AIDS 中英雙語課件

AcquiredImmunodeficiencySyndrome

(AIDS)ZXueDepartmentofLeWFMedicalUniversityIntroductionIntroductionAIDSwasCausedby

HIV(humanimmunodeficiencyvirus).AIDSwasfirstreportedintheUnitedStatesin1981andhassincebecomeamajorworldwideepidemic.概述艾滋病1981年在美國被首次報道，現(xiàn)已成為一種重要的世界性流行病.

Since1981morethan900,000casesofAIDShavebeenreportedintheUnitedStates.Asmanyas950,000AmericansmaybeinfectedwithHIV,one-quarterofwhomareunawareoftheirinfection.TheepidemicisgrowingmostrapidlyamongminoritypopulationsandisaleadingkillerofAfrican-Americanmalesages25to44.In2003,two-thirdsofU.S.AIDScasesinbothwomenandchildrenwereamongAfrican-Americans.Introduction

自1981以來，美國有超過900000例艾滋病病例報告。多達950000的美國人可能感染艾滋病，1/4的人不知道自己感染了。在少數(shù)民族人群中，這一流行病正在迅速增長，這是非洲裔美國男性25歲至44歲的主要殺手。在2003，三分之二的美國艾滋病病例中，婦女和兒童都是非裔美國人中的。Introduction

PeoplediagnosedwithAIDSmaygetlife-threateningdiseasescalledopportunisticinfections,whicharecausedbymicrobessuchasvirusesorbacteriathatusuallydonotmakehealthypeoplesick.Introduction

被診斷患有艾滋病的人可能會患上危及生命的疾病——機會性感染，這是由通常不使健康的人生病的病毒或細菌等微生物引起。Introduction

AIDStransmitthroughthefollowingthreeways:sexualtransmission,bloodtransmission

andmother-to-childtransmission.

Thelymphocyte(CD4+Tlymphocyte)isthetargetandattackedcellofHIV.Thefunctionofcell-mediatedimmunityisdestroyedandavarietyofneoplasms,opportunityinfections,andothermanifestationsthreatenedlivesareusuallyconcomitant

inHIVinfection.Introduction

艾滋病病毒通過與感染者的性接觸和血液接觸傳播。淋巴細胞（CD4+T淋巴細胞）是HIV的攻擊目標。伴隨著艾滋病病毒感染的是細胞介導(dǎo)的免疫功能受到破壞及各種腫瘤、機會感染和其他威脅生命的表現(xiàn)。Introduction

TheAIDSpandemic

hasalteredtheworld’smedicalsystem,people’sbehavior,andprecipitatedanationalandinternationalcrisis.AIDShasreducedthehistoricalapathybetweenrichandpoornations.ThedevelopedanddevelopingworldsareequallyconcernedaboutthespreadofAIDS.

Introduction

艾滋病的流行已經(jīng)改變了世界的醫(yī)療體系，人們的行為，并導(dǎo)致了一個國家和國際的危機。艾滋病減少了富人和窮人之間的歷史冷漠。發(fā)達國家和發(fā)展中國家同樣關(guān)注艾滋病的傳播。IntroductioncachexiaIntroduction

Etiology

病原學(xué)

HIVisamemberoftheRetroviridae,Lentivirus,withadiameterof90-140nanometerandagenome

of2single-stranded,positivelysensedRNAsof9749nmsurroundedbyaproteinenvelopeconsistedofhostmembraneandviralglycoprotein,gp120andgp41,gp120isanextracellular

proteinandgp41isatransmembrane

protein.

Etiology

HIV是反轉(zhuǎn)錄病毒科慢病毒屬的一員，是直徑90-140納米的球形顆粒，由兩條長約9749納米的正鏈單鏈RNA和包圍在外的蛋白質(zhì)外殼組成，蛋白質(zhì)外殼包括宿主細胞膜和病毒糖蛋白—gp120和gp41,gp120的是一種外膜糖蛋白，gp41是一種跨膜糖蛋白。Etiology

Thereare2typesofHIV,HIV-1andHIV-2.HIV-1isresponsiblefortheglobalprevalenceofAIDSandexhibitsastrongtropism

forCD4+Tcells.HIV-2hasbeenfoundtobeendemicinwesternAfricaandisreportedtobelesspathogenic.

Etiology

有2種類型的HIV，HIV-1和HIV-2。HIV-1是艾滋病全球流行的主要毒株，表現(xiàn)出強的嗜CD4+T細胞性。HIV-2局限于西非地區(qū)，致病性較低。EtiologyHIVprimarilyinfectsCD4+

Tlymphocytes,macrophage,Bcells,smallneurogliacells

andhemapoieticstemcell

andmayinfectothercellsthatdonotexpressCD4.

