10.26.2016 at 19:25
Today, in the Volgograd region, ARV therapy covers everyone who needs it, and this is almost every second of those who are under dispensary observation at the regional center for the prevention and control of AIDS. But experts also say something else: over the years, HIV infection has “developed” into a social problem, since many HIV-infected people become disabled. Observer Olga SURAGINA talked with the head of the Main Bureau of Medical and Social Expertise for the Volgograd Region, Lyudmila GICHKUN, about how the quality of life of these people is maintained.
The medicine works
– Lyudmila Petrovna, how many HIV-infected people are recognized as disabled according to the results of a medical and social examination?
- Not much. For the period from 2005 to 2015 - 139 people. This is only 0.05% among all those newly recognized as disabled over the same period of time. I note that the Volgograd region is not among the thirty regions of the Russian Federation with the highest mortality rate among HIV-infected people. In 2015, this figure was 5.4 times lower than the national average, and this trend has persisted for several years. This is clear evidence of the effectiveness and quality of antiretroviral therapy that HIV-infected people receive.
– That is, not everyone who is diagnosed with HIV infection by doctors is immediately and automatically recognized as disabled?
- Of course not. Patients with stage 4 HIV are referred for medical and social examination when clinical manifestations of immunodeficiency begin. Against this background, infectious and/or oncological secondary diseases and functional disorders develop. Depending on the severity of functional impairments and limitations in life activity, various disability groups are determined. The methodology for medical and social examination of patients with HIV infection is clearly defined in clause 5.4.2 of the order of the Ministry of Labor and Social Protection of the Russian Federation dated December 17, 2015 No. 1024n “On classifications and criteria used in carrying out medical and social examination of citizens by federal state medical institutions -social expertise".
From "A" to "B"
– Can you give specific examples?
- Please. Depending on the severity of the manifestations of secondary diseases in HIV-infected people, stages 4A, 4B and 4C are distinguished. Let's say stage 4A usually develops 6-10 years after infection. It is characterized by bacterial, fungal and viral lesions of the mucous membranes and skin, and inflammatory diseases of the upper respiratory tract. In this case, patients can fully retain their ability to work, although the quality of their work undoubtedly decreases. Modern treatment for emerging diseases prescribed during this period can be very effective. When using ARV therapy, the patient usually returns to work for at least several years. Therefore, taking into account the severity and nature of work in stage 4A in the progression phase, it is possible to establish disability group III.
– When does stage 4B occur?
– Usually 7–10 years from the moment of infection. During this period, lesions of internal organs and the peripheral nervous system, localized Kaposi's sarcoma, begin to develop. This stage of the disease is characterized by long-term disability, since there is a pronounced decrease in the body’s adaptive capabilities and, as a consequence, a severe course of secondary diseases. It is taking into account the frequency and severity of their exacerbations in an HIV-infected patient that disability group II is determined.
– Stage 4B, presumably, is already associated with the depletion of the body’s protective reserves?
- Yes. It usually appears 10–12 years after infection. Stages 4B and terminal stage 5 are characterized by severe impairment of motor functions, mental changes, and severe opportunistic infections. All this leads to rapid exhaustion of the body, to complete loss of ability to work and to the definition of group I disability. By the way, according to statistics, not everyone who is infected with HIV develops the last stage of the disease - AIDS. A significant proportion of those infected die even before this. The cause of death can be heart attacks, strokes, drug overdose, complications of hepatitis (cirrhosis and liver cancer).
Don't drink, don't smoke!
– What influences the rate of development of HIV and its transition to the AIDS stage?
– First of all, the initial state of human health before infection. The better it was, the longer the body resists the disease. It has been proven that the use of drugs, alcohol and tobacco accelerates the destruction of the body by HIV infection by approximately two times. Diseases transmitted through blood and sexual contact create an additional burden on the immune system. An important role is played by the living conditions of an HIV-infected person: non-compliance with the rules of personal hygiene, rational diet, physical activity and rest. And, of course, the most important factor is the untimely start of ARV therapy and treatment of associated infections. Early seeking medical help and timely treatment can significantly prolong the life of an HIV-infected patient.
