Showing posts with label sida. Show all posts
AIDS general
S.I.D.A. is an
abbreviation for "Syndrome Acquired Immune Deficiency." That is to
say that this disease is characterized by the destruction of the immune defense
system. "Acquired" because they say it is contagious.
This is a fatal
disease in the present state of our knowledge, contagious, caused by a virus
called a retrovirus that has the ability to destroy the T4 cells that are part
of the white blood cells responsible for defending the body. Therefore, the
body is no longer able to defend themselves against mombreuses infectious diseases
in particular (such diseases are called "opportunistic").
The virus is
transmitted through sexual contact, injection of contaminated blood and from
mother to fetus.
In the present
state of our knowledge, two distinct viruses are able to infect humans: HIV-1
and HIV-2 (also known as HIV-1 and HIV-2).
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AIDS and toxoplasmosis
It is usually by
brain damage that occurs toxoplasma infection in patients with AIDS.
It is most often
reactivation of intracerebral cysts.
Patients with
IgG levels above 150 units / ml Toxoplasma are more likely to have a clinically
speaking
cerebral
toxoplasmosis.
Regular
Toxoplasma IgG assay is useful for predicting a possible clinical
manifestation, this especially if the CD4 count is below 200 per mm3.
A rate greater
than 150 IgG should be considered for the establishment of a primary
prophylaxis of cerebral toxoplasmosis, even if the CD4 is above 100 per mm3, of
course depending on the decision the medical team.
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blown AIDS
Is referred to by the name the stage of the disease become symptomatic.
HIV infection that begins after the infection may remain silent for many years.
Meanwhile, the immune system gradually drop. This is why we must watch very carefully with HIV, particularly the number of T4-CELL, which will determine when the use of antiviral drugs (AZT, DDI, see these terms) will become mandatory.
See: AIDS and HIV AIDS MONITORING TREATMENT
Despite current treatments, the body's defenses down and Opportunistic Diseases will appear. This is the time that is designated as AIDS AVERE.
Opportunistic infections are numerous. It should be mentioned in particular:
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AIDS testing special cases
In pregnant
women, if risk factors should be offered a test for (see ELISA), in particular:
- Women whose
partner is HIV positive,
- Women who have
multiple sexual partners,
- For those who
use drugs.
The continuation
of a pregnancy in cases of HIV from mother still serious problems.
In the new-born
to HIV positive mothers in the first months of baby's life antibodies that are
detected may be those transmitted by the mother. The infant's own antibodies
are detectable only from the 14th month. 30% of children born to HIV-positive
mothers are actually affected by the virus.
In comatose
patients, it may be necessary to search for the test, even without the consent of
the patient who can not give the course.
After being
bitten by a syringe in a public place (public garden, beach, for example), the
risk of contagion seems low pitting depends on the state of the syringe, the
needle and the possible content of the syringe. However, a test should be
applied in the following weeks.
Some countries
require a certificate of seronegative to let foreigners on their territory. It
is therefore necessary to learn and do the tests before departure.
Some insurance
companies require HIV-free certificate. The subscriber can only give results to
the medical officer of the company who is required anyway, professional secrecy
under Article 378 of the Criminal Code. It can, at most, transmit information by
establishing a ranking on a scale of risk.
If contaminated
needlestick in a person's medical staff must:
- To bleed
profusely,
- Meticulously
clean,
- Taking AZT
immediately (before the fourth hour after the accident)
- To perform
serology to affirm the initial negativity and assay VIRAL LOAD (see this teme)
within hours or days,
- Consider a
triple therapy
- Monitoring the
serology in the following weeks.
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Helper T cells
It is a variety
of CELL (qv) T, which contribute to the production of antibodies with B cells,
so that a critical role in cell-mediated immunity.
These
lymphocytesT4 HELPER, also called "auxiliary T cells" present
themselves in two subgroups:
- TH1 and TH2
distinguished by the cytokines they secrete.
- TH1 produce
Interleukin IL-2 and Interferon gamma (SEE THESE TERMS)
These cells are
responsible, among other things, delayed hypersensitivity reactions.
TH2 produce
several interleukins IL-4, IL-6, IL-10.