Etiology

HIV主要感染CD4+的T淋巴細胞、巨噬細胞、B細胞、小神經(jīng)膠質(zhì)細胞和造血干細胞，也可能感染其它不表達CD4的細胞。Etiology

Thevirusissensitivetoheat,25%alcohol，etc.

butinsensitivetoultravioletradiation

andγradiation.Etiology

HIV病毒對熱,25%酒精和0.2%次氯酸鈉敏感，但是對0.1%的甲醛和紫外線和γ射線不敏感。EtiologyEpidemiology流行病學(xué)

SourceofInfection

HIVinfectedpeopleandAIDSpatientsistheonlysourceofinfection.

Epidemiology

傳染源

艾滋病病毒感染者和艾滋病病人是唯一的傳染源。EpidemiologyRoutesofTransmission

HIVisspreadmostcommonlybyhavingunprotectedsexwithaninfectedpartner.Theviruscanenterthebodythroughtheliningofthevagina,vulva,penis,rectum,ormouthduringsex.

Epidemiology

艾滋病病毒最常見的傳播途徑是與受感染者間無防護的性行為。該病毒可以通過陰道，外陰，陰莖，直腸或口腔粘膜在性交時進入人體。Epidemiology傳播途徑

HIVhasbeenfoundinsaliva,tears,nervoussystemtissue,blood,semen(includingpre-seminalfluid),vaginal

fluid,andbreastmilkofpatientsandcarriers.However,onlyblood,semen,vaginalsecretions,andbreastmilkhavebeenproventotransmitinfectiontoothers.

EpidemiologyRoutesofTransmission傳播途徑

艾滋病毒存在于唾液，淚液，神經(jīng)系統(tǒng)組織，血液，精液（包括預(yù)精液），陰道液，以及患者和攜帶者母乳中。

然而，只有血液，精液，陰道分泌物，和母乳被證實有感染性。EpidemiologyRiskyBehavior

HIVcanbeinfectedtoanyonewhopracticesriskybehaviors，suchas:

Sharingdrugneedlesorsyringes.Havingsexualcontact,includingoral,withaninfectedpersonwithoutusingacondom.HavingsexualcontactwithsomeonewhoseHIVstatusisunknown.Epidemiology風(fēng)險行為

艾滋病病毒可以感染參與風(fēng)險活動的任何人，如：

共享藥物針頭或注射器。

性接觸，包括口交，與感染者沒有使用安全套。

與艾滋病病毒感染狀況不明者的性接觸。Epidemiology

HIValsocanbespreadthroughcontactwithinfectedblood.BeforedonatedbloodwasscreenedforevidenceofHIVinfectionandbeforeheat-treatingtechniquesusedtodestroyHIVinbloodproductswereintroduced,HIVwastransmittedmainlythroughtransfusionsofcontaminatedbloodorbloodcomponents.Today,becauseofbloodscreeningandheattreatment,theriskofgettingHIVfromsuchtransfusionsisextremelysmall.

EpidemiologyRoutesofTransmission

艾滋病病毒也可通過接觸受感染的血液接觸傳播。由于獻血前HIV感染的篩查及破壞艾滋病病毒熱處理技術(shù)的引進，現(xiàn)在艾滋病毒主要傳播途徑是通過被污染的血液或血液成分輸血。因為現(xiàn)在血液篩查和熱處理，輸血感染艾滋病病毒的風(fēng)險是非常小的。Epidemiology傳播途徑

MothertoChildWomencantransmitHIVtotheirbabiesduringpregnancyorbirth.Approximatelyone-quartertoone-thirdofalluntreatedpregnantwomeninfectedwithHIVwillpasstheinfectiontotheirbabies.HIValsocanbespreadtobabiesthroughthebreastmilkofmothersinfectedwiththevirus.

EpidemiologyRoutesofTransmission

女性可以在懷孕或分娩時將艾滋病病毒傳給嬰兒。大約有四分之一到三分之一的未經(jīng)治療的艾滋病孕婦會將疾病傳染給嬰兒。艾滋病毒也可以通過病毒感染母親的母乳傳到嬰兒。Epidemiology傳播途徑

Ifthemothertakescertaindrugsduringpregnancy,herbaby’schanceofgettinginfectedwithHIVwillbesignificantlyreduced.IfhealthcarecentersprovidetreatmenttotheHIV-infectedpregnantwomenanddelivertheirbabiesbycesareansection,thechanceofthebabybeinginfectedcanbereducedto1%.HIVinfectionofnewbornshavebeenalmosteradicatedintheUnitedStatesduetoappropriatetreatment.

