cervix).

All of them also serve as target cells for HIV. The effect of the immunodeficiency virus on macromers depends on their type. So, penetrating into a nerve cell, it almost does not damage its membrane. Therefore, having become infected, it continues to work for a considerable time and serve as a refuge for the virus. Cells that live for a long time can contain many pathogenic organisms and serve as their repository. In them, HIV is not vulnerable to the effects of drugs and the immune system. And for storage cells this does not pass without a trace, their structure is greatly modified.

The difference between HIV infection and AIDS

Some people think that HIV and AIDS are the same thing. Is it so? HIV (Human Immunodeficiency Virus) damages the immune system and it stops protecting the body from infections.

A few years after becoming infected with HIV, a weakened patient develops serious illnesses, then he is diagnosed with AIDS (acquired immunodeficiency syndrome). This means that HIV is a virus that suppresses the immune system, and AIDS is a whole bunch of diseases caused by the causative agent of the AIDS virus.

Risk factors

Immunodeficiency is a dangerous and incurable disease. In most cases, HIV infection occurs due to inappropriate behavior of people, and not because they belong to a certain group with an increased risk of developing the disease.

There are several risk factors that contribute to contracting AIDS.

Basic:

• use of the same syringe by different persons;
• promiscuous sex;
• unverified donor material;
• contact of medical personnel with an infected patient;
• prostitution.

Biological:

• the presence of sexually transmitted diseases (gonorrhea, syphilis, chlamydia, trichomoniasis);
• defects in the structure of the genital organs (injured, narrow, with neoplasms);
• high viral loads (the more virus is in the blood, the greater the possibility of infection);
• a weak immune system;
• violations of the skin and mucous membranes;
• genetic characteristics of the virus (different strains have unequal speed of movement, aggressiveness, the ability to defeat cellular material).

Psychological:

• personal character traits (pedantry, impulsivity, inclination to take risks, ardor, inability to control oneself);
• attitudes towards HIV and AIDS;
• communication style;
• mental disorders;
• depressive state.

How the AIDS virus spreads

Only when a person comes into contact with biological fluids (blood, semen, vaginal secretions) and tissues or organs that contain the virus can AIDS spread.

1. The most dangerous is contact with blood. After a single transfusion of infected blood, human infection occurs in almost 100% of cases.
2. Vertical transmission of the virus (from mother to embryo) ranks second (approximately 30%).
3. With a single use of medical instruments (needles, syringes) containing HIV-infected blood, the probability of being infected with the AIDS virus is about 1%.
4. Significantly less often, HIV infection occurs through sexual intercourse. Moreover, it has been established that infection of a woman from a man happens twice as often as infection of the stronger sex from the weaker. It has been noticed that the use of condoms significantly reduces the likelihood of infection during sexual intercourse.
5. The very low possibility of contracting an infection with an accidental needle prick, it is only 0.3%.

The incubation period of HIV

In the first stage, AIDS patients show no signs of illness. The virus has just entered the body and has not had time to gain a foothold. It can only be detected by a blood test. The latent period of the disease lasts about three months. It depends on the immunity of the sick person.

Symptoms

In AIDS patients, the onset of the disease is very difficult to detect. Its earliest symptoms are:

• swollen lymph nodes;
• pathological conditions similar to the flu (coughing, fever, loss of appetite, body aches, fatigue, general weakness).

Other medical conditions can have these symptoms. But if a person has had sexual intercourse or there was some kind of medical intervention, then a blood test for HIV infection should be taken. An infected person may not have symptoms, but despite this, they may already infect another person. Sometimes, only a few years after infection, when the AIDS virus infects immune cells, late signs of the disease appear:

• persistent night sweats and fever;
• constant tiredness;
• loss of weight and appetite for no reason;
• enlarged and painful lymph nodes;
• tumors on the skin, mouth and nose are dark red;
• frequent acute respiratory infections;
• dry cough, shallow breathing.

Fighting AIDS in men and women

The male sex is significantly less concerned about their health than the female. Symptoms of HIV infection appear earlier, but they are blurred and are often perceived as signs of colds. Not taking the problem seriously, men do not go to their doctor in time, and the diagnosis is made when the AIDS virus already infects the cells of the immune system.