It activates B
cells and differentiation of eosinophils, produce ANTIBODY (see this term) IgE,
and are responsible for allergic reactions.
These cells
strongly reduced in certain diseases such as AIDS. Therefore, immunity
decreases and the body can be reached so-called opportunistic diseases (see
CONDITIONS Opportunistic).
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AIDS and mental disorders
Psychiatric and
neurological manifestations of AIDS are present in 60% of AIDS patients.
These events are
primarily infectious brain events related to immune deficiency (toxoplasmosis,
cryptococcosis) or at LYMPHOMA (qv) primitive brain.
The most common
manifestations are however related to the impairment of the nervous tissue by
the virus. The virus has a tropism (attraction) to the white matter, especially
some glial cells (microglia).
The usual
symptoms are:
. memory
disorders,
. apathy,
. psycho-motor
inhibition,
. the subject is
difficult to focus intellectually
. a general
disinterest
. sometimes
headaches.
These symptoms
may be mistaken for a depressive syndrome and can wander the diagnosis.
Neurological
examination is normal at this stage, the brain scanner also, but can already
indicate hypodense white matter.
Sometimes, the
procession will inaugural psychiatric disease with all the consequences this
may have in subjects with major professional responsibilities, social or
political.
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Influenza vaccination in practice
Influenza is a
disease caused by myxovirus influenzae A and B, responsible for seasonal
epidemics.
She is
responsible for many deaths in each epidemic, especially among the elderly with
prior cardiovascular disease.
The vaccine is
composed of several strains: those that were detected in the previous month.
They are named
after the cities where virology laboratories have identified the pathogenic
strains, but it is not impossible that they originated elsewhere.
For winter
2007/2008 the vaccine is composed as follows:
- An A / /
strain Solomon Island 3/2006 (H1N1)
- A strains
Winconsin 67/2005 (H3N2)
or
A/Hiroshima/52/2005
- A similar
strain B / Malaisia 2506/2004
The influenza
virus, or rather influenza virus mutate (change is) very quickly and this is
the reason that one is obliged each year to produce a suitable pathogen strains
detected six months before winter vaccine.
THAT
VACCINATION?
- Those likely
to decompensate preexisting severe disease (worsening of pre-existing disease)
- Pregnant women
from the 4th month of pregnancy women
- People over
65,
- Patients with
diabetes,
- Patients with
heart failure,
- Patients with
respiratory failure,
- Patients with
chronic nephropathy (kidney disease)
- Immunocompromised,
- Patients with
cancer,
- Children,
especially asthmatics,
- The exposed
through their work, all health professions in particular,
- Teachers,
- Professional
leaders whose presence is essential to their job,
- Students take
exams or important competition
- The staff of
nursing homes and hospitals,
- The top
athletes.
WHEN VACCINATED?
This vaccine is
very well tolerated, there is very little intolerance.
Immunity is
acquired after 15 days and lasts six to eight months.
The best time to
get vaccinated is the second half of October (unless an epidemic announcement
earlier).
HOW TO
VACCINATION AND HOW MUCH IT COST?
It is issued by
the pharmacies for order or support sent by the Social Security Fund. This support
must be signed by the attending physician.
Vaccination can
be done by your doctor or at clinics and public hospitals.
It is free and
dispensed by the pharmacist against support sent by the Social Security trust
fund to which the patient
1) for people
over 70 years
2) irrespective
of age for patients:
-
Insulin-dependent diabetes or not can not be balanced by diet alone,
- Of disabling
stroke,
- With severe
kidney disease and pristine pure nephrotic syndrome,
- A serious
violation of neuromuscular including myopathy,
- Cystic
fibrosis
- CHD poorly
tolerated,
- With severe
heart failure,
- Serious
cardiac valvular disease,
- Severe chronic
respiratory insufficiency,
- AIDS.
Patients under
these conditions and those seventy years and older can apply for free care from
their social security fund until the end of December if they have not received
directly.
The vaccine is
also free for migrants living permanently in France on a regular basis and
provided with a Form E 106, E 109, E 121 or E 122 and elderly persons in
nursing institutions.
