Syndrome purchased to the immunodeficit (AIDS) - main the world, medical social and political problem of age ХХ. In 1981 in « to morbidity of the Weekly announcer and death rate», published in Center the USA on control after zabolevaniyami (CENTER of control of diseases, Atlas), the first mention appeared in AIDS. In him talked about pnevmocistnoy pneumonia for masculine homosexuals, not having in anamnesis diagnoses of born or second immunodeficitov. Exciter Pneumocystis carinii widely the wide is widespread on earth among people and animal and not morbific for persons with the normal immune system. Afterwards appeared reports about patients in which together with pnevmocistnoy pneumonia, was kandidoz diagnosed. To August, 1981, there was information already about 111 such patients. In addition, it was described exceptionally, because this dependent for age of group a khvoroba is a sarcoma Kaposhi. Researchers drew a conclusion about a defeat immune systems unknown etiology, it was confirmed immunological by by researches. A term appeared AIDS is a syndrome of the bought immunodeficit, in AIDS of English. Middle 1981 can be examined, beginning epidemic SNIDU. Already then the cases of illnesses were proposed among injection drug addicts, haemophilia of patients by, recipients of donor blood, new-born from materey from a group risk, sexual partners of persons, staggered AIDS. In 1983 in the laboratory of Luke Montan`I In Paris there was izolevani the institute of Pasteraм Т-cellular lymphotropic by the virus of man (LAV). Robert Gallo and his workers was opened at the same time a lymphotropic virus makes 3 types (HTLV3), what appeared identical to the first. In the total the name of virus of immunodeficit of man - HIV purchased a foothold after him (HIV). He behaves to the subfamily lentivirusess, families retrovirusov, RNK-SODERZHASCHIKH, і having enzymes, - reverse transkriptazu (revertazu), integrase, proteazu. At hit HIV in frisky cage RNK under influence revertazy transforms on DNK, which built in DNK of cellular proprietor, producting new viral RNK virus particles-copies, remaining in a cage on the term of life.The kernel of cage is surrounded by a shell, containing the glycoprotein of gp120, obuslavlivayuschiy attaching of virus to to to the cages of organism of man, to having a receptor of Cd4. This receptor is carried mainly cages, circulatory in blood, lymph and tissue liquid, and also related to to to the heterospecific elements of nervous fabric. New viral particles are attacked by cages, causing their death, violating their co-operating with other cages, that conducts to to to the making progress dysimmunities. Plenty of circulatory in blood viral particles determines probability of rapid decline of amount of immune cages. Taking into account clear connection between development of disease and decline for a patient amounts of Cd4-limfocitov, scientists suppose that their decline is main by the feature of pathogeny AIDS. The function of limfocitov is violated also helpers/inductors, that results in the spontaneous activating of V-kletok and development polyclonality gipergammaglobulinemii due to the products of heterospecific immunoproteins. As a result, the concentration of circulatory immune rises complexes. As a result of changes of immunity soprotivlyaemost` goes down to to to the second infections and tumours. Due to the direct cytopathic action of virus or as a result of the mediated action (autoimmunnye mechanisms) possibly defeat cages of the nervous system and different cages of the system of blood, serdechno-sosudistoy, kostno-myshechnoy, endocrine and other systems. On processes, conditioned the action of HIV, the wide spectrum of processes, caused is laid on by the developing second diseases. All of it obuslavlivaet poliorgannost` defeats and variety of clinical simptomatiki.

In present tense two types of virus - HIV-1 and HIV-2, differentiating to on are known to the structural and antigen descriptions. There are reliable distinctions in flow of disease, caused these viruses. Flow of infection, caused HIV-2, considered more long. Among HIV-1 and HIV-2 select large number genetically different groups. As well as all of retrovirusy, virus of HIV characterized high changeability. It is considered that in the organism of man to on to the measure of progress of infection, from bessimptomnoy to manifestnoy, takes a place evolution of virus from less virulent to more virulent variant. HIV is unstable in an external environment, sensible to external influences, practically fully inaktiviruetsya at heating higher 56°s during 30 mines, perishes at boiling through 1-3 mines, and also under act of disinfectants (3%-nyy solution peroxigens, 5%-nyy solution of lizola, 70%-nyy - ethyl spirit). Possibly his maintainance in an external environment in liquids, containing a virus in high concentrations, such as blood and sperm. Ruinous for HIV sun and artificial Uf-izluchenie, and also all of types of ionizing radiation. In blood, Intended for transfusion, the virus lives years, in the frozen sperm neskolko months. There were data that the HIV loses activity under vozdejstviem the protective enzymes containing in a saliva and sweat. HIV transfers at ukusah blood-sicking insects do not occur.