Epidemiology

如果母親在懷孕期間接受某些藥物治療，她的孩子的感染機會就會顯著減少。如果醫(yī)療中心給予艾滋病毒孕婦一定的治療并施行剖宮產(chǎn)，嬰兒被感染的幾率可以降低到1％。因為恰當?shù)闹委?，美國差不多已?jīng)根除新生兒感染HIV這一現(xiàn)象。Epidemiology

AlthoughresearchershavefoundHIVcanexisitinthesalivaofinfectedpeople,thereisnoevidencethattheviruscanbespreadbycontactwithsaliva.LaboratorystudiesrevealthatsalivahasnaturalpropertiestolimittheinfectivityofHIV,andthevirusamountinsalivaappearstobeverylow.ResearchonpeopleinfectedwithHIVhasfoundnoevidencethattheviruscanbespreadtoothersthroughsalivabykissing.EpidemiologyRoutesofTransmission盡管研究人員已經(jīng)發(fā)現(xiàn)感染者唾液中存在HIV，但沒有證據(jù)表明，病毒可通過與唾液接觸傳播。實驗室的研究表明，唾液具有天然的屬性來限制艾滋病毒的感染性，并且病毒量在唾液似乎是非常低的。研究HIV感染者發(fā)現(xiàn)，沒有證據(jù)表明該病毒可以通過接吻傳播給他人。Epidemiology傳播途徑ContaminatedNeedlesHIVisfrequentlyspreadamonginjectiondrugusersbysharingneedlesorsyringescontaminatedwithverysmallquantitiesofbloodfromsomeoneinfectedwiththevirus.Itisrare,however,forapatienttogiveHIVtoahealthcareworkerorvice-versabyaccidentalstickswithcontaminatedneedlesorothermedicalinstruments.

EpidemiologyRoutesofTransmission

共用沾有微量病毒感染者血液的針頭或注射器便可以造成HIV在靜脈吸毒者間的傳播。

健康的衛(wèi)生工作者通過被患者污染的針頭或其他醫(yī)療器械刺傷而感染HIV病毒是罕見的，反之亦然。Epidemiology傳播途徑Theliningofthemouth,however,canbeinfectedbyHIV,andtheinstancesofHIVtransmissionthroughoralintercoursehavebeenreported.Scientistshaven’tfoundanyevidencethatHIVcanbespreadthroughsweat,tears,urine,orfeces.EpidemiologyRoutesofTransmission但是，HIV可以通過在口腔粘膜傳播，既往曾有通過口腔性交傳播HIV的報道。

沒有證據(jù)表明艾滋病病毒可以通過汗液，淚液，尿液或糞便傳播。Epidemiology傳播途徑CasualContactStudiesaboutfamiliesofHIV-infectedpeoplehaveshownclearlythatHIVcannotspreadthroughcasualcontactsuchassharingfoodutensils,towelsandbedding,swimmingpools,telephones,ortoiletseats.HIVcannotspreadbyinsectsbitingsuchasmosquitoesorbedbugs.

EpidemiologyRoutesofTransmission

艾滋病病毒不會通過日常接觸傳播，如共用餐具食物，毛巾和床上用品，游泳池，電話，或馬桶座。

艾滋病毒不能通過昆蟲叮咬傳播，如蚊子、臭蟲。Epidemiology傳播途徑HighRiskPopulations

Thoseathighestriskincludehomosexual

orbisexual

menengaginginunprotectedsex,intravenous

druguserswhoshareneedles,thesexualpartnersofthosewhoparticipateinhigh-riskactivities,infantsbornbymotherswithHIV,andpersonswhoreceivedbloodtransfusionsorclottingproducts

between1977and1985(priortostandardscreeningforthevirusintheblood).Epidemiology易感人群

高風(fēng)險包括同性或雙性戀男子從事無保護的性行為，共用針頭，有高風(fēng)險活動的性伴侶，艾滋病病毒母親誕生的嬰兒，1977年和1985年之間接受輸血或凝血制品的人。EpidemiologyEpidemiologyEpidemiologyPathogenesis

andpathology發(fā)病機制和病理GeneralProcess

HIV-1entersitstargetcellsbyinteractionofthevirion

glycoproteins,gp120andgp41,withtheCD4molecule.Oncethevirusentersthecell,uncoatingoccurs.AreversetranscriptaseenzymetranscribesviralRNAintodouble-strandedDNA,whichisinsertedintothehostcellchromosome.Withactivationofthecellbyantigenic

orviralstimulation,DNAtranscription

occursandnewviralparticlesareassembled

atthecellsurfaceafter2-10yearstoinfectothercells.