When you get
your vaccine at your pharmacy, it will keep it in the crisper of your
refrigerator until use.
CONTRAINDICATIONS
- Holders subjects
of true allergy to egg proteins should not be vaccinated. It is necessary to
assert such an allergy to have an anaphylactic (allergic) reaction after eating
some eggs.
- An HIV HIV
(AIDS)-indicates not formally against an influenza vaccination, in any case,
shall be made only when absolutely necessary. It is best to use in these
patients preventive medication: the Roflual, or Mantadix (see HIV-positive and
AIDS VACCINE).
POI:
INSTITUT PASTEUR
25 rue du
Docteur Roux
75015 PARIS
tel: 01 45 68 80
00
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sida
Misconceptions about AIDS
The link between
HIV and AIDS as well as treatment methods implemented at present are still
questioned by some.
In all cases, it
is essential to put an end to these misconceptions for an effective fight
against AIDS!
AIDS denial
Certain
assumptions are made about the justification of the onset of AIDS. It is
essential to put an end to these misconceptions for an effective fight against
AIDS! Good information is an important step in preventing the disease.
"AIDS is
not a disease scientifically well defined and is not caused by HIV"
"The
existence of HIV is still discussing and reliability testing"
"The
evidence on the sexual transmission is questionable"
"The
discovered anti-viral drugs for so-called treatment of the disease spread more
AIDS"
"The death
in people with AIDS are associated with taking anti-viral drugs and
malnutrition."
AIDS and
pregnancy
The risk of
transmission to the partner and the child is great. However, HIV-positive women
of childbearing age and can have a child with a new medical technique called assisted
reproductive technology.
Pregnancy does
not worsen the AIDS when the woman has no signs of the disease and there is no
risk or defects, or of abortions or premature deliveries. Early diagnosis
should be made in the newborn for appropriate care.
AIDS and
religion
Although the
position and vision of religious entities are sometimes different about
sexuality and AIDS, religious leaders still have influence on the behavior and
attitudes of their members and can give their support to people with AIDS and
that their families.
However, the
importance of condom use was clearly demonstrated in reducing the risk of
contamination by the AIDS virus. Until now, the use of condoms remains the
major method of prevention.
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Rights of AIDS patients
Access to care,
the right to seek care, access to medications.
Patients' rights
Disclosure of
HIV status of the patient without his consent by a family member or a third
party is illegal because is a revelation of the privacy of the patient.
Before going
abroad, it is better to learn about the laws of the country to determine
whether the entry of HIV-positive people is prohibited or not.
In case of minor
illness, the minor's consent is required, as well as the parents.
However, when
treatment decided by the physician is required to save the patient, parental
consent may be omitted, if the minor opposition, it will be required to be
accompanied by an adult.
Labor rights
The employer is
not required to have health questionnaire about the patient or the disease or
diagnosis of the patient. Similarly, the patient is not required to disclose
their status to their employer.
The patient is
entitled to request sick leave (different for the public sector and the private
sector). No profession is prohibited for AIDS.
social Rights
People with AIDS
receive social benefits from the financing of the common, or the region or the
department.
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AIDS everyday
The impact of HIV on the daily life of the patient is not to
be overlooked: the multiple medications and their side effects, psychological
turmoil, ...
However, there is no risk of transmission of AIDS every day
and it is good to remind the patient and his entourage because only sexual
fluids (semen and vaginal fluids) and blood are factors of contamination.
Also, it would be unfair to keep the patient away from the
family.
Tips
Do not refuse to seek treatment for fear of infecting others
or fear of discrimination (dental care is essentially important)
Know how to face social exclusion, harassment and whispers
of others: to trust his doctor that he inform his entourage on the risks of
contamination. The information is the only way to avoid discrimination.
During a trip to bring his insurance card, her immunization
card (to be updated), learn about the laws regarding AIDS in the country of
destination, bring a certificate medical and treatment in an amount sufficient
to avoid breaking the drug intake.
Comply with precautions to prevent contamination and risk
situations (use of condoms during sex, cleaning and dressing wounds, ....)
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AIDS associations
Many associations fighting against
AIDS exist in France.