a HIV-infection it is extended geographically everywhere. A HIV-1 infection - antroponoz. Animals in natural conditions do not catch a HIV-1. A RVICH-infection source is a HIV-infected the person at all stages of disease, kak in asymptomatic virusonositelstva, and during developed klinicheskih illness displays. A susceptibility to a HIV at people the general. Specific antibodies klassa And, found out on mucous membranes of genitals can be the reason nevospriimchivosti to HIV infection.

Ways of transfer of a HIV-infection: sexual, parenteralnyj, vertical. Sexual put transfers it is realised at heterosexual and homosexual sexual kontaktah. The probability of infection raises at inflammatory diseases polovyh bodies. Parenteralnyj the way infitsirovanija meets basically among inektsionnyh addicts. The general syringes i needles, a drug in which blood is added can be factors of transfer of a HIV thus. Infitsirovanie it is possible at perelivanii the infected blood, its preparations, use polluted by blood meditsinskih the tools, done not pass corresponding processing. Bodies and fabrics of the donors used for transplantatsii can be factors peredachi a virus. If the woman is infected by a HIV, probability infitsirovanija a fruit sostavljaet about 50 %. The child can be infected to, during time and after sorts. / RKONTAKTNO-household and air-drop ways of transfer at a HIV-infection not vstrechajutsja.

the HIV-infection is characterised by the long-term current clinically connected with progressirujushchim by decrease of immunity and leading to development of heavy forms opportunisticheskih of diseases. Till now was considered, that in bolshinstve HIV-infection cases has a unique outcome - destruction infected VICH an organism. However the theory of infectious process supposes existence as malovirulentnyh or defective shtammov a HIV, and patients steady against an infection. Srednjuju life expectancy of the infected person estimate now in 12 let, however duration of illness can be connected with infection ways, prinadlezhnostju to various groups of the population, age, racial features i availability of medical aid.

Clinic. After the incubatory period, in from 2 weeks do 6 and more months, in 50-70 % of cases there comes lasting from several days to 2 months the period of primary clinical displays in the form of feverish sostojanija which can be accompanied by increase limfouzlov, a stomatitis, pjatnistoj a rash, a pharyngitis, a diarrhoeia, spleen increase, sometimes the phenomena entsefalita. In many cases it can be observed erased or malosimptomnoe nachalo diseases, however the majority of the infected HIV by 6 months from the moment infitsirovanija has antibodies to a HIV.

Early clinical displays of a HIV-infection, except for increase limfouzlov, pass, and then within several years others klinicheskie HIV-infection signs are not found out in the infected persons. During this period it is saved aktivnost a HIV and there is a slow decrease in quantity of CD4-cages. When zashchitnye forces of an organism weaken enough, at the patient start to arise raznoobraznye the opportunistic diseases, which expressiveness further narastaet in process of decrease in quantity of CD4-cages. At considerable decrease kolichestva these cages developing opportunistic defeats get ugrozhajushchy for a life character. In the absence of adequate therapy of the patient pogibaet.

Except somatic defeats, at sick HIV-infections develop nejropsihicheskie the changes connected with news about infection by a virus, there is tselaja a group of stresses because of which are broken or stop social and mezhlichnostnye communications caught, level of their self-estimation decreases, is oppressed emotsionalnyj a background, the life of patients practically varies. Any infectious zabolevanie was not accompanied till now such expressed stigmatizatsiej, as a HIV-infection. The adverse forecast of disease, osobennosti transfers of the activator, young age caught - all these factors usugubljajut a socially-psychological situation of patients. At HIV-2 infection zabolevanie progresses a little bit more slowly. In due time and correctly begun lechenie can increase for some years life expectancy infected lits, and also to improve quality of their life.

many researchers tried to display a HIV-infection Current with the help klinicheskih classifications. In our country the following classification of a RVICH-infection (V.I.Pokrovsky, 1989) is accepted.