PathogenesisandPathology

HIV-1通過有CD4分子的病毒體糖蛋白gp120和gp41的相互作用進入其靶細胞。

一旦病毒進入細胞，即發(fā)生脫殼。病毒RNA在逆轉(zhuǎn)錄酶作用下轉(zhuǎn)錄為雙鏈DNA，后者被插入到宿主細胞染色體中。

HIV病毒感染其他細胞2-10年后，抗原或病毒刺激使被感染的細胞激活，脫氧核糖核酸開始轉(zhuǎn)錄，并且新病毒顆粒在細胞表面進行組裝。PathogenesisandPathologydynamicimitationPathogenesisandPathologyPathogenesisandPathologyHuman’sT-lymphocyteandVirusAttackingT-lymphocyteHIVinLymphTissueHIVinfectthehumannormalcellHuman’sT-lymphocyteMechanismsofdepletionofCD4+Ｔlymphocytes

PotentialmechanismsforCD4+celldestructionmayincludedirectlysisbecauseofvirusreproduction,killingofstemcells

ofbonemarrow,syncytium

formationbetweenuninfectedandinfectedcells,apoptosis,andfreegp120mediatedantibodydependentcytotoxicity.

PathogenesisandPathology

CD4+T淋巴細胞的損耗機制

對CD4+細胞破壞的潛在機制包括病毒復(fù)制造成的細胞直接裂解、骨髓干細胞的破壞、未感染和感染的細胞之間的合胞體形成、凋亡細胞和游離的gp120介導(dǎo)的抗體依賴性細胞毒性作用。

PathogenesisandPathology

Functionalabnormalityofmono-phagocytes

HIVcanreplicateinprogenitorcells

ofmono-phagocytesofbonemarrowinhighlevels.Functionofmono-phagocytesisabnormal.Virusdisseminates

throughthebloodstream

andlymphatics

tothegerminalcenter

oflymphnodes.Theinfectedmono-phagocytesserveasalargereservoir

ofHIVandplayavitalroleofvirusspreadtonervoussystem.

PathogenesisandPathology

單核-吞噬細胞功能異常

HIV能在單核-吞噬祖細胞中高水平復(fù)制。單核吞噬細胞出現(xiàn)功能異常。病毒通過血液和淋巴管到淋巴結(jié)的生發(fā)中心。受感染的單核吞噬細胞作為艾滋病毒的一個儲存庫，是感染神經(jīng)系統(tǒng)的一個主要因素。

PathogenesisandPathology

AbnormalitiesofBlymphocytes

1.Bcellsaremulticlonal

activated,2.IgGandIgAincrease,3.Circulatingimmunecomplexexist,4.ThenumbersofperipheralbloodBlymphocytesincrease,

5.Theresponsetothestimulationofnewantigensdecrease.

PathogenesisandPathology

B淋巴細胞異常

1.B細胞多克隆激活，

2.IgG和IgA的增加，

3.循環(huán)免疫復(fù)合物存在，

4.外周血B細胞及淋巴細胞的增加，

5.新的抗原刺激反應(yīng)

的降低。PathogenesisandPathologyAbnormalitiesofNKcells

NKcellcountisalmostnormalbutfunctionallydeficient.Itmayrelatetothedeficiencyofcytokine

production,suchasIL-2.

PathogenesisandPathologyNK細胞異常

NK細胞數(shù)量幾乎是正常的，但在功能上有缺陷。

它可能涉及細胞因子產(chǎn)生的缺乏，如IL-2的缺乏。PathogenesisandPathologyImmuneresponsepostHIVinfection

HIVInfectioncausesmanyimmuneresponse,includingproductionofneutralizingantibodies,antibodydependentcomplement-mediatedcytotoxicity,Tlymphocyte-mediatedcytotoxicity,NKcell-mediatedcytotoxicity,etc.AlthoughHIVenvelope-bindingantibodiescanbedetectedinseraofinfectedindividualsafter2to3weeksfollowinginfection,mostoftheseantibodieslacktheabilitytoeliminatethevirus.ThereplicationofHIVisinhibitedbytheinfectedindividuals’immuneresponseduringtheseveralyearsofpostinfectionandactivatedbyseveralfactorsthatareunclear,suchasTNF-a,TNF-BandIL-6(interleukin-6),especiallyTNF-a.PathogenesisandPathology

HIV感染導(dǎo)致許多免疫反應(yīng)，包括生產(chǎn)中和抗體，抗體依賴性補體介導(dǎo)的細胞毒性，T細胞介導(dǎo)的細胞毒作用，NK細胞介導(dǎo)的細胞毒作用等等。盡管HIV包膜結(jié)合抗體可以在感染的個體的血清中在被感染后的2到3周被檢測，但這些抗體并不能消除病毒。在感染后的數(shù)年內(nèi)，受感染個體的免疫應(yīng)答能抑制HIV的復(fù)制，幾個不明確細胞因子對病毒的復(fù)制有激活作用，如TNF-α，TNF-β和IL-6（白細胞介素-6），尤其是腫瘤壞死因子。PathogenesisandPathologyClinicalManifestations臨床表現(xiàn)Clinicalstages

Classifiedinto4stagesbyUnitedCentersforDiseaseControl(CDC).

ClinicalManifestation臨床階段

CDC(美國疾病控制中心)將臨床階段分為4期.