Women are much more attentive to their health, and their disease process is much slower than that of men. Along with the general symptoms of the disease, female representatives may experience vaginal discharge with a mucous structure, painful sensations during menstruation and enlargement of the mammary glands. Unlike men, they more often have an increase in lymph nodes in the genital area. All this causes a feeling of discomfort, anxiety, insomnia, a state of depression. A woman is forced to see a doctor with symptoms that may indicate the presence of an immunodeficiency virus.

Is it true that the AIDS virus dies quickly?

On the "persistence" of HIV, the existing data are often contradictory. It is known that in the open air after a few minutes the virus ceases to exist. But in the inside of the syringe, its vital activity continues much longer. How long does the AIDS virus live outside the human body? Answering this question, it should be noted that there are many misconceptions and misinterpretations of scientific research.

In laboratory conditions, when the virus concentration exceeds the real values \u200b\u200bby 100,000 times, the survivability of HIV is from one to three days from the moment the liquid dries. According to these data, the virus can survive outside the body for only a few minutes. For this reason, household infection does not occur. But the vitality of pathogenic organisms in the cannula and inside the syringe depends on:

• the volume of blood in the needle;
• the number of virus in the blood;
• temperature.

According to the research results, it was found that with a high concentration of viral particles in the blood, it can exist for up to 48 days, gradually reducing its vital activity. With low blood volumes, small amounts of virus, and high temperatures, the life span of HIV is significantly reduced.

Temperature and HIV

The opinion that the virus is instantly destroyed outside the human body at room temperature is erroneous. Of course, HIV is not a bacterium, does not contain spores, and therefore does not live in soil and water for months. Nevertheless, it is covered with a protein membrane and in a dry drop of mucus or blood can live for several days, and under suitable conditions, for several weeks. Over time, the number of pathogenic organisms decreases significantly, so a small number of them are not capable of infecting humans. And the virus from the external environment enters the skin, lungs or digestive tract, and not into the blood.

At what temperature does the AIDS virus die? The immunodeficiency virus is really not resistant to fever. When the infected material is heated to 56 degrees for 30 minutes, almost all pathogenic organisms are killed, and when boiled, their death occurs almost instantly. In the presence of a large content of viral particles (blood clots), boiling should be carried out a little longer to neutralize it.

Is there a cure for AIDS?

A patient with an immunodeficiency virus, without resorting to treatment, can live from 5 to 10 years. A magic vaccine for AIDS patients has not yet been found, but scientists are successfully working on its invention. There are already medicines that prevent the virus from multiplying, suspend the disease, preventing the transition of HIV to AIDS. Patients using medications are in a satisfactory condition and can work. Doctors believe that their life expectancy will increase significantly.

Prevention

While the search for an effective vaccine against the immunodeficiency virus is underway, the only effective means of fighting the infection is educational activities among the population. The most effective and effortless method of preventing AIDS is through cleanliness in personal relationships. To do this, you should:

• use only your own personal hygiene products;
• have one partner;
• use condoms;
• avoid sexual intercourse with strangers;
• avoid group contact.

The second direction of prevention is activities in medical institutions:

• examination and control over donors, patients at risk, pregnant women;
• monitoring the fertility of infected women;
• use only sterile medical instruments, disposable syringes and blood transfusion systems.

A healthy lifestyle based on physical activity, sensible diet, real rest, giving up bad habits and stress is the best AIDS prevention.

The human immunodeficiency virus (HIV, in English HIV) is the cause of HIV infection, which always ends with the development of AIDS - the syndrome of acquired immunodeficiency in humans, in which infectious diseases develop in severe form and neoplastic processes.

The source of viruses is only a sick person. His blood, semen and vaginal secretions have a concentration of infectious material sufficient for infection. Sexual, parenteral and transplacental are the main routes of transmission. Human Immunodeficiency Virus - 1 is the most virulent. It is he who is the cause of epidemics in many countries of the world.

HIV was first discovered in 1983 in two independent laboratories: the laboratory of Luc Montagny of the Pasteur Institute (France) and the National Cancer Institute in the laboratory of Robert Gallo (USA).