Invaluable
The action of associations fighting
against AIDS is crucial in preventing the disease (condom promotion, screening
information, ...).
These associations are an important
support for patients and their families.
It is often necessary for the
patient and his family to join such associations that provide assistance and
support, such as the establishment of such sharing sessions between patients,
between families of patients, information sessions , education and counseling
on HIV / AIDS.
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AIDS prevention
At present,
despite the existence of several drugs in the management of patients, no
treatment can even cure AIDS.
Prevention is
the first recommendation for both sick for those who are uninfected.
To inform risk
situations transmission
1. Direct
contact with the blood of an infected person (wound, if menstruation, ...)
2. Direct
contact with semen and vaginal secretions: unprotected sex, torn condom during
sexual intercourse, anal intercourse or vaginal unprotected fellatio in contact
with sperm.
3. The exchange
of sexual material or personal property which may have traces of blood (razor)
4. For drug
users, needle exchanges or other injection equipment (needles, for example)
5. Presence of
sexually transmitted diseases
To protect
1. Wearing a
condom during sexual intercourse (to learn about their use)
2. Piercings or
tattoos should be performed under sterile conditions and the rooms must include
decontamination tanks and bins, sinks, work surfaces sterile stocks of sterile
single use disposable materials ...
3. Persons
performing piercings and tattoos and addicts should be aware of the conditions
of care and risks associated with these actions
4. All wounds
should be protected and covered by a bandage
5. All pregnant
women should have conducted a screening test
Get tested
Know are HIV
status is the best way to protect yourself and protect others.
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AIDS: state of play
AIDS is a major
public health problem because the number of people with AIDS is increasing
every year and the majority are located in developing countries.
History
The disease
appeared for the first time in 1970 and mainly concerned the gay community by
creating an epidemic in North America.
In 1981, the
signs were found among homosexuals in Western Europe and America as well as in
women with multiple partners in parts of Africa.
The AIDS virus
was described in 1982 and the first treatment was discovered in 1987 but was
made available in 1990. However, the first treatment was not curative but had
the effect of influencing the proliferation of viruses and slow the disease.
Approximately
33.3 million people in the world (latest UN data / AIDS) are reached in 2009
and men aged 15 to 39 years are most affected.
Status of
Research
In 2004,
approximately 440,000 patients in developed countries received antiviral
therapy and currently more than 700,000 people living with HIV receive
treatment in accordance with the government aid and their partners.
WHO announces
today, under the facilitation of access to antiviral drugs, the provision of
these drugs in developing countries.
Hope for a
vaccine?
Although no
vaccine has yet been developed, the results of studies and research on several
clinical trials currently revive the hope of vaccine against AIDS.
A team of U.S.
researchers has discovered how to neutralize the AIDS virus but these results
are still theoretical.
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AIDS: What symptoms?
The different manifestations of one person to another and
AIDS can not be collected.
In all cases, the presence or absence of signs, risky
behavior (unprotected sex, multiple sexual partners, ...) justifies the
importance of testing.
Difference between HIV positive and AIDS patient?
The distinction between HIV-positive people and people with
AIDS lies in the evolution of the disease.
The term "HIV positive" means that the test has
detected the presence of the AIDS virus in the blood of the person we are
talking about positive person. The person is not sick and is doing well. At
this point, drugs can have positive effects on the body's natural defenses.
AIDS is a serious development stage and advanced HIV
infection. The infected person is sick, weak and resistant to treatment against
the virus. The body is unable to defend itself against other diseases
(influenza, tuberculosis, ...)
All HIV-positive people are not systematically AIDS. By
cons, they can transmit the virus to others.
What are the warning signs?
Primary infection
The first signs appearing in after infection but are often
overlooked by the infected person days: fever, headache, sore throat, fatigue,
muscle pain.
Stages of the disease
The second stage has no signs for several years but the
person can transmit the disease.
The third stage is characterized by the appearance of some
banal but disease-related signs such as fatigue, weight loss, night sweats,
fever, dry cough, shortness of breath or gastrointestinal disorders (diarrhea).
The fourth stage is called "AIDS disease" and
characterized by the occurrence of other infections (tuberculosis, colds,
herpes, cancer, ...)