Young, unmarried
– Your specialists are analyzing primary disability among HIV-infected people, studying the causes of the development of the disease, the characteristics of the gender and age structure of disabled people, etc. What is the average statistical portrait of a disabled person with HIV?
– Of the 139 people recognized as disabled for the first time due to HIV infection, 96% were people of working age and 3.4% were of retirement age. Men predominate (64%). Urban residents make up 89%. 19% have their own family, 41% live alone, and the same number live with their parents. 45% of disabled people with HIV have secondary education, 39% have secondary technical education, and 5% have higher education. Moreover, only 11% of them are employed. It turned out that 75% became infected through sexual contact and 23% through drug injection.
– As far as I know, the timing of the development of signs of disability was also analyzed?
- Yes. In 19% this occurred within 1–2 years after diagnosis of the disease, in 29% within 4–5 years, in 52% after 6 years or more. In 14%, disability group I was determined, in 65% - II, in 29% of cases - III. We also studied the need of disabled people with HIV for basic types of rehabilitation.
- And what is the result?
– It turned out that absolutely 100% of them needed drug therapy and clinical observation, outpatient and inpatient treatment, psychotherapy and psychological correction. The need for social rehabilitation measures was 73.4%, the need for professional rehabilitation – 67.5%.
Barrier to the virus
– At the beginning of February, the Ministry of Health presented for public discussion a draft strategy to combat the spread of HIV infection in the Russian Federation until 2020. How effective, in your opinion, are the measures proposed there?
– The developers of the strategy plan to increase the coverage of ARV therapy to 60% of patients with HIV. According to forecasts, this will reduce the growth rate of the epidemic by almost half and prevent up to 40 thousand new cases of HIV infection annually. This, I believe, will be a significant achievement.
After the immunodeficiency virus enters the human blood, the disease goes through several stages until the infection finally destroys the natural defenses and the body becomes defenseless against the attack of various diseases. HIV itself is not fatal, but what it does to the human body is dangerous.
Few patients survive to stage 4b, which occurs approximately fifteen years after contracting HIV infection. During this period, the patient develops infectious or oncological diseases that lead to death. The human body is no longer able to resist viruses. The majority of patients die from deterioration of nerve cells and brain diseases.
How much a person is given after infection depends on many factors; the disease does not always develop gradually. Passing one stage after another, it is possible to observe both the rapidly developing disease and the stages of its spontaneous remission and retreat. Determining the stages of development of immunodeficiency is based on determining the titer of HIV or the amount of antibodies to the virus, but in the last stages of the disease the method is less accurate.
The first stage of the development of the disease is direct infection with the virus and its active reproduction. In the second stage, HIV begins to gain a foothold in the blood, causing symptoms similar to those of a cold. The total duration of development is up to 24 months.
At the third stage, the body is still able to withstand the attacks of the virus (the lymph nodes are affected). The duration of the stage is determined by the individual resistance of the body and can last from 24 months to 20 years (it all depends on how quickly the virus deals with CD4 lymphocytes).
When the disease reaches the fourth stage, a person’s immunity is so destroyed that it can no longer stop the development of the virus - and loses the fight for life. The minimum level of CD4 cells, macrophages and other defense cells is determined in human blood. The human body gradually loses the battle to HIV and the virus completely occupies the body, provoking the development of neoplasms and severe infections.
It is at the fourth stage that the body becomes defenseless against infection, which a normal person can quickly and easily cope with.
These diseases are called opportunistic (from the Latin benefit, opportunity) infections or HIV-related diseases, that is, those that take advantage of the state of practical absence of immunity. For the development of one of these pathologies, the presence of HIV is necessary; some, combined with immunodeficiency, take on an unusually severe form.
Pre-AIDS according to the classification accepted in Russia, which was developed by V.I. Pokrovsky, has three stages of gradual development:
If in phase 4A concomitant infections are treatable, but require a longer time, then in stage 4B they are practically incurable. The stage is determined based on symptoms of concomitant diseases and an analytical study of the number of CD4 cells in the blood.
In some cases, remission of pre-AIDS is observed, but it is not possible to determine whether the cause is a spontaneous process or highly active antiretroviral therapy.