I. A stage inkubatsii.

II. A stage of primary displays:

III. A stage of secondary diseases:

And - loss of weight of a body less than 10 %, superficial fungoid, bacterial, virusnye defeats of a skin and the mucous membranes, surrounding deprive, repeated faringity, a sinusitis;

- progressing loss of weight of a body more than 10 %, an inexplicable diarrhoeia or lihoradka more than 1 month, hairy lejkoplakija, a tuberculosis of lungs, repeated ili proof bacterial, fungoid, virus, protozoan defeats internal organov (without disseminatsii) or deep defeats of a skin and mucous membranes, povtornyj or disseminirovannyj surrounding deprive, the localised sarcoma Kaposhi;

In - generalizovannye bacterial, virus, fungoid, protozoan and parazitarnye diseases, pnevmotsistnaja a pneumonia, the candidiasis of a gullet atypical mikobakterioz, vnelegochnyj a tuberculosis, kaheksija, disseminirovannaja a sarcoma Kaposhi, defeats TSNS of a various aetiology.

IV. A terminal stage.

Allocate also three immunologicheskie categories depending on level Sd4-limfotsitov:   1) more than 0,5 h 109/l Sd4-cages in 1 mm3 blood; 2) from 0,2 to 0,5 h 109/l in 1 mm3; 3) less than 0,2 h 109/l in 1 mm3.

Thus, each patient can be carried to this or that category on klinicheskim and immunologicheskim to criteria.

In the given classification all displays of illness from the moment zarazhenija to destruction of the patient are considered, switching on and what, probably, are still unknown.

HIV-infection Diagnostics is carried out by a complex estimation epidemiologicheskih data, results of clinical inspection and laboratory issledovany. HIV-infection diagnostics includes two consecutive etapa: an establishment actually the HIV-infection diagnosis, i.e. Definition sostojanija infitsirovanija a HIV, and an establishment of the developed clinical diagnosis, v t. ch. Definition of a stage, character of a current of a HIV-infection and the forecast zabolevanija. Clinical inspection is an obligatory stage clinical diagnostiki a HIV-infection. Epidemiological and laboratory data can be dostatochno to organise protivoepidemicheskie actions but if not provedeno clinical inspection, it is impossible to organise correct treatment patsienta. After an establishment of the diagnosis of a HIV-infection it is spent further uglublennoe inspection, character of a current of disease, degree snizhenija immunity is specified, the aetiology and character of secondary diseases - and is appointed sootvetstvujushchaja therapy. Clinical criteria of an estimation of weight of a current zabolevanija is presence, weight and frequency of occurrence clinical projavleny disease and secondary defeats. The is more often arise opportunisticheskie diseases, the they it is heavier, and the is worse they give in lecheniju, the more hard the forecast. And prognozirovanija HIV-infection currents concern laboratory criteria of an estimation of weight definition of level Cd4-limfotsitov i quantities of a virus in blood (virus loading). Level CD4, its change pozvoljajut to judge depth developed at a sick immunodeficiency, serve kriteriem for definition of probability of occurrence of secondary diseases, pomogajut to define necessity not only protivoretrovirusnoj therapies, but also himioprofilaktiki secondary diseases. Virus loading now schitaetsja one of the most important criteria of a current of disease. High pokazatel virus loading is the earliest sign beginning progressirovanija diseases and adverse prognosticheskim a symptom. Data pokazatel it is used for a fast estimation of efficiency protivovirusnoj terapii. Significant change of concentration RNK the difference in an indicator po to comparison with the previous level not less than three times (0,5 log 10) is considered a HIV. At effektivnoj protivoretrovirusnoj therapies already to 4 - 8th week the HIV in three-five times is marked snizhenie level RNK. To 12 - 16th week of treatment at the majority patsientov level RNK the HIV becomes not defined. Sharp infectious zabolevanija and vaccination can temporarily raise level of virus loading.