ClinicalManifestation1.AcuteHIVInfection(PhaseI)

Flu-likesymptomsarepresentinsome

patients.Fever,lethargy,headaches,lymphadenopathy,sorethroat,andmacularrash

arethemostcommonsignsandsymptoms.Thesesymptomsusuallylastfor3-14days.Duringthisperiod,patientshavehighinfectivity,andHIVispresentinlargequantitiesingenitalfluids.

ClinicalManifestation急性期

部分患者出現(xiàn)類似流感的癥狀，如發(fā)燒，嗜睡，頭痛，淋巴結(jié)腫大，咽喉痛和斑疹。這些癥狀通常持續(xù)3-14天。在此期間，患者有較高的傳染性，艾滋病大量存在于生殖器的體液內(nèi)。ClinicalManifestationAcuteHIVInfection(PhaseI)

Laboratoryabnormalitiesincludelymphopenia,thrombocytopenia,andelevatedhepaticenzymes.HIVandp24antigencanbedetected.CD4+/CD8+reversesfollowingtheincreaseofCD8+TlymphocytescountandthenormalcountofCD4+cells.

ClinicalManifestation急性期

實驗室檢查異常包括淋巴細胞減少，血小板減少和轉(zhuǎn)氨酶升高。HIV和p24抗原可以被檢測。CD4+/CD8+比值降低，CD8+T淋巴細胞的增加計數(shù)和CD4+細胞的正常計數(shù)。ClinicalManifestationtherashAcuteHIVinfection((phaseI)Folliculitis(phaseI)Pruriticdermatitis(phaseI)Genitalherpes（GH）(phaseI)ClinicalManifestation2.Asymptomatic

HIVInfection(PhaseII)

ThisstageoriginatesfromprimaryHIVinfectionimmediatelyorfollowingthedisappearanceofthesignsofphaseI,havingcommunicabilityandlastingfor2-10yearsorevenmore.

Therearenotanyclinicalsymptoms.HIV,p24andantibodiestoglycoproteinsaredetectable.ClinicalManifestation2.無癥狀感染期

這個階段從HIV感染初期立即出現(xiàn)或I期癥狀消失后出現(xiàn)，有傳染性，持續(xù)2-10年甚至更長。沒有任何臨床癥狀。

可檢測到HIV，p24和抗體糖蛋白。ClinicalManifestation

ThemostobviouseffectofHIVinfectionisthedeclineofthenumberofCD4+Tcellsfoundintheblood.雖然沒有癥狀Duringthisperiod,thevirusismultiplying,infecting,andkillingthecellsoftheimmunesystemactively.Asymptomatic

HIVInfection(PhaseII)ClinicalManifestation

艾滋病毒感染的最明顯變化是在血液中的CD4+T細胞數(shù)量的減少。在此期間，雖無癥狀，病毒仍繁殖，感染并殺傷免疫細胞。2.無癥狀感染期ClinicalManifestationLymphnodeenlargement

iscommon.Generalizedlymphadenopathy

involvesmorethan2areasoflymphnodesenlargementexcludingtheinguinalarea.Thisphaseusuallylastsmorethan3months.3.Persistent

GeneralizedLymphodenopathy

(PGL,PhaseIII)ClinicalManifestation淋巴結(jié)腫大是常見的。全身淋巴結(jié)腫大是指2個以上的區(qū)域淋巴結(jié)腫大，不包括腹股溝區(qū)域。這個階段一般持續(xù)3個月以上。

持續(xù)性全身淋巴結(jié)腫大ClinicalManifestationNecklymphadenopathy(phaseIII)ClinicalManifestationClinicalManifestation4.AIDS(PhaseIV)

Thereare5groupsofmanifestations1）Constitutionaldisease

includes:fever,fatigue,rash,pharyngitis,diarrhea,weightloss,nightsweats,lymphadenopathy,hepatosplenomegaly,andetc.2)Nervoussystemsymptomsincludes:progressivedementia,hemiparesis,blindness,headaches,andepilepsyseizure.93ClinicalManifestationAIDS期

5組表現(xiàn)

1）常見癥狀包括：發(fā)熱，乏力，皮疹，咽炎，腹瀉，消瘦，盜汗，全身淋巴結(jié)腫大，肝脾腫大，等。

2）神經(jīng)系統(tǒng)癥狀包括：進行性癡呆，偏癱，失明，頭痛和癲癇發(fā)作。94AIDS(PhaseIV)AIDS(PhaseIV)

3)Opportunisticinfectionsincludes:awidevarietyofbacteria,viruses,fungiandotherpathogensuchaspneumocystic

carinii,penicilliummarneffei,tuberclebacillus,cytomegalovirus

(CMV),EBvirus(EBV),candidaalbicans.ClinicalManifestation3）機會性感染包括：各種各樣的細菌，病毒，真菌等病原體如pneumocystic囊蟲，馬爾尼菲青霉菌，結(jié)核桿菌，巨細胞病毒（CMV），EB病毒（EBV），白色念珠菌。ClinicalManifestationOpportunisticinfection:infectedbyCandidaalbicans.Leukoplakia（phaseIV）Opportunisticinfection:infectedbycytomegalovirus