Stage 4 Pre-AIDS shows a critically low level of body defense and the maximum load of HIV on the immune system. A person practically loses the ability to resist the disease, but the use of HAART and treatment of concomitant diseases in many cases makes it possible to stop the development of pathology.
The onset of stage 4B indicates that the virus has found a way to cope with the drugs that block it, and the transition to the next phase becomes faster. Changing the medicine used allows you to stop the development of the virus and bypass its protection.
HIV infection can stop, and stage 4B will not occur. The stopped development of the virus shows that a balance has been achieved between the state of the body and the course of the pathogen. This “falling asleep” of the virus also occurs at stage 4B - this means that with sufficient medical support, the patient can live indefinitely.
Many people experience chest pain, severe coughing, accompanied by bloody sputum.
Signs:
The patient's skin condition also worsens. Quite often, a person develops ulcers on the palms and in the armpits. The wounds bleed and pus accumulates in them. This phenomenon is temporary, the ulcers usually disappear after the initiation of appropriate therapy. The patient may have a sharp rise in body temperature and develop bronchitis or flu. The danger of the situation is that influenza, which develops at stage 4B of HIV infection, can be fatal.
A patient suffering from HIV infection often experiences anemia. With this disease, the level of hemoglobin in the blood decreases and the risk of heart failure increases. The patient complains of loss of appetite and weight loss.
Regular consumption of alcoholic beverages, smoking and drug addiction doubles the aggressiveness of the human immunodeficiency virus. At this stage, additional infection of a person with sexually transmitted diseases, hepatitis C, which accelerates the destruction of the body and the patient’s refusal of a rational way of life: an established daily routine, diet, feasible physical activity, has an extremely negative impact.
Late treatment, non-compliance with doctor’s prescriptions, or refusal to treat HIV and related infections accelerates the transition of the disease to the terminal stage. At this stage of the disease, patients are extremely exhausted, they have no appetite, there is constant fatigue, and patients spend almost all their time in bed.
The accompanying pathology in this phase of the lesion is Pneumocystis pneumonia (characteristic only for this stage of HIV and is considered one of its symptoms). The patient suffers from the herpes virus, which causes permanent ulcers and lesions on the mucous membranes.
The intestines experience attacks from protozoan microorganisms (protozoa), diseases from which are considered characteristics of the onset of stage 4B.
Often there is total damage by the tuberculosis bacillus to the bones, membranes of the brain, intestines, and skin of the human body; characterized by infection with mycobacteria (protozoa, similar to the tuberculosis bacillus), which attack the skin, digestive system, lungs, and central nervous system. Mycobacteria normally very rarely infect humans, although the causative agent of leprosy belongs to this group.
Cryptococcal meningitis, which is typical for HIV-infected people, also does not occur in healthy people (the causative agent is the yeast fungus cryptococcus, which lives in the soil). Characteristic of the last stage of HIV are various malignant neoplasms that arise anywhere in the body, heart and kidney failure.
Characteristic of stage 4B of HIV is damage to the central nervous system, classified as HIV (AIDS) dementia. It manifests itself in a decrease in intellectual abilities, memory and personality disorders, and coordination problems.
Accompanying disorders are depression and anxiety, psychosis, insomnia, and leaving home. The patient is constantly in a state of deep depression caused by the presence of a complex of diseases and suffering.
Against the background of emotional depression, pathologies of the central nervous system and heart rapidly develop. At this stage of HIV, patients refuse the help of a psychologist, although professional consultations and the patient’s desire to fight for life often significantly improve the condition.
Pregnancy does not accelerate the development of immunodeficiency, but you should not have a child at stage 4B of HIV infection. The probability of infection of the baby in the womb is quite high. In addition, the virus may develop resistance to drugs.
During pregnancy, a woman’s body is especially vulnerable; her immune system is aimed, first of all, at protecting the unborn child from contracting HIV infection. At the initial stage, the patient can become a mother only if there are no other contraindications to bearing a baby.
Medicine does not know a medicine that could completely stop the infection of the human immunodeficiency virus, but modern methods of treating HIV make it possible to block the replication process of the pathogen and prolong the life of patients. The effectiveness of the drugs is very high - if you follow the doctor’s prescriptions and take the medicine correctly, the process of growth of CD4 leukocytes and massive suppression of HIV is possible.