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Screening for AIDS
The testing of
AIDS is to a blood test to detect the presence there of anti-HIV *.
Screening is
recommended for people at risk.
Those most at
risk
- Homosexuals
and sex workers, drug users
- People with
multiple sexual partners
- Children born
to a woman with AIDS
- People who have
had unprotected sex
- People exposed
to health care professionals, police officers, firefighters, rescue
- People with a
history of blood transfusion or organ transplant
* Anti-HIV
antibodies: These are particles produced by the immune body to detect and
neutralize the HIV virus when they are found in the blood.
HIV and
Reporting
AIDS is a
notifiable disease, such as rabies, measles and dengue.
The doctor sends
some information concerning the patient (eg, age, place of residence,
occupation, ...) while maintaining the anonymity of the patient.
These data are
collected in an epidemiological and statistical interest, in order to develop
public health strategies more appropriate in the context of the fight against
AIDS.
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What treatments against AIDS?
It eThe
anti-viral
The goals of
treatment with anti-viral are:
- Slowing the
spread of viruses to reduce the viral load (amount of virus in the body).
- Maintain
effective in the fight against the virus CD4 lymphocytes.
Nucleoside
reverse transcriptase inhibitors (NRTIs)
Action: Prevents
processing of viral RNA proviral DNA
Side Effects:
Risk of kidney toxicity
Non-nucleoside
reverse transcriptase inhibitors (NNRTIs)
Action: Prevents
processing of viral RNA proviral DNA
Side Effects:
May cause skin rashes. Cons-indicated in pregnant women
Protease
inhibitors
Mode of Action:
Inhibits maturation of new virus and block the infection of other cells
Side effects
interactions with other drugs
Integrase
inhibitors
Action: Prevents
touch proviral DNA to the DNA of the host cell
Side effects:
dizziness, digestive disorders, liver toxicity
Fusion
inhibitors
Mode of Action:
Inhibits fusion of the virus with the host cell and blocks viral entry into the
cell
Side effects:
muscle pain, lung disease.
These treatments
and enable a longer life expectancy and improves the patient's quality of life.
HAART
It is the combination
of three drugs against the virus (3 nukes) whose main action is to slow the
growth. The side effects are transient, but in no case should encourage the
patient to stop taking the drug in order to ensure its effectiveness.
These side
effects are usually related to intolerance to 3 concomitant medications. The
most common are headaches, digestive disorders (nausea and vomiting), loss of
appetite, fatigue, and skin rashes.
The quadruple
Based on the
same principle as the combination therapy, it is used to improve the
effectiveness of antiviral immunity against the virus itself.
Researchers have
shown that the combination of several drug molecules avoids resistance
virales.xiste several strains of anti-viral types that differ in their mode of
action
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HIV / AIDS
The virus HIV /
AIDS infects the cells of the immune defense system called "CD4".
However, it may
infect other cells of the immune system, such as white blood cells and
macrophages.
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sida
Transmission SIDA4
The AIDS virus
is found in blood, semen, vaginal fluid and breast milk.
The transmission
of the AIDS virus is one of 3 modes.
The sexually
This is the most
common mode of infection and the most common (especially in the gay
population). The virus is usually transmitted through unprotected sexual
intercourse and each with an infected person can transmit the disease.
For sex with
oral contact, there are 0.005% risk of transmission to sexual intercourse and
anal type, transmission probability is 0.3% (source: AIDS-info service).
However, there
is transmission, mucous membranes should be sensitive to facilitate HIV
infection. Sexually transmitted diseases are the most frequent causes weakening
of vaginal mucosa.
The bloodstream
Contamination
can be done by:
- Blood
transfusion
- Use of
contaminated needles (syringe exchange among drug users, razors, tattoos ...)
- Transmission
by contact with an open blood of an infected wound.
Transmission
from mother to child
This mode of
transmission may occur at the time of delivery, the baby upon contact with
vaginal fluid or breastfeeding (through breast milk).
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HIV reduced vertical transmission intrapartum
The mother-child
transmission of the AIDS virus (HIV) tends to decrease, particularly through
the use of cesarean limit transmission during childbirth, according to a study
published in the journal "JAIDS".