Figure: 1. Luc Montagnier (left photo) and Robert Gallo (right photo).

Human immunodeficiency viruses infect cells on the surface of which there are CD4 + receptors:

• T-lymphocytes (recognize and destroy cells that carry foreign antigens),
• tissue macrophages and monocytes (capture and digest bacteria and foreign particles),
• follicular dendritic cells (stimulates T-lymphocytes),
• neuroglia cells,
• langerhans cells,
• epithelial cells of the intestine and cervix.

When their concentration of T-lymphocytes is below 200 in 1 μl, cellular immunity ceases to protect the patient's body. The infected cells die. AIDS develops.

Figure: 2. HIV leaves the target cell. It is now called the virion.

HIV classification

Human immunodeficiency virus belongs to the family retroviruses, kind lentiviruses... It has lymphotropicity. There are 2 main types of immunodeficiency viruses - HIV-1 and HIV-2. The types of HIV-3 and HIV-4 are rare species. Their role in the spread of infection is subtle.

• Retroviruses (from latin retro - reverse) belong to the family of RNA-containing viruses that infect vertebrates. Unlike oncoviruses, HIV leads infected cells to death, and does not cause their proliferative growth, as oncoviruses do. Retroviruses are the cause of the development of malignant processes in the form of sarcoma and leukemia in a number of animals, and only one species causes lymphosarcoma in humans.
• Lentiviruses (from latin lentus - slow) cause diseases with a long incubation period and a slow but steadily progressive course. Lentiviruses deliver a significant amount of genetic material to the host cell and are capable of replication (renewal) in non-dividing cells.

Figure: 3. When a new virus comes out, it is called a virion. The photo shows an immature virion. The nucleocapsid is not structured. The outer shell is wide and loose.

HIV-1 and HIV-2 - the main types of HIV

Human immunodeficiency viruses differ from each other genetically and in antigenic characteristics. The modern classification distinguishes 2 main types of viruses: human immunodeficiency virus - 1 (HIV-1) and human immunodeficiency virus - 2 (HIV-2). However, HIV-3 and HIV-4 are also known - rare species with an inconspicuous role in the spread of the epidemic. It is believed that HIV-1 arose as a result of the transmission of immunodeficiency virus to humans by chimpanzees, and HIV-2 - from red-headed mangobey.

Both types of virus, when ingested, cause immunodeficiency. There are differences in the clinical course of the disease.

Figure: 4. It is believed that HIV-1 arose as a result of the transmission of immunodeficiency virus to humans by chimpanzees, and HIV-2 - from red-headed mangobey.

Human Immunodeficiency Virus - 1 (HIV-1)

HIV-1 was first described in 1983. It is the most pathogenic and widespread of all HIV viruses. Minor changes in the genome of this type of virus lead to the emergence of a large number of new strains, which allows the pathogen to escape from the patient's immune system and acquire drug resistance to antiviral drugs.

• It is HIV-1 that has become the culprit in the global epidemic.
• Human immunodeficiency viruses - 1 are divided into several groups: M, N, O and P, 90% of which are group M. In turn, group M is subdivided into 11 subtypes that dominate in certain parts of the world.
• HIV-1 subtype A is widespread in Russia and Africa. At present, there has been a mixing of the currently dominant strain A and the AG strain brought from Central Asia. This is how a more dangerous strain of HIV-1A63 appeared.
• When infected with HIV-1, the disease often progresses to the AIDS stage.
• In the AIDS stage, oral candidiasis and chronic fever are more common.

In each case, when there is no indication of the type of virus, human immunodeficiency virus-1 is meant.

Immunodeficiency Virus-2 (HIV-2)

HIV-2 is a result of the transmission of the immunodeficiency virus to humans from red-headed mangobey. Identified in 1986. Described 8 groups of viruses, but in epidemic terms, only groups A and B are more dangerous.