Treatment is aimed at suppressing HIV and preventing the development of concomitant infections, long-term preservation of the patient’s acceptable condition, psychological and emotional supervision and support for patients.
The doctor, using HAART and symptomatic treatment, tries to ensure that the stage of secondary diseases does not progress to AIDS. At stage 4B, the last stage of HIV, HAART is always prescribed.
HAART is carried out:
The drugs are prescribed to the patient in combination, periodically changing combinations.
If a patient has HIV dementia, therapy with Zidovudine and Didanosine is prescribed simultaneously, a course of treatment of at least 4 months. When mental disorders manifest themselves, appropriate drug treatment is used.
HIV-related infections are treated with symptomatic therapy: antibiotics, antiviral and antimycotic agents. Complex treatment includes general health-improving medications (vitamins and supplements), and physiotherapy is used whenever possible.
The prognosis for AIDS is not very optimistic. The average life expectancy of a patient is 1-3 years.
The rate of transition of HIV infection to the stage of acquired immunodeficiency syndrome is influenced by the following factors:
Modern medications can stop the development of the disease at stage 4B. Therefore, there is no need to despair and give up!
I want to know how AIDS is divided into stages of the disease, I’m interested in 4, and in general how long do people live with AIDS and I got the best answer
Answer from White lily[guru]
According to the classification proposed by V.I. Pokrovsky in 2001, HIV infection in the body goes through 5 stages:
Incubation stage (stage 1): from the moment of infection until clinical manifestations of acute infection and/or antibody production (on average from 3 weeks to 3 months).
Stage of primary manifestations (stage 2):
2 "A" - asymptomatic, when there are no clinical manifestations of HIV infection or opportunistic diseases, and the response to the introduction of HIV is the production of antibodies.
2 "B" - acute HIV infection without secondary diseases (various clinical manifestations, most of them similar to the symptoms of other infections).
2 "B" - acute HIV infection with secondary diseases (against the background of a temporary decrease in CD4 lymphocytes, secondary diseases develop - sore throat, bacterial pneumonia, candidiasis, herpes - as a rule, they are well treatable). The duration of clinical manifestations of acute HIV infection is usually 2 - 3 weeks.
Latent stage (stage 3): Slow progression of immunodeficiency. The only clinical manifestation is enlarged lymph nodes, which may be absent. The duration of the latent stage is from 2 - 3 to 20 or more years, on average 6 - 7 years. There is a gradual decrease in the level of CD4 lymphocytes.
Stage of secondary diseases (stage 4): HIV replication continues, leading to the death of CD4 lymphocytes and the development of secondary (opportunistic) diseases, infectious and/or oncological, against the background of immunodeficiency. Symptoms at this stage are reversible, that is, they can go away on their own or as a result of treatment. Depending on the severity of secondary diseases, the following stages are distinguished.
4 "A" - it is characterized by bacterial, fungal and viral lesions of the mucous membranes and skin, inflammatory diseases of the upper respiratory tract.
4 "B" - more severe and long-lasting skin lesions, Kaposi's sarcoma, weight loss, damage to the peripheral nervous system and internal organs.
4 "B" - severe, life-threatening opportunistic diseases.
Terminal stage (stage 5): Damage to organs and systems is irreversible. Even adequately administered antiviral therapy and treatment of opportunistic diseases are not effective, and the patient dies within a few months.
Read it though
After the human immunodeficiency virus enters the body, the disease goes through several successive stages. There are 4 independent stages of HIV infection, each of which has its own distinctive characteristics.
The reaction of each organism to the penetration of the virus is individual. The stage of secondary diseases, which occurs as the fourth stage, can occur either several years after the primary manifestations or a couple of months after the onset of clinical symptoms. This depends on the internal reserves of the human body, which determine the duration of the latent (or asymptomatic) phase - the third stage.
The main laboratory sign of phase 4 of the progression of HIV infection, that is, the rapid transition to persistent immunodeficiency, is a significant decrease in the level of CD4 cells in the blood of an infected person.