(CMV)Iridocyclitis（phaseIV）Opportunisticinfection:infectedbyfungi.Ringwormofnailsandkeratitis（phaseIV）Opportunisticinfection:infectedbybacteriaandvirusesSuperficialinfection（phaseIV）Opportunisticinfection:infectedbytuberclebacillus（TB）

andHerpeszostervirus（HZV）.Crewelsandherpeszoster（phaseIV）ClinicalManifestation4)Neoplasia

include:Kaposi’ssarcoma(KS),non-Hodgkin’slymphoma(NHL),andprimarycentralnervoussystem(CNS)lymphoma,andinvasivesquamouscellcarcinoma

ofthecervix.5)Othersincludediseasesotherthanopportunisticinfectionsandneoplasia.103ClinicalManifestation4）瘤形成包括：卡波濟氏肉瘤（KS），非何杰金氏淋巴瘤（NHL），和原發(fā)性中樞神經(jīng)系統(tǒng)（CNS）淋巴瘤，和子宮頸的侵襲性鱗狀細胞癌。5）其他疾病

其它機會致病感染和腫瘤104ClinicalManifestationKS（tongue)KS（skin)KS（smallintestine)KS（leg)KS（upperlimb)KS（face)ClinicalManifestationWHATISAIDS?ThetermAIDSappliestothemostadvancedstageofHIVinfection.CDChasdevelopedofficialcriteriaforthedefinitionofAIDSandisresponsiblefortrackingthespreadofAIDSintheUnitedStates.109WHATISAIDS?該術(shù)語適用于艾滋病感染艾滋病毒的最后階段。CDC已經(jīng)為艾滋病的定義制定了官方標準，并負責(zé)跟蹤美國艾滋病的傳播情況。110CDC‘sdefinitionforAIDSincludesallHIV-infectedpeoplewhoseCD4+Tcellsisfewerthan200percubicmillimeterofblood.(HealthyadultsusuallyhaveCD4+T-cellcountsof1,000ormore.)Inaddition,thedefinitionincludes26clinicalconditionsthataffectpeoplewithadvancedHIVdisease.Mostoftheseconditionsareopportunisticinfectionsthatgenerallydonotaffecthealthypeople.InpeoplewithAIDS,theseinfectionsareoftensevereandsometimesfatalbecausetheimmunesystemissoravagedbyHIVthatthebodycannotfightoffcertainbacteria,viruses,fungi,parasites,andothermicrobes.ClinicalManifestation疾病預(yù)防控制中心的定義為艾滋病包括所有艾滋病病毒感染者的CD4+T細胞是少于200個每立方毫米。（健康成人通常有1000以上的CD4+T細胞計數(shù)）。此外，這個定義包括影響晚期艾滋病毒疾病的26個臨床條件。大多數(shù)的這些情況是不影響健康的人的機會性感染。而在艾滋病人，因為免疫系統(tǒng)被HIV破壞，身體無法抵御某些細菌，病毒，真菌，寄生蟲等微生物，這些感染往往是嚴重的，有時甚至是致命的。ClinicalManifestationSymptomsofopportunisticinfectionscommoninpeoplewithAIDSinclude:CoughingandshortnessofbreathSeizuresandlackofcoordinationDifficultorpainfulswallowingMentalsymptomssuchasconfusionandforgetfulnessSevereandpersistentdiarrheaFeverVisionlossNausea,abdominalcramps,andvomitingWeightlossandextremefatigueSevereheadachesComaClinicalManifestation在艾滋病常見機會性感染的癥狀包括：

咳嗽和氣短

癲癇發(fā)作和缺乏協(xié)調(diào)

困難或吞咽疼痛

精神癥狀，如混亂和健忘

嚴重和持續(xù)性腹瀉

發(fā)熱

視力減退

惡心，腹部絞痛，嘔吐

減肥和極度疲勞

劇烈頭痛

昏迷ClinicalManifestationRespiratorysystem

Pneumocystiscariniipneumonia(PCP),Kaposi’ssarcoma(KS),TB.Themostcommonsymptomsandsignsaresinusitis,coughandfever,dyspnea,andetc.ClinicalManifestationSystematicManifestations呼吸系統(tǒng)

卡氏肺囊蟲肺炎（PCP），卡波濟氏肉瘤（KS），TB。最常見的癥狀和體征鼻竇炎，咳嗽和發(fā)燒，呼吸困難等ClinicalManifestationSystematicManifestationsDigestivesystem

