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HIV/AIDS in children

HIV/AIDS in children. Plan of the lecture. The etiology of HIV infection, history of the HIV discovery HIV infection e pidemiology, pathogenesis HIV infection d iagnostic criteria HIV infection Antiretroviral Therapy HIV infection prevention. HIV - infection. AIDS.

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HIV/AIDS in children

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  1. HIV/AIDS in children

  2. Plan of the lecture • The etiology of HIV infection, history of the HIV discovery • HIV infection epidemiology, pathogenesis • HIV infection diagnostic criteria • HIV infection Antiretroviral Therapy • HIV infection prevention

  3. HIV-infection AIDS 8-10 years in average* *without treatment HIV: Human Immunedefficiency Virus a retrovirus, its genetic material, RNA, while replicating change the structure of host cell DNA AIDS: Aquired Immune Defficiency Syndrome

  4. HIV infection - a chronic infectious disease that develops because of infection with human immunodeficiency virus (HIV) and is characterized by progressive immune system damageAIDS - a terminal (final) 4th stage of the HIV infection course as the result of the human immune system destruction by the virus (HIV), and loss of human capacity to resist infections and diseases

  5. History of HIV discovery • Spring 1981 - + 5 patients with malignant pneumocystis pneumonia

  6. History of HIV discovery • winter 1980-81-- first patients with Kaposi sarcoma, malignant form in the United States

  7. They had opened HIV R. GALLO L. Montonae

  8. Human immunodeficiency virus • 109 new viruses Appears every day • reverse transcriptase makes “errors" at each transcription • there significant number mutations due large number of errors, but on undetectable level

  9. Etiology • HIV - Т- lymphotropic retrovirus of ІІІ type • RNA-containing, cells-targets – DNA-соntaining (helpers T-lymphocytes) • Enzymes: reverse transcriptase (revertase), protease • Specific markers – p24, gp41, gp120, gp160 • Genome of the virus include 3 structure genes (as all retroviruses) and 6 regulatory genes (increase replication, activate of virus protein structure synthesis)

  10. HIV BIOLOGICAL CHARACTERISTICS - HIGH genetic variability (up to 104 -105mutations / gene / every replication cycle, predominantly in the gene gp120) Resistance of HIV in an infected organism - Rapid development of drug resistance - Modified tropism of HIV at different stages of disease - Difficulty in creating an effective vaccine

  11. Stability of the virus in the Environment • When drying the cell cultures will kill the virus at t˚ +23 +27 ˚C for 3-7 days. • In liquid at a temperature of +23-27 C - within 15 days, • In the blood for transfusion is going through the years, and in the frozen serum - activity persists up to 10 years. • HIV dies quickly when using disinfectants, UV radiation, when heated above 56 C loses activity after 30 minutes. • HIV loses activity under the influence of protective enzymes of saliva and sweat.

  12. Epidemiology • Source – sick and carrier (contagious during all life) • Mеchanism of transmission – contact (wound), vertical • Ways of transmission: • natural:sexual (homosexuals – 1-3 %, females – 0.6 %, males – 0.09 %) • vertical (transplacentar – 15-20 %, childbirth – 50-70 %, during breast feeding – 20-30 %) • artificial:parenteral manipulations and drug using – 30 %, blood recipients – 100 %, transplantation of organs and tissues, artificial abortion – 100 % • professional:infection of medical personal – 0.1-0.4 %. Intrahospital outbreaks.

  13. WHAT   BE   FOR   TRANSFER   HIV? • Ways of transmission: • sexual, • Through the blood, • From mother to child HIV HIV + Factorstransfer (Biologicalfluids with highHIV-content) Vaginal - secret HIV- sperm blood milk When  absence although one of these factors the chain will torn and infection is not developed

  14. Estimated risk of transmission HIV from mother to child(in the absence of any interventions) • During pregnancy, 5-10% • During childbirth 10-20% • When breastfed 5-20%

  15. HIV is not transmitted: • When insect bites (mosquitoes, fleas, lice, beetles, flies, etc.) • With saliva, sweat, urine, feces, sputum, discharge from the nose, tears, vomitus (if there is no visible admixture of blood) • Household contact

  16. Transmission has not been provedduring puncture • Cerebrospinal • Synovial • Pleural • Peritoneal • Pericardial • Amniotic

  17. Biological fluids, which contacted you may be infected HIV: • Blood and any liquid with a visible admixture of blood • Sperm • Vaginal Discharge • Culture containing HIV

  18. Treated with care require: • any biological fluid, if it is difficult to determine what kind of fluid • Any excised (or deleted by other means, in vivo or post-mortem) human tissues and organs • tissues and organs of experimental animals infected with blood-borne infections; • any cuts of unknown origin.