• HIV-2 is less virulent than HIV-1.
• When HIV-1 and HIV-2 enter the human body simultaneously, HIV-2 provides, albeit small, protection of cells against HIV-1 infection.
• The disease lasts longer and rarely progresses to the AIDS stage.
• With a disease in 1 μL of blood, there are significantly fewer viruses than with HIV-1 infection.
• With HIV-2, infections such as chronic diarrhea, cholangitis, encephalitis, and severe infections are more common.

The structure of HIV

Figure: 5. The structure of HIV.

The virus residing outside the cell is called virion... Virions are the final phase in the development of viruses. It is on these representatives of the microworld that the classification and systematization of viruses is based.

HIV-1 and HIV-2 have a nucleus (bullet nucleocapsid) made of RNA and enzymes and an envelope (membrane or supercapsid). Mature virions contain up to several thousand different types of protein molecules, have a spherical shape with a diameter of 100 to 180 nm.

The structure of the HIV nucleocapsid

• Inside HIV there are 2 single-stranded viral RNAs and 3 enzymes: reverse transcriptase (reverse transcriptase), integrase and protease, tightly bound (packed) with capsid proteins p24, p7 and p9.
• Outside the capsid, there are 2,000 molecules of matrix p17 protein 5 - 7 nm thick. They are located between the capsid of the virus and the outer envelope.
• Nucleocapsid proteins p7 and p9 provide communication with genomic RNA.
• The capsid of HIV-1 is associated with 200 copies of cyclophilin A, which is involved in the assembly of the virion.
• Inside (or outside?) Of the virion capsid is the Vhr protein.

Explanation of some designations

Virus genome is a collection of genes containing biological information that is necessary for the construction and maintenance of the vital activity of a microorganism. Genomic nucleic acid itself is not infectious.

Reverse transcriptase (revertase) Is an enzyme involved in the synthesis of DNA on an RNA template. The name "reverse" is derived from the fact that most of these processes take place in the other direction, when RNA is synthesized from the DNA matrix.

Integraza Is an enzyme that accelerates (catalyzes) the incorporation (integration) of HIV DNA into the host chromosome. The DNA of the virus is closed in a ring before integration.

ProteaseIs an enzyme that cleaves peptide bonds between amino acids in proteins.

Figure: 6. The electron micrograph clearly shows the nucleocapsids of already matured virions (photo on the left). Photo "D" shows viruses captured by macrophages.

The structure of the HIV shell

• The membranes of HIV (capsid and supercapsid) protect the genetic material from chemical, physical and mechanical damage. The outer membrane helps the virus to interact with the receptors of the target cell.
• The envelope is formed during the budding period and consists of a layer of phospholipids permeated with 72 glycoprotein complexes and host membrane cells.
• Thanks to envelope glycoproteins, viruses tend only to certain host cells that carry special CD4 + receptors on their surface - T-lymphocytes, monocytes, tissue macrophages, follicular dendritic cells, neuroglia, Langerhans cells, intestinal and cervical epithelial cells, which determines the development of manifestations HIV infection.
• When meeting with host cells, transmembrane glycoproteins gp41 and surface glycoproteins gp120 are inserted into their membranes. Viruses lacking these proteins are unable to enter target cells.

Figure: 7. The photo shows a 3D model of HIV.

Figure: 8. The photo on the right shows a cross-section of HIV.

Genome of HIV

The HIV genome is represented by two identical RNA strands. The length of each strand is about 10 thousand nucleotides. The genome includes 3 main structural and 7 regulatory and functional genes encoding 15 different proteins.

• The structural (capsid and supercapsid) proteins of HIV are encoded genome Gag.
• Non-structural proteins are encoded genome Pol.
• Genes Tat, Nef, Vif, Rev, Vpu and Vprencode proteins that regulate the processes of multiplication and assembly of viruses, suppress the activity of cellular antiviral systems.

Figure: 9. Normal lymphocyte (left photo) infected with HIV (right photo). Multiple bubbles form on the surface of the infected cell.

HIV proteins

As soon as the virion has penetrated into the host cell (now called the virus), a DNA copy of the genome is synthesized using the reverse transcriptase enzyme, which is inserted into the genome of the host cell. This is how a provirus is formed.