Fungalandviralinfectionsarecommon.Orallesions,dysphagia

andodynophagia,acuteabdominalpain,diarrheaandweightlossarecommonsigns.ClinicalManifestationSystematicManifestations消化系統(tǒng)

真菌和病毒感染是常見的?？谇粷?，吞咽困難和吞咽疼痛，急性腹痛，腹瀉和體重減輕是常見的體征。ClinicalManifestationSystematicManifestationsNervoussystem

Opportunisticinfections;neoplasia;HIVmeningitis.Skin

KS,fungalandviralinfections.Oralhairyleucoplakia,wart.Eyes

Cytomegalovirus(CMV)infections,KS.ClinicalManifestationSystematicManifestations神經(jīng)系統(tǒng)

機會性感染;腫瘤;艾滋病毒性腦膜炎。

皮膚

KS，真菌和病毒感染?？谇幻珷畎装?，疣。

眼睛

巨細胞病毒（CMV）感染，KSClinicalManifestationSystematicManifestationsLaboratory

Examinations實驗室檢查Routinetests

Bloodtest，UrinetestImmunologicaltest

CD4+Tlymphocytecountdecreases:CD4+/CD8+<1.0;

LaboratoryExaminations

常規(guī)試驗

血液檢查，尿液檢查

免疫學(xué)試驗

CD4+T淋巴細胞計數(shù)下降：正常（0.8-1.2）×109/L;CD4+/CD8+<1.0;

LaboratoryExaminationsSerologicaltest1.HIVantibodydetection:Antibodyforp24andgp120detection.ELISA,Westernblot(WB).

2.HIVantigendetection:ELISAforp24antigen.3.HIVnucleicaciddetection:NorthernblotorRT-PCRforHIVRNAassay,PCRforHIVDNAassay,bDNAforHIVquantification.

LaboratoryExaminations血清學(xué)檢查

1.艾滋病病毒抗體檢測：對p24和gp120的檢測。ELISA，免疫印跡（WB）。

2.HIV抗原檢測：ELISA檢測p24抗原。

3.艾滋病毒核酸檢測：Northern雜交或RT-PCR檢測HIVRNA檢測，PCR檢測HIVDNA，bDNA艾滋病毒定量檢測。LaboratoryExaminationsDiagnosisEpidemiologyfeatureClinicalmanifestationsLabexaminations

BecauseearlyHIVinfectionoftencausesnosymptoms,yourhealthcareproviderusuallydiagnoseitbytestingyourbloodforthepresenceofantibodies(disease-fightingproteins)toHIV.HIVantibodiesgenerallydonotreachnoticeablelevelsinthebloodfor1to3monthsfollowinginfection.Itmaytaketheantibodiesaslongas6monthstobeproducedinquantitieslargeenoughtoshowupinstandardbloodtests.

Diagnosis由于早期的艾滋病病毒感染常無任何癥狀，通常是通過檢測血液中HIV抗體來診斷艾滋病。在感染后的1到3個月，HIV抗體水平不會顯著升高。它可能攜帶抗體長達6個月，到抗體數(shù)量足夠大時，才可檢測到。

DiagnosisHence,todeterminewhetheryouhavebeenrecentlyinfected(acuteinfection),yourhealthcareproviderwillscreenyouforthepresenceofHIVgeneticmaterial.DirectscreeningofHIVisextremelycriticalinordertopreventtransmissionofHIVfromrecentlyinfectedindividuals.

Diagnosis通過對HIV遺傳物質(zhì)的進行篩查的方式可確定是否在最近感染（急性感染）。為了防止艾滋病毒從近期感染者傳播傳播病毒，艾滋病毒直接篩選是至關(guān)重要的。

DiagnosisIfyouhavebeenexposedtothevirus,youshouldgetanHIVtestassoonaspossible.Youarelikelytodevelopantibodiestothevirus-within6weeksto12monthsafterexposuretothevirus.Youshouldbetestedearly,ifinfected,youcandiscusswithyourhealthcareproviderwhenyoushouldstarttreatmenttohelpyourimmunesystemcombatHIVandpreventtheemergenceofcertainopportunisticinfections(seethetreatmentbelow).

Diagnosis如果你已經(jīng)接觸到病毒，需要盡快進行HIV檢測。在接觸病毒后的6周到12個月內(nèi)可產(chǎn)生病毒抗體。應(yīng)該及早檢測，如果被感染，應(yīng)該開始治療，以幫助免疫系統(tǒng)抗擊艾滋病毒，并防止某些機會性感染的出現(xiàn)。

DiagnosisEarlytestalsoalertsyoutoavoidhigh-riskbehaviorsthatcouldspreadthevirustoothers.

Diagnosis早期的檢測提示你避免把病毒傳染給其他人的高危行為。

DiagnosisHealthcareprovidersdiagnoseHIVinfectionbyusingtwodifferenttypesofantibodytests:ELISAandWesternBlot.IfyouarelikelytobeinfectedwithHIVbuthavebeentestednegativeforbothtests,yourhealthcareprovidermayrequestadditionaltests.Youalsomaybetoldtorepeatantibodytestsatalaterdate,thenantibodiestoHIVaremorelikelytohavedeveloped.