  19. Contacts associated with therisk ofinfection: • Trans-dermal contact • Needlesticks • cut with a sharp object • Contact with biological materials on mucous membranes or broken skin • Contact intact skin with blood, biological tissues or fluids for a long time or over a large area

  20. Assessment of infection risk • contact with HIV-infected blood through the damaged skin, 0,3% (0,2 - 0,5%) • getting blood on the mucous membranes - 0,09% (0,006-0,5%) • contact with intact skin - the risk is not detected • contact with body fluids - the risk is not detected

  21. The risk of transmission of the virus in trauma with a sharp instrument contaminated with body fluids of an infected patient * Невакцинированные медработники

  22. Ways of infection when professionally contact 10% 90% From: CDC. MMWR 1998;47:No. RR-7.

  23. Pathogenesis of HIV infection in humans • Infection occurs through close contact with blood or other body fluids containing the virus in sufficient quantities for infection (semen, vaginal secretions, breast milk) • In the penetration of the virus in the body involved mucosal dendritic cells • The virus rapidly infects activated CD4 lymphocytes near the gate of infection and reaches with them the regional lymph nodes • Following this, HIV is spread through the body with blood and lymph

  24. Pathogenesis of HIV infection • The virus is detected in the blood and lymph nodes, in long-living lymphocytes it is contained in a latent form, which makes it impossible to completely eliminate. • Persistent failure of the lymphatic system occurs within 48 hours • In contact with infected blood or other body fluids should be as soon as possible to take preventive measures (optimal in the first hours after contact) • For some groups of patients it is characterized by depression of the immune system and a more rapid progression of infection. These include: • Infants • Individuals with defects in the immune system

  25. The life cycle of HIV and a target for drugs

  26. HIV and the immune system • HIV uses mostly CD 4 cells to reproduce • CD 4 cells - contain CD 4 receptors on their surface • CD 4 receptors are located on the surface of many cells, but mainly on the T 4 lymphocytes (T helper) • The shell of the virus contains a molecule that helps him connect to the CD4 receptor and to penetrate into the cell

  27. A “Window" Period АТ

  28. HIV and the immune system "Window" Period This is the time needed to accumulate in the body a sufficient number of antibodies to HIV, which is determined by laboratory tests (3 months - in 99%)

  29. DEVELOPMENT OF HIV INFECTION Stages: • Acute viral infection • The latent period of asymptomatic carriers • HIV infection (4thstage - AIDS)

  30. Development of the disease2004 WHO Classification • Clinical stage I • Asymptomatic • Generalized lymphadenopathy

  31. Development of the disease2004 WHO Classification • Clinical stage II • Weight loss is less than 10% of the original • Mild skin and mucous damages • Shingles (herpes Zoster) • Recurrent upper respiratory tract infection

  32. Herpetic stomatitis (Canker Sore)

  33. Herpes simplex

  34. Rerccurent Herpes labialis (Cold Sore)

  35. Herpes Zoster

  36. Development of the disease2004 WHO Classification • Clinical stage III • Weight loss is more than 10% of the original • Diarrhea of unknown etiology • Prolonged fever of unknown etiology • Oral Candidiasis • Oral hairy leukoplakia • Pulmonary tuberculosis • Serious bacterial infection

  37. Oral Candidiasis (thrush)

  38. Oral Candidiasis (thrush)

  39. Leukoplakia Oral hairy leukoplakia

  40. Development of the disease2004 WHO Classification Clinical stage IV (AIDS) • HIV cachexia • PCP • Toxoplasmosis • Kaposi’s sarcoma • Lymphoma • Other AIDS indicator disease

  41. Kaposi sarcoma

  42. Mouth cancer

  43. Condyloma acuminata (Human Papylomavirus infection)

  44. Lichen planus

  45. Indicators that determine the stage of HIV infection: Clinical Immunological Virological Opportunistic infections and AIDS - Indicator diseases Number   and% CD4/8 Virus load Total   number  of lymphocytes

  46. Examples of the diagnosis by WHO classification: • HIV infection, the second clinical stage, without significant immunosuppression • HIV infection, the fourth clinical stage, severe immunosuppression.

  47. Opportunistic infections • HIV slowly destroys CD 4 cells during many years of infection • When the number of CD 4 cells decreases germs of infectious diseases can easily penetrate into the body, causing the development of opportunistic infections(germs that do not cause pathological process in people with normal immunity)

  48. Laboratory studies • Serological methods for diagnosis of HIV infection. • ELISA(routine serological test). • Immune blot method (Western blot). • Determination of antigen-R24. Determination of R24-antigen in serum implies the presence of HIV in the body. It appears in the blood, as in the early stages, and in progression of HIV infection. • Molecular genetic and virological research methods • HIV DNA PCR • HIV RNA PCR • Getting HIV culture

  49. Diagnosis of HIV-infected child under 18 months: • age - under 18 months + • antibodies to HIV determined in serum (ELISA and immuneblot)or a child was born by HIV-infected women + • child has two positive results, done by one of the following methods: • PCR DNA • a culture of HIV • definition of R24 antigen.

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