Clinically, stage 4 is characterized by:
According to the classification of V.I. Pokrovsky, there are 3 phases of the fourth stage of HIV, which precedes the onset of AIDS (acquired immunodeficiency syndrome) - a, b and c. This division is based on differences in the clinical manifestations of the disease, as well as on different levels of CD4 cells. Let's consider the characteristics of each phase.
At this stage, the CD4 cell level does not fall below 500 cells/mm3. Phase 4a occurs approximately 8-10 years from the moment of infection. The disease in this phase is still easily amenable to medical correction with antiviral drugs.
HIV infection in stage 4a is characterized by various concomitant infections:
In this case, damage occurs to the skin, organs of the genitourinary system and respiratory tract.
The fourth phase A is sometimes characterized by the occurrence of a period of remission - the absence of a transition to immune deficiency. This process can occur spontaneously and slow down the progression of the disease for many years.
As this phase of the disease progresses, the CD4 cell count begins to decline, but does not cross the threshold of 200 cells per mm3. The onset of period 4b occurs approximately 9-12 years after the immunodeficiency virus enters the human body.
If a patient is diagnosed with phase 4b of HIV, this means that the disease is progressing and the body’s adaptive abilities are decreasing. At this stage, the patient’s working capacity is usually greatly reduced, and he is forced to switch to light work and receive disability.
This period is characterized by a decrease in the concentration of CD4 in human blood below 200 cells per mm3. Phase 4c develops 15 years after infection. Often people don’t even live to see it. This is not due to the spread of the virus in the body itself, but to the intensive development of generalized viral, fungal, bacterial or protozoal infections.
The onset of this phase of the disease indicates that the immunodeficiency virus has adapted to the effects of the drugs used for treatment. Therefore, in order to slow down the transition from stage 4 HIV infection to AIDS, it is necessary to change medications.
The stage of occurrence of secondary opportunistic diseases requires constant monitoring of the patient at the Center for Prevention and Control of AIDS. In this institution, the following assistance measures are provided to HIV-infected people:
Unfortunately, at the moment, it is possible to destroy the virus in the human body. However, there are means that can alleviate the patient’s condition and improve his quality of life. For this purpose, antiretroviral drugs are used in various individually selected combinations.
At stage 4c on an ongoing basis. The following groups of drugs can be used:
Of particular note is the possibility of pregnancy in women with stage 4 HIV. It has been proven that conceiving a child does not aggravate or accelerate the development of the disease and its transition to the terminal stage. However, at this stage of disease development, the risk of transmission of infection to a child in utero is almost 100%. At stage 4, a woman requires mandatory treatment with antiviral drugs that negatively affect the fetus. Therefore, if possible, it is better not to plan a pregnancy at the fourth stage of HIV infection.
Stage 4 HIV can occur quickly or only after several decades. It is impossible to say for sure how long they live with her. For each person, the process of suppression of the immune system occurs individually and has a different duration.
May depend on the following factors:
On average, it takes about 15 years from the initial signs of HIV infection to the development of AIDS in a patient. However, for some people this process occurs over several months.
The main cause of death in patients at the fourth stage is. Also, the causes of death are often cancer and severe infectious diseases; cirrhosis of the liver; pulmonary pathologies.
With timely antiretroviral therapy, an infected person has a chance to prolong his life. To do this, you must follow all the doctor’s recommendations and monitor the level of viral load in blood tests.
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Clinical manifestations of the disease and the mechanisms of their development differ significantly in its different periods, therefore, for the correct approach to assessing clinical manifestations, the results of immunological and virological studies, and determining therapeutic tactics, a rational clinical-pathogenetic classification is important.
In Russia, the classification developed in 2001 by V.I. is used. Pokrovsky and taking into account the therapy being carried out. According to this classification there are 5 stages of HIV infection.