Further, with the help of enzymes on the provirus matrix, new RNA molecules of the virus are synthesized, as well as structural and regulatory proteins that carry out the assembly and budding of viruses. Inside the virus, as well as on its surface, in addition to those encoded by the genome, there are proteins that are captured by the virus particle from the host cells.

The genes Gag, Pol and Env are responsible for the synthesis of major HIV proteins.

Structural proteins of HIV

The Gag gene is responsible for the synthesis of HIV structural proteins. Structural proteins are part of the viral particle itself. They form the capsid and viral envelope.

HIV capsid proteins

Capsid proteins form a container (case) for nucleic acid, are part of genomic proteins and form enzymes. The capsid membrane is assembled not from individual proteins, but from subunits. Its assembly is programmed into the RNA.

• The p24 protein forms the nucleocapsid envelope.
• The p17 protein forms a matrix substance.
• Proteins p9 and p7 provide communication with genomic RNA.

Fig. 10. Lymphocyte infected with HIV. The elongated structures on the cell surface are caused by the overproduction of the Gag protein. (Photo by NIBSC).

Supercapsid proteins

The Env gene is responsible for the synthesis of HIV envelope proteins. Proteins of this group are part of the outer membrane of the virion, which consists of a layer of phospholipids permeated with 72 glycoprotein complexes. The free (outer) part of the glycoprotein complex contains the amino group of the DO-end. The end immersed in the lipid layer contains the C-terminus hydroxyl group. Thanks to glycoprotein complexes, virions attach to the host cell. They are called attachment proteins.

In the course of evolution, viruses acquired an addressing function - the search for the desired host cells among many other cells, for which special proteins appeared on their surface that recognize sensitive cells and their receptors.

The outer envelope of the virion consists of protein complexes (gp120 and gp41 proteins) and host envelope cells, which are captured by viruses during budding.

• Protein gp120 (outermost) provides binding to target cells.
• Protein gp41 provides the penetration of virions into the cell.

Non-structural proteins

Non-structural proteins are encoded by the Pol gene. They serve the processes of virus reproduction at its various stages. The Pol gene encodes enzymes involved in the integration of the viral genome into the host cell genome and enzymes involved in the virus replication.

The following non-structural proteins of HIV are currently most studied:

• p66 - reverse transcriptase (participates in DNA synthesis on an RNA template);
• p31 - integrase (catalyzes the integration of the virus DNA into the host chromosome;
• p10 - protease (cleaves peptide bonds between amino acids in large protein molecules).

Other HIV genes

Genes such as Tat, Nef, Vif, Rev, Vpu and Vpr encode proteins that regulate the processes of multiplication and assembly of viruses and suppress the activity of cellular antiviral systems.

Fig. 11. The photo on the left shows the process of budding virions. The nucleocapsid is not yet structured, the outer shell is thicker due to the presence of membrane proteins. The photo on the right shows mature virions in the extracellular space (electron micrograph). Nucleocapsids have acquired the shape of a truncated cone. The shell has become thin, as some of the proteins of the outer shell are lost.

Antigenic structure of HIV

Human immunodeficiency viruses - 1 are divided into several groups: M, N, O and P, 90% of which are group M. In turn, group M is subdivided into 11 subtypes that dominate in certain parts of the world. They differ from each other in the amino acid composition of proteins.

The main antigens of the human immunodeficiency virus include:

• group- and species-specific antigens: proteins that make up the nucleocapsid envelope - p24;
• type-specific antigens: proteins that provide communication with target cells - gp120 and proteins that ensure the penetration of virions into cells - gp41.

HIV possesses high biological activity and the frequency of genetic changes (high variability) that occur during self-reproduction, which creates great obstacles to the development of vaccines and effective drugs.

HIV replication

Replication (reproduction) of HIV occurs in the host cell in stages.

1. Encounter with the cage.Virions in the human body are present in all biological fluids, but in epidemiological terms, the greatest danger is blood, vaginal secretions and sperm, which have a concentration of infectious material sufficient for infection.

   

   Figure: 12. HIV infects an immune cell (marked in yellow).