In utero transmission
Dr. Laurence S.
Magder, the department of epidemiology and preventive medicine at the
University of Maryland, and colleagues analyzed data from the study WITS (Women
and infants transmission study), a prospective, multicenter, longitudinal who
began in 1989.
The transmission
was defined as having occurred in utero, that is to say during pregnancy if the
tests performed in the child tested positive within 48 hours after birth and
during delivery (intrapartum) if they became positive only during the first
week.
From 1990 to
2001, 1797 children are born to HIV-positive (HIV +). The viral status could be
determined for 1709 of them: in fact, 9.7% were infected. This rate has
decreased over time, from 18.1% in 1990-1992 to 1.6% in 1999-2000.
Caesarean
section reduces the risk of intrapartum transmission
Of the 166 HIV +
children, the authors estimate that 33.7% were infected in utero and 66.3% at
delivery.
If the
proportion of transmission in utero is the lowest, it tends to increase due to
the greater reduction of intrapartum transmission.
Finally, the
rate of transmission in utero decreased less (4.9% in 1993-1994 vs. 1.6% in
1999-2001) the rate of intrapartum transmission (13.9% vs. 0.5% in 1990-1992 to
1999-2001).
The
administration of antiretroviral therapy during labor and especially the wider
voluntary Caesarean section, since the recommendations made in 1999 by the
American College of Obstetricians and Gynecologists for HIV + women with a
viral load greater than 1,000 copies / ml, explain the favorable intrapartum
transmission.
Intrapartum
transmission was significantly associated with the duration of rupture of the
placental membrane, the authors say, where the interests of cesarean that
occurs before this step.
Recommendations
to reduce the risk in utero
Risk factors for
in utero transmission include maternal use of hard drugs, viral load and
antiretroviral therapy, the authors write.
"These data
suggest that interventions to reduce vertical transmission should include
screening for HIV infection before or early in pregnancy, improving access to
treatment for addicted women and early initiation highly active antiretroviral
therapy during pregnancy in order to best limit the replication of HIV,
"they conclude.
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HIV interruption ineffective antiretroviral therapy in patients with multiple resistance
An attempt to
interrupt antiretroviral therapy in patients with treatment failure has endured
several negative results, report doctors at the Pitié-Salpêtrière Hospital
(Paris, thirteenth district) in the journal "AIDS."
Effect of
interruption of antiretroviral
Interruption of
treatment aims to promote the resurgence of wild-ART-sensitive strains in
patients with multiple resistances. Wild strains replicating faster than the
resistant strains, treatment interruption would thus increase the effectiveness
of antiretroviral drugs.
The team of Dr.
Christine Katlama had achieved encouraging results in an interruption of
eight-week trial. Twenty-four weeks after resumption of treatment, the
researchers observed a decrease in viral load greater in patients who
discontinued treatment than those having continued.
The same team
investigated whether the results could be improved with a longer interruption
of 24 weeks instead of 8. This interruption has a good reversion of viral
phenotype. Patients were sensitive to antiretroviral 4.9 average effect,
against 0.8 before the test.
Resumption of
treatment, based on antiretrovirals to which the patients were sensitive again,
however, has not had the desired effect. Twenty-four weeks after resumption of
treatment, the viral load of patients had increased their CD4 counts were lower
than the values recorded at the beginning of the trial, before the
discontinuation.
Reappearance of
resistance
In addition,
antiretroviral resistance mutations recurred after four weeks of treatment in
13 patients, and after 24 weeks in the other 10.
Fifteen patients
(65%) also underwent several conditions related to the virus, including eight
cases of esophageal candidiasis. All these events occurred after rechallenge.
"It seems
that the key point that the interruption is effective is the number of
antiretrovirals to which the patient is still sensitive before
interruption," the researchers assume.
In the first
study, in which treatment interruption lasted eight weeks, the patients had an
average sensitivity of 1.4 antiretroviral.
"In our
study, the average was 0.8. There was therefore no new antiretroviral which
patients had never been exposed.'s Rapid resurgence of these resistant strains
after rechallenge shows that n 'had not disappeared, "noted the authors.
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