1. Incubation stage
2. Stage of primary manifestations
Flow options:
3. Latent stage
4. Stage of secondary diseases
4A. Body weight loss less than 10%; fungal, viral, bacterial lesions of the skin and mucous membranes; shingles; repeated pharyngitis, sinusitis
4B. Loss of body weight more than 10%; unexplained diarrhea or fever for more than 1 month; hairy leukoplakia; pulmonary tuberculosis; repeated or persistent viral, bacterial, fungal, protozoal lesions of internal organs; recurrent or disseminated herpes zoster; localized Kaposi's sarcoma
5. Terminal stage.
The duration of the incubation period is determined from the moment of infection until the appearance of the first symptoms of the disease and ranges from 2-3 weeks to 2-3 months or seroconversion, which occurs from 2 weeks to 3 months after infection. In most cases, the disease begins acutely and is characterized by polymorphism of clinical manifestations.
Almost all patients experience fever. A common symptom is polyadenopathy. Most often, the axillary, occipital and cervical lymph nodes are enlarged. Often there is a cough and sore throat caused by pharyngitis. Most patients have a rash (erythematous, maculopapular, roseolous, urticarial) on the face, trunk and limbs. Ulcerations of the mucous membranes of the mouth, esophagus, and genitals are common. Less commonly observed are myalgia and arthralgia, diarrhea, and hepatolienal syndrome.
Possible damage to the nervous system (meningoencephalitis, meningitis, polyradiculoneuritis, etc.). 10-15% of patients also have manifestations of opportunistic infections (candidiasis of the mucous membranes of the mouth, esophagus, Pneumocystis pneumonia, herpetic infection). In some patients, the stage of primary manifestations is asymptomatic.
When examining blood in the first days of the disease, lymphopenia is possible with a decrease in the amount of CD4 and, to a lesser extent, CD8. Subsequently, it gives way to lymphocytosis, mainly due to an increase in CD8 levels. Atypical wide-plasma mononuclear cells are often found in the blood, which allows, along with such clinical symptoms as fever, polyadrenopathy, enlarged spleen and liver, to designate these manifestations of the disease as mononucleosis-like syndrome.
The duration of the acute febrile phase ranges from 5 days to 1.5 months, most often within 2-4 weeks. The acute phase in some cases, especially in young children, can be fatal, but in the vast majority of patients, as a result of stimulation of all the body’s defense systems, a huge number of continuously produced viruses are destroyed and the disease enters the latent stage (3), which lasts from several months up to 20 years (on average 6-7 years). This phase may be absent and after the clinical manifestations of acute infection have subsided, polyadenopathy is detected; in other cases, polyadenopathy develops several months or years after the acute febrile phase and for a long time serves as the only clinical manifestation of HIV infection.
It is conventionally believed that generalized lymphadenopathy can be diagnosed when an enlargement of at least two lymph nodes to a size of more than 1 cm is detected in two groups of lymph nodes or more (except for the anterior cervical and inguinal) for 3 months or more.
The lymph nodes have a soft-elastic consistency, are painless, are not fused to each other or to the surrounding tissues, their sizes range from 1 to 5 cm. The posterior cervical, supraclavicular, axillary, and ulnar lymph nodes are most often affected, but other groups may also be involved in the pathological process. During dynamic observation, the appearance of new enlarged nodes is noted, at the same time, the size of the previously enlarged lymph nodes decreases or they cease to be palpable. In this phase of the disease, which is detected in 2/3 of patients, a slow steady decrease in the number of CD4 lymphocytes and an increase in the “viral load” are observed, i.e. the number of viral particles in 1 μl of blood. The critical level is considered to be a decrease in the number of CD4 cells to 0.5.10⁹/l.
Following this, the disease passes into the 4th stage (stage of secondary diseases), caused by the development of opportunistic infections and neoplasms. Typically, patients have several opportunistic infections. Their spectrum and clinical manifestations vary significantly depending on the severity of immunodeficiency and the circulation of the corresponding pathogens in a given region. Thus, protozoal infections and helminthiasis are common among African residents, Pneumocystis pneumonia is common in North America and Western Europe, and cytomegalovirus infection, tuberculosis, candidiasis, and toxoplasmosis are common in the Russian Federation.