2. Fusion with the target cell.After searching for a target cell, virions bind to the cell membrane through the CD4 receptors and penetrate deep into the cell.
3. Reverse transcription.Inside the cell, the RNA of the virus is released from the capsid. With the participation of reverse transcriptase, DNA is synthesized based on single-stranded RNA.
4. Integration of DNA into the genome of the host cell.The synthesized DNA moves into the nucleus of the target cell, where it is incorporated into the chromosome. The viral DNA embedded in a cell's chromosome is called a provirus.
5. Synthesis of protein molecules.Further, with the help of enzymes on the provirus matrix, new RNA molecules of the virus are synthesized, as well as structural and regulatory proteins that assemble and budding virions.
6. Assembly of virions and budding.Virions are collected in the cytoplasm of the cell and are not initially infectious, as they are formed from precursor polyproteins. As the virion matures, precursor proteins under the influence of viral proteases are cleaved into functional components. The matured virion buds from the cell, capturing part of the proteins of the cell membrane to build its outer shell.

   

   Figure: 13. Virions collect under the outer membrane of the cell. Unusual protrusions are visible - the exit sites of the virions.

   

   Fig. 14. The photo shows the process of HIV budding (formation of virions).

   When leaving the cell, virions capture a part of the outer membrane of the cell (the "leg" of the virion is visible). In immature virions, the nucleocapsid is unstructured (it looks like a black semicircle). The capsid of the matured virion is cone-shaped.

7. Virion life after exiting an infected host cell... Virion in blood plasma lives no more than 8 hours. Half of all virions die within 6 hours. In other biological fluids, the life span of virions is much shorter. Viruses infect CD4 + lymphocytes, monocytes, macrophages, Langerhans cells (skin), alveolar macrophages (lungs), colon and kidney epithelial cells, cervical cells, oligodendroglia cells, and astrocytes (brain). T-lymphocytes are the main reservoir of human immunodeficiency viruses.

Fig. 15. Figure "b" (photo on the left) shows immature virions. The nucleocapsid is in the stage of formation (rounded), the proteins of the envelope protrude outward in the form of prominences. Figure "a" (photo on the right) shows a mature virion. The nucleocapsid membrane has lost most of the proteins and has become thinner and denser, and the nucleocapsid has acquired the shape of a truncated cone, which distinguishes it from many other viruses.

Fig. 16. On the surface of the infected cell, multiple bubbles are visible, between which newly formed viruses have appeared. The vesicles are significantly larger and less dense than HIV.

HIV mutations

• HIV is the most pathogenic and widespread of all viruses. Minor changes in its genome lead to the emergence of a large number of new strains, which allows the pathogen to escape from the patient's immune system and acquire drug resistance to antiviral drugs. The antigenic variability of HIV is several times higher than that of SARS, the mutation frequency of which is 10 -5 nucleotides per day. Its transcription rate is higher than that of other viruses and amounts to about 20 million viral particles per day. All this complicates both the diagnosis and the search for methods of specific prevention of this formidable disease.
• In the body of an infected patient, there is a merciless struggle between his immune system and HIV. Under the influence of immunity, the virus mutates. But, as scientists have established, constant mutations lead to a weakening of the microorganism: its damaging ability decreases, the development time of AIDS is lengthened.

Fig. 17. In photo "B" there are normal virions: 4 budding (on a stalk) and 1 matured. In the photo "C" and "E" mutated virions. Photo "C" shows immature virions caused by mutations in the protease enzyme. In photo "E" there is a matured virion, but it cannot assemble a normal capsid.

Resilience of HIV in the external environment

The sensitivity of the human immunodeficiency virus to external influences

• Heating to 56 ° C inactivates the virus within 30 minutes, when boiled, the virus dies instantly.
• The pathogen is sensitive to all disinfectants: hydrogen peroxide, lysol, ether, acetone, sodium hypochlorite, ethyl alcohol, chloramine, bleach, etc. Inactivation occurs within 3 - 5 minutes.
• The death of the virus occurs when the pH of the medium changes - below 0.1 and above 13.
• Ultraviolet and ionizing radiation is harmful.