Treatment. HIV-infection treatment is the major problem modern meditsiny. Though in Russia the HIV-infected number in comparison with other countries otnositelno is insignificant, however it steadily increases. Therefore to all doctors neobhodimo to know about HIV-infection treatment. Recently in sredstvah the mass information periodically there are messages about new protivovirusnyh the means, allowing to "cure" a HIV-infected. As example tomu the information on the preparation created in Armenia armenikum can serve. To sozhaleniju while there are no medical products which could completely izbavit the patient from a HIV-infection though the prevention of its progressing javljaetsja quite real problem. Main objectives of therapy of a HIV-infection - predotvratit or to delay development of defeats menacing to a life and to provide bolee long preservation of quality of a life of the patient, and also with the help ratsionalnoj therapy and preventive maintenance of secondary diseases in a combination with protivoretrovirusnoj therapy to achieve remission, restoration of quality of a life and ego longer preservation. To main principles of therapy of a HIV-infection mozhno to carry: necessity of creation of a guarding psychological mode; svoevremennoe the beginning protivoretrovirusnoj therapy and preventive maintenance secondary zabolevany; careful selection of combinations of medical products; Early diagnostika and timely treatment of secondary diseases. There are indications dlja purposes protiv oretrovirusnoj therapies. Indications and tactics are defined klinicheskoj by a disease stage. The unconditional indication to protivoretrovirusnoj terapii are: a sharp HIV-infection in clinically expressed form (2А) and nalichie at the patient of clinical displays of opportunistic diseases (3А, 3B, 3В) a HIV-infection. At revealing of indications to carrying out protivoretrovirusnoj terapii additional inspection of the patient is spent. The treatment keystone to success javljaetsja desire and readiness of the patient to be treated, psihologicheskaja preparation of the patient, its consultation apropos predpolagaemoj efficiency, the account of contra-indications and complications planned terapii therefore is obligatory. To patients from an asymptomatic HIV-infection treatment offer, if the number of CD4-cages makes less than 500 in 1 mm3 or concentration RNK a HIV prevyshaet 20 000 (PTSR) copies/ml. Other patients can be observed only though nekotorye experts consider expedient to appoint it therapy. At bessimptomnom an infection current early therapy has certain lacks: uhudshenie qualities of a life at the expense of undesirable effects and complexity of schemes antiretrovirusnoj therapies, possibilities of early development of stability of a virus, toksichnost protivovirusnyh means. If the doctor and the patient have made decision to begin antiretrovirusnuju therapy it should be aggressive and provide maksimalnoe suppression replikatsii a virus. Modern antiretrovirusnye preparaty it is possible to divide into three gruppy.