When the level of CD4 lymphocytes is in the range of 0.2-0.5 10⁹/l, bacterial skin lesions, pneumonia, herpes zoster, candidiasis of the oral mucosa, pulmonary tuberculosis, Kaposi's sarcoma, B-cell lymphomas, etc. appear. lymphocytes up to 0.2-0.5 10⁹ /l, Pneumocystis pneumonia, generalized herpes simplex, toxoplasmosis, cryptococcosis, miliary and extrapulmonary tuberculosis, multifocal leukoencephalopathy, esophageal candidiasis develop. At the same time, exhaustion, dementia, and damage to the peripheral nervous system increase. When the number of CD4 cells decreases below 0.05 10⁹ /l, a generalized cytomegalovirus infection and atypical mycobacteriosis occur.
Skin lesions are most often caused by staphylococcus (folliculitis, boils, carbuncles), and recurrent herpes simplex with a tendency to a long course and the appearance of deep ulcerative lesions is also characteristic. The same applies to lesions caused by the chickenpox virus - shingles, which leaves behind permanent scars. Candida lesions in the form of annular cheilitis, cracks and maceration of the corners of the mouth are characteristic. Bright red spots of skin infiltration appear in the inguinal folds, armpits, and under the mammary glands.
The most commonly observed non-infectious skin lesions are seborrheic dermatitis and xeroderma. A typical secondary lesion is Kaposi's sarcoma, especially in men. It is characterized by the appearance on the skin of multiple nodules of various shades (crimson, purple, slate gray), which gradually enlarge and reach a diameter of 5 cm or more. The nodules are clearly demarcated from the surrounding skin, which is often pigmented. In later stages, tumor nodes form, which often ulcerate. The mucous membranes and internal organs are also affected. Elements of Kaposi's sarcoma can appear on the extremities (lower leg, foot), face (tip of the nose, parotid region), and trunk.
Damage to the respiratory system is manifested by cough (often with sputum), hemoptysis, shortness of breath, and fever. They can have different etiologies (tuberculosis, atypical mycobacteriosis, legionellosis, coccal flora, cytomegaloviruses, pneumocystis, toxoplasma, cryptococci, candida, aspergillus). Possible lymphomas of the lungs.
Damage to the gastrointestinal tract throughout the course of the disease is one of the typical manifestations of the disease. A picture of erosive or ulcerative stomatitis, gingivitis, and hairy leukoplakia of the tongue is often observed, in which vertically located whitish folds appear on the lateral surface of the tongue. In this case, patients do not show any complaints. Candida lesions in the form of whitish cheesy deposits on the tongue, tonsils and other parts of the oral mucosa are not uncommon.
Diarrheal syndrome in the later stages of HIV infection is characterized by duration, frequent recurrence, and in some cases can lead to dehydration. Diarrhea is based on polyetiological damage to the entire digestive tract (bacterial, fungal, viral, protozoal, helminthic). Endoscopic examination reveals catarrhal, erosive and ulcerative lesions.
Myocardial lesions, manifested by tachycardia, dullness of heart sounds, are often nonspecific, but they may be associated with an opportunistic viral infection (cytomegalovirus infection). ECG and ultrasound of the heart reveal changes of a different nature, which progress as the disease develops and are found in all patients in the terminal stage. One of the secondary lesions is bacterial endocarditis.
Possible kidney damage in the form of progressive nephropathy, up to the development of renal failure.
Damage to all parts of the nervous system is one of the typical manifestations of HIV infection. The development of the AIDS-dementia complex is directly related to the effect of HIV. Already in the early stages of HIV infection, there is a decrease in memory, attention, and loss of practical skills. Then orientation in space and time is disturbed, the decline in intelligence progresses up to complete dementia, apathy, muscle tremors, and paresis appear. CNS lesions can be caused by Toxoplasma. In this case, a picture of focal encephalitis develops. Lesions caused by cytomegalovirus have polymorphic symptoms, including mental disorders, dementia, convulsions, focal symptoms, disorders of consciousness up to the development of coma.
Meningoencephalitis caused by other members of the herpetic virus family, as well as fungal and bacterial infections, are possible. Violations of socio-psychological adaptation, antisocial behavior of patients, and suicidal excesses play an important role in the clinical picture of the disease.
The blood picture in HIV infection is characterized by progressive anemia, thrombocytomy, lymphopenia and an increase in ESR.
Yushchuk N.D., Vengerov Yu.Ya.
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