Human immunodeficiency virus resistance

• HIV lives in blood and its components for transfusion.
• In a liquid medium at a temperature of 23 to 27 ° C - 25 days.
• In frozen semen - several months, in blood serum - up to 10 years.
• HIV is killed when frozen below 70 ° C;
• In dried form in blood serum and semen, they remain viable for a day.

Fig. 18. Many mature virions are ready to infect other cells.

Many people ask the question: What is AIDS? This is the final stage of the disease caused by the human immunodeficiency virus - HIV (see photo below). Thus, from what has been said, we can conclude about the difference between these two concepts.

HIV and AIDS: what's the difference

So how is HIV different from AIDS? The difference is that the first abbreviation denotes the name of the virus - the cause of the disease, and the second - the disease itself, which manifests itself in the form of acquired immunodeficiency syndrome. Do not confuse these two concepts, as they are not identical!

What is HIV infection

HIV infection is a disease of which it is caused. This virus contains two identical RNA molecules, each of which contains complete genetic information. An important feature of the causative agent of AIDS is pronounced lymphotropism, especially towards T-lymphocytes "helpers". A definite relationship was revealed between the virus and the histocompatibility antigens of the HLA system.

The stages of the HIV replication cycle are shown in the figure below.

Specific interaction of the virus on the surface of the cell membrane (1) with subsequent penetration into the cell (2); synthesis of a DNA copy of the RNA genome of the virus using reverse transcriptase (3); the transition of virus-specific DNA from the cytoplasm of an infected cell to its nucleus (4) and the insertion of virus-specific DNA into the genome of the host cell (5); assembly and budding of newly formed particles (6).

Under the influence of viral gene expression products, the host cell undergoes degeneration or neoplastic transformation. The listed cytopathic effects are an important feature of HIV infection and are uncommon for most retroviruses. The cytopathic effect of an infectious agent is associated with the presence of a virus-specific transactivating factor.

How HIV is transmitted from person to person

The human immunodeficiency virus is isolated in almost all body fluids: from saliva to cerebrospinal fluid. It is found directly in the tissues of the brain, lymph nodes, bone marrow cells and skin. But, despite the vastness of localizations, HIV can be transmitted from person to person only through blood and semen. Therefore, the question “is HIV transmitted through saliva” widespread among the population can only be answered in the negative.

Infection in the overwhelming majority of cases occurs through sexual contact during homo- and heterosexual contacts. Transmission of the virus is possible through transfusion of whole blood, red blood cells and plasma. Most cases of AIDS in children are associated with congenital from a sick mother to a child, as well as with transplacental infection. A number of cases of the disease are due to the transmission of the human immunodeficiency virus by intramuscular, intravenous and subcutaneous injections, medical scarification or tattoos.

Risk groups for HIV infection

• Homosexuals
• Bisexual
• People who use drugs
• Patients with hemophilia
• Prostitutes
• Children from mothers with AIDS
• Patients with venereal diseases

The key mechanism of various disorders of the system of cellular and humoral immune status in HIV is that the AIDS virus primarily affects T-helpers as a result of its cytopathic action of the etiological factor.

The main manifestations of impaired functioning of the immune system in AIDS are presented below.

Immune system disorders in human immunodeficiency virus

1. Decrease in the total number of circulating lymphocytes
2. A decrease in the number of T-helpers and a change in the content of T-suppressors, leading to a decrease in the ratio of T-helpers / T-suppressors in AIDS - less than 1; normal - about 2
3. Decreased delayed-type hypersensitivity reaction Decreased lymphokine production
4. Increased levels of serum immunoglobulins and circulating immune complexes
5. Functional disorders of monocytes / macrophages: decreased chemotaxis, spontaneous increase in the production of such as interleukin-1, and prostaglandin E 2
6. High titer in blood serum of altered acid-labile alpha-interferon

The incubation period of HIV before the appearance of the first symptoms and the development of manifest forms of AIDS can be quite long and depends on the ways and nature of infection, the size of the infectious dose of the pathogen, as well as other factors that contribute to the reproduction of the virus in the body.

On average, the incubation period is 12-15 months, with fluctuations from 2 weeks to 2-4 years or more.

A shorter incubation period is observed with homosexual and parenteral routes of infection and in children born to sick parents.