Return transkriptaza and proteaza are the enzymes of a virus necessary for it replikatsii. Accordingly suppression of these enzymes leads to delay razmnozhenija a HIV. As the most effective consider a combination of one ingibitora proteazy (for example, indinavira or ritonavira) and two nukleozidnyh ingibitorov obratnoj transkriptazy (zidovudina and didanozina, stavudina and didanozina, stavudina and lamivudina, didanozina and lamivudina, zidovudina and zaltsitabina, zidovudina and lamivudina). Alternative ingibitoru proteazy can be new nenukleozidnyj ingibitor return transkriptazy - ifavirents. Therapy by two nukleozidnymi ingibitorami transkriptazy concedes return by efficiency kombinatsii three preparations, and monotherapy by any antiretrovirusnymi means schitaetsja inefficient (unless alternative terapija it is impossible, or during pregnancy for the purpose of the prevention perinatalnoj transmissions). Possibility of simultaneous application treh nukleozidnyh ingibitorov by return transkriptazy, for example, abakavira, zidovudina and lamivudina is discussed. However, according to experts, now nevertheless predpochtitelno use of preparations of different classes. All antiretrovirusnye sredstva should be appointed simultaneously in the maximum dose (an exception sostavljajut ritonavir and nevirapin which doses can be increased). At klinicheskih HIV-infection displays antiretrovirusnaja therapy is shown all bolnym. It is necessary to use the most powerful combination of preparations, obespechivajushchih the maximum suppression replikatsii a virus. The patient AIDS more often prihoditsja to appoint not only protivovirusnye means, but also preparations for lechenija opportunistic infections. In such cases it is necessary to consider vzaimodejstvie between them, and also possibility of occurrence similar nezhelatelnyh effects. For example, rifampicin which is applied at treatment aktivnogo a tuberculosis, reduces level ingibitorov proteazy in blood. The last, v the turn, break a rifampicin metabolism. Powerful protivovirusnaja therapy vosstanavlivaet immune function of the patient. Strengthening immunologicheskogo and-or vospalitelnogo the answer can lead to occurrence of new symptoms in patients with subklinicheskimi opportunistic infections (for example, TSMV). Expediently prodolzhit antiretrovirusnuju therapy and to spend adequate treatment opportunisticheskoj infections. Sometimes for whatever reasons it is necessary preryvat antiretrovirusnuju therapy. Authentic data on on how much dnej, weeks or months it is possible to cancel without consequences one preparation or all kombinatsiju, no. If there is a necessity for therapy interruption on long srok theoretically it is better to cancel all preparations, than to continue therapy by one ili two antiretrovirusnymi means. Such approach allows to reduce to minimumu risk of occurrence steady shtammov a virus. Frequently doctors face with tem, that the chosen scheme of therapy not always gives sufficient virologic and immunologichesky effect that compels to change treatment. The most important criterion effektivnosti therapies is dynamics of virus loading. Confirmed klinicheski significant increase of concentration RNK the HIV in plasma which is impossible objasnit interkurrentnoj an infection or vaccination, specifies on neeffektivnost treatments (irrespective of dynamics of number of CD4-cages). At a choice novoj treatment schemes it is necessary to consider the reasons of its change. If therapy davala virologic effect, but called the expressed collateral reactions tselesoobrazno to cancel a preparation which caused the undesirable phenomena, and naznachit other means of the same class, but with other profile of toxicity and perenosimosti. If therapy has led to the expressed suppression replikatsii a virus, no is inadequate from the modern point of view (for example, two nukleozidnyh ingibitora to return transkriptazy or monotherapy) there is a question: prodolzhat spent therapy or to add other means. The majority ekspertov believe, that inadequate therapy finally will appear neeffektivnoj, and consider second tactics expedient. At an inefficiency pervonachalnogo treatments it is preferable to replace the inadequate scheme completely. Osoboe the trouble calls possibility of cross stability to various ingibitoram proteazy. Are available that certificate, that shtammy a virus which priobreli resistance to one preparation of group, possess lowered chuvstvitelnostju or are steady against the majority or all ingibitoram proteazy. In svjazi with it many experts consider expedient to switch on two ingibitora proteazy in new schemes of treatment. antiretrovirusnaja therapy at sick of a sharp RVICH-infection reduces virus loading and favorably influences on immune funktsiju, however the remote clinical effect of similar therapy is studied nedostatochno. Many experts consider expedient to continue treatment neopredelenno long time, since. After the therapy termination viremija can pojavitsja again or increase.

Now there is a sharp requirement for new ways of treatment, kotorye would be effective for constantly growing number of a HIV-infected patsientov, already lechennyh aforementioned preparations. Data about new klasse protivovirusnyh means are obtained is ingibitor fuzii (preparation Т-20), which primenjalsja in a combination with traditional preparations. Unlike others preparatov for treatment of a HIV-infection which block replikatsiju once popavshego in a cage of the person of a virus, Т-20 represents peptid, prepjatstvujushchy to virus penetration in kletku.

Pay attention!

• a HIV-infection it is geographically extended everywhere
• by a HIV-infection Source is a HIV-infected the person on all disease stages, from asymptomatic virusonositelstva to developed clinical displays
• the Incubatory period lasts from 2 weeks till 6 months
• Antibodies to a HIV appear at the majority infected to 6 month from the infection moment
• HIV-infection Diagnostics complex, s witches on results epidemiological, clinical and laboratory data
• the Primary goals of therapy of a HIV-infection - prevention or maximum a delay of development of statuses menacing to a life

Article is published in magazine Treating the Doctor