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1、AcquiredImmuneDeficiencysyndrome AIDS THESECONDAFFILIATEDHOSPITAL CQUMSZHOUZHI周智 1 Definition AIDSisafatalchronicinfectiousdiseasecausedbytheHumanImmunodeficiencyVirus HIV transmittedmainlythroughsexualcontactsandbodyfluids characterizedpathologicallybyselectivedepletionofhelperT CD4 lymphocytesandi
2、mpairmentofcell mediatedimmunity andclinicallybysevereopportunisticinfectionsandmalignancies 2 Classification HIV 1andHIV 2 belongtofamilyRetroviridae subfamilyLentivirus andwerediscoveredin1983and1985 respectively Etiology 3 4 5 吸附 脱衣壳 逆转录 环化 前病毒 整合 转录 翻译 核心颗粒装配 出芽 HIV动态感染过程 6 Thereplicationcycleof
3、HIV 7 HIVgenome Ninegenes 3structuregenes 3regulatorygenesand3unknownfunctiongenes l GAG groupantigen geneencodesmaincoreproteinp24 2 pol polymerase geneencodesreversetranscriptase 3 ENVgeneencodessurfaceproteinsgp120andgp41 8 Tropism Highaffinityoftheviralgp120envelopeproteinfortheCD4molecule recep
4、tor whichisnormallyonthesurfaceofhelperTlymphocytes 10 20 ofbloodmonocytesandmacrophages 5 ofBcells neuroglia neuronsofcentralnervoussystem LangerhanscellsinskinandcolorectalepithelialcellsarealsoknowtoexpresssmallamountsofCD4ontheirsurfaces 9 InitialReports June5 1981 5casesofPCPingaymenfromUCLA MM
5、WR July3 1981 26additionalcasesDec10 1981 3NEJMpapersdescribecases GottliebMSNEJM2001 344 1788 91 10 OtherEarlyDevelopments1 1982 Term AIDS coinedFirstcasesinwomenreportedFirsttransfusionandverticallytransmittedcasesreported1983 IsolationofaretrovirusfromapatientwithAIDSbyMontagnier sgroup1984 Detec
6、tionofHTLV IIIinptswithandatriskforAIDS Gallo SepkowitzKNEJM2001 344 1764 72 11 Source NationalAIDScasesurveillancedata CDC OtherEarlyDevelopments2 1985 FDAapprovesfirstcommercialHIVantibodytest1986 NIHestablishestheAIDSClinicalTrialsGroup1987 AZT firstantiretroviralapprovedbyFDA 12 Epidemiology Fir
7、stcaserepotedinmid 1981fromUSA 80 000 000Infectedpersonallovertheword Over24 800 000AIDSpatientsdied NewlyIncreased50 000 000peryear 16000patientseveryday 11caseseveryminute Africa America Asia Europe Atleast1 000 000infectedpersoninChina 13 EstimatednumberofpeoplenewlyinfectedwithHIVglobally 1990 2
8、007 14 HIVepidemicinChina Sincethefirstcasewasreportedinmid 1981fromU S A over150nationsintheworldreportedAIDS AIDSwasfirstreportedinBeijing China in1985 SincethentheHIVepidemichasbecomemorevisibleinChina Thecasesreportedareincreasingeveryyearandhavespreadthroughoutthecountry 15 FourphasesoftheHIVep
9、idemicinChina Firstphase 1985 1988 wasmarkedbyasmallnumberofAIDScasesincoastalcities Secondphase 1989 1993 identificationofHIVinfectionin146drugusersinsouthwesternYunnanProvince Thirdphase 1994 2000 HIVinfectionhadbeenreportedinall31provinces regions andmunicipalities HIVinfectionhadbeenreportedinal
10、l31provinces regions andmunicipalities Fourthphase 2001 thesilencesurroundingHIVinChinawasbeginningtoend 16 2014年12月01日国家卫计委在线访谈透露 云南 广西 四川三个省份的感染者和病人占全国的45 2014年1 10月新报告的艾滋病病毒感染者和病人数量上 四川省增加最多 有1万余例 其次是云南9601例 而广东 广西新报告数亦都超过5000例 17 EpidemiologySourcesofinfection patientNon symptomcarriers HIVexist
11、sin BloodsalivasementearVaginaldischargesmilk 18 HIVinBodyFluids Semen11 000 VaginalFluid7 000 Blood18 000 AmnioticFluid4 000 Saliva1 AveragenumberofHIVparticlesin1mlofthesebodyfluids 19 RoutesofTransmissionofHIV SexualContact Male to maleMale to femaleorviceversaFemale to femaleBloodExposure Inject
12、ingdruguse needlesharingOccupationalexposureTransfusionofbloodproductsPerinatal TransmissionfrommomtobabyBreastfeeding 20 EpidemiologyRoutesoftransmisson 1 Homosexualandheterosexualcontact 2 Injectionviai v drugaddiction bloodandbloodproducts 3 Mothertochildperinataltransmission 4 Healthcareworkersm
13、aybeinfectedbyneedlestickorbybrokenskinoccasionally 21 22 EpidemiologyHighriskgroups Malehomosexuals sexualprovisionincludingprostitution i v drugaddictsandhemophiliacsrepeateduseserumproducts 23 Pathogenesis CD4 TlymphocyteandotherCD4 cellsarelargelydamagedbyHIVindirectandindirectway andleadtodysfu
14、nctionanddeficiencyincell mediatedimmuneresponse 24 ClinicalmanifestationIncubationperiod 2 10years AcuteHIVinfectionAsymptomaticHIVinfectionPersistentgeneralizedlymphadenopathy PGL AIDS 25 Stage1 Primary Short flu likeillness occursonetosixweeksafterinfectionnosymptomsatallInfectedpersoncaninfectot
15、herpeople 26 Stage2 Asymptomatic LastsforanaverageoftenyearsThisstageisfreefromsymptomsTheremaybeswollenglandsThelevelofHIVintheblooddropstoverylowlevelsHIVantibodiesaredetectableintheblood 27 Stage3 Symptomatic ThesymptomsaremildTheimmunesystemdeterioratesemergenceofopportunisticinfectionsandcancer
16、s 28 Stage4 HIV AIDS TheimmunesystemweakensTheillnessesbecomemoresevereleadingtoanAIDSdiagnosis 29 Clinicalmanifestation AIDSconstitutionalsymptoms Fever malaise anorexia diarrhea lossofbodyweightetc alsoknownasAIDSrelatedcomplex ARC Centralnervoussystemsymptoms Headache epilepsy progressivedementia paraplegiaetc 30 Severeopportunisticinfections PneumocysticCariniiPneumonia PCP Cryptococcalmeningitis pulmonarytuberculosis Candidiasis cryptosporidiosis Histoplasmosis etc 31 Opportunisticmalignanc