Antibodies to HIV can be detected as early as 2-8 weeks after infection, but the seronegative period sometimes lasts up to 6 or more weeks.

Depending on the characteristics of the symptoms, the course of the infectious process in AIDS can be:

• asymptomatic
• clinically pronounced
• rapidly progressing.

The first symptoms of HIV

The first symptoms of AIDS are as follows:

• Fever up to 1 month or more
• Generalized lymphadenopathy
• Decrease in body weight (by 10% or more)
• Long-term (at least 2 months)
• Anemia
• Opportunistic infections:
  • :
    • generalized candidiasis,
    • herpes infection,
    • kaposi's sarcoma,
  • cytomegalovirus and bacterial infections,
  • tuberculosis
• HIV-related CNS lesions:
  • dementia,
  • myelopathy,
  • peripheral neuropathy,
  • aseptic meningitis
• Pneumocystis pneumonia
• Laboratory indicators:
  • lymph and leukopenia,
  • thrombocytopenia,
  • erythropenia,
  • signs of deficiency of humoral and cellular immunity

Diagnosis of HIV infection

For the serological diagnosis of HIV infection, the methods of enzyme-linked immunosorbent assay are primarily used. Two modifications of this method have been developed in Russia. A common disadvantage of enzyme-linked immunosorbent assays for AIDS research is the rather high frequency of false positive reactions. They are due to the very nature of this particular disease, in which the disintegration of cells affected by the virus is accompanied by the release of various cellular antigens into the blood, to which antibodies are produced. A positive AIDS immunoassay is the primary screening method and should be confirmed by immune blotting.

Immunoblot for HIV

The meaning of the immunoblot is as follows:

The purified virus is destroyed with a detergent, its proteins are separated by gel electrophoresis, and then transferred to nitrocellulose strips. The reaction is set by immersing a strip with a virus protein in the test serum diluted in a buffer solution, adding a conjugate of antibodies to human immunoglobulins, washing, setting and accounting for the enzymatic reaction.

The immune blot reaction in AIDS is quite specific, since after separation of proteins by electrophoresis, each of them occupies a strictly defined place depending on its molecular weight.

The Institute of Immunology of the Academy of Medical Sciences of the Russian Federation has developed a highly sensitive and safe test system "Peptoscrin", based on the use of synthetic antigens to antibodies against the virus.

When using any diagnostic AIDS tests, in order to increase the reliability of positive test results for the presence of antibodies to HIV, it is advisable to repeat the reactions with the same reagents or additionally carry out a parallel reaction under identical conditions.

During the initial examination of risk groups, as well as in the absence of data in dynamics, the test results obtained cannot yet reliably indicate the absence or presence of AIDS. Primary positive results require increased attention when conducting a repeated in-depth study of a patient or a donor suspected of a disease, including epidemiological, immunological and clinical methods.

Surveying the population and donors for the diagnosis of HIV infection is the most important, but not the only, but rather the first link in the overall system for tracking the spread of the disease and identifying persons - sources of infection.

HIV treatment

Groups of drugs for antiretroviral therapy for AIDS (clickable photo)

Treatment of HIV patients should be carried out in a hospital with subsequent dispensary observation and periodic hospitalization. An AIDS patient should be informed about the diagnosis and warned about criminal liability for infecting others.

Infected, but not sick, are subject to periodic (at least 1 time per quarter) re-examination to identify the dynamics of the infectious process and the possible detection of symptoms of AIDS in an active form or, conversely, recovery.

Persons with antibodies to the human immunodeficiency virus, who have not detected the expression of the virus, should be re-examined at least once every 6-10 months. They should be warned that they cannot donate blood.

A list of drugs for antiretroviral therapy for human immunodeficiency virus is shown in the photo above.

The combination of medications and the frequency, as well as the duration of their administration should be determined exclusively by the doctor!

Is HIV cured or not?

This question worries many, especially those infected with AIDS. Unfortunately, despite the achievements of scientists in the development of drugs for antiretroviral therapy for human immunodeficiency virus, there is still no drug that can cure HIV. AIDS can only be put into remission, but the body cannot be rid of it.