DiagnosisELISA和WesternBlot：使用兩種不同類型的抗體檢測可確診感染艾滋病毒。如果有可能被感染艾滋病毒，但測試均為陰性，可要求額外的測試。也可在以后的日子重復(fù)抗體試驗，這樣艾滋病毒抗體更容易被發(fā)現(xiàn)。

DiagnosisBabiesbornbymothersinfectedwithHIVmayormaynotbeinfectedwiththevirus,butallcancarrytheirmothers'antibodiesagainstHIVforseveralmonths.Ifthesebabieslacksymptoms,adoctorcannotmakeadefinitivediagnosisofHIVinfectionusingstandardantibody.HealthcareprovidersareusingnewandmoreaccuratetechnicstodetermineHIVinfectionininfantsbetweenages3monthsand15months.TheyareevaluatingmanybloodteststodeterminewhichoneisbestforthediagnoseofHIVinfectioninbabiesyoungerthan3months.

Diagnosis由感染了艾滋病病毒的母親所生的嬰兒可能會感染病毒，但都可以隨身攜帶來自母親的抗HIV抗體數(shù)月。

如果這些孩子沒有癥狀，醫(yī)生不能使艾滋病病毒感染標準來診斷艾滋病。

新的和更精確的工藝可以確診感染艾滋病毒的3歲個月至15個月的嬰兒。他們正在評估多種血液測試，以確定哪一個是最適用于年齡小于3個月嬰兒的診斷。

DiagnosisTreatment治療AntiretroviraltherapiesSincetheapprovalofthefirstantiretroviralagent,therehasbeencontinualdebateovertheoptimaltimetoinitiateantiretroviraltherapy.AtthistimethereisageneralconsensusthatanypatientwithanAIDSdiagnosisisathighriskforprogressingtomoreadvanceddisease,hospitalization,evendeathforanyfurtherdelayinthera

Treatment

抗逆轉(zhuǎn)錄病毒療法

隨著第一個抗逆轉(zhuǎn)錄病毒藥物的批準，對于啟動抗逆轉(zhuǎn)錄病毒治療的最佳的時間的爭論就從未停止?，F(xiàn)在的普遍共識是從確診艾滋病到發(fā)展為更嚴重的疾病，住院治療，甚至死亡的任何進一步開始治療。

TreatmentAntiretroviraltherapies

Aplasma

HIVRNAlevelofgreaterthan1000to10000copies/mlisthought

tobegiven

therapy,regardlessofCD4+lymphocytecount.TheasymptomaticpatientswithCD4+Tlymphocytecountlowerthan0.5*109/Landsymptomaticpatientsmustreceivetreatment.

Treatment抗逆轉(zhuǎn)錄病毒療法

血漿HIVRNA水平大于1000至10000/毫升時給予治療，不管CD4+淋巴細胞計數(shù)多少。無癥狀患者的CD4+T淋巴細胞計數(shù)低于0.5×109/L和有癥狀的患者必須接受治療。

TreatmentCurrentlyavailableantiretroviraltherapeuticagents

canbedividedinto3categories:

1.Thenucleosideanalogue

reversetranscriptaseinhibitors(NRTIs).2.Non-nucleosidereversetranscriptaseinhibitors(NNRTIs)3.Proteaseinhibitors

(PIs).

Treatment目前可用的抗逆轉(zhuǎn)錄病毒的治療劑，可分為3類：

1.核苷類似物逆轉(zhuǎn)錄酶抑制劑（NRTI類藥物）。

2.非核苷逆轉(zhuǎn)錄酶抑制劑（NNRTIs）

3.蛋白酶抑制劑（PIS）。

TreatmentHighlyactiveantiretroviraltherapy(HAART)isatreatmentregimenthatusesacombinationofreversetranscriptase

inhibitorsandproteaseinhibitorstotreatpatients,suchastwoNRTIswithaPI,ortwoNRTIswithaNNRTI,ortwoPIswithaNRTI,etc.Theprimaryagentsasfollows:

Treatment高效抗逆轉(zhuǎn)錄病毒療法（HAART）是逆轉(zhuǎn)錄酶抑制劑和蛋白酶抑制劑的組合，如兩種NRTI使用PI，或兩種NRTI與NNRTI，或兩個PI與NRTI等

TreatmentNucleosideanaloguereversetranscriptaseinhibitors(NRTIs)Thereare6agentsinthisclass.TheyactonHIVreversetranscriptasethroughcompletitivebinding

toreversetranscriptaseinplace

ofendogenous

nucleosidesandbyinducingthetermination

oftheelongating

viralDNA.