4 periods of HIV infection. How does HIV infection manifest in men and women? Signs and symptoms of end-stage HIV infection

After the virus enters the human body, the infection develops in several stages. When infected with HIV, a certain classification of periods of progression of the infectious process has been adopted. The incubation stage is immediately observed, followed by the stage of primary manifestations and the subclinical stage (when the latent virus experiences a latent period). The third stage of HIV develops into the fourth - the time of progression of secondary ailments. This review will focus on the penultimate stage of HIV, which includes HIV 4a, HIV 4b and HIV 4c.

The stage of manifestations of secondary diseases can occur either several years after the first symptoms or months after the onset of characteristic symptoms. How quickly the pathology progresses depends on the patient’s level of immunity.

Among the main signs of the progression phase of characteristic symptoms is the transition to persistent immunodeficiency. This is evidenced by a decrease in the concentration of CD4 cells in the patient’s blood.

In the table below we list the main characteristics of the 4th (fourth) stage of HIV:

The described stage is followed by the terminal AIDS stage, which ends in the death of the patient.

Stage 4a

The period begins when the subclinical stage ends - 8-10 years after infection. During this period, the patient is susceptible to various infectious infections, namely:

• viral;
• bacterial;
• fungal;
• protozoan.

During the development of infectious processes, the mucous membranes of the oral cavity and skin, organs of the respiratory and genitourinary systems suffer.

Attention! In some cases, this phase is characterized by a period of remission - the disease does not develop into immunodeficiency, causing a slowdown in the final stage.

Stage 4b

The period begins 9-12 years after HIV infection. When a patient is diagnosed with this phase of pathology, we are talking about the rapid progression of the disease, which leads to a decrease in the level of adaptation of the human body. The patient switches to light work and begins to suffer from disability. The development of acquired immunodeficiency syndrome (AIDS), a diagnosis so hated by people, is just around the corner.

Stage 4c

Phase 4c occurs 15 years after infection. Often patients do not survive to this stage of HIV. This fact is explained by the rapid development of secondary ailments of a bacterial, fungal, protozoal nature.

When this highly active phase begins, they talk about the fact that the virus is adapted to drugs applicable before this stage (in period 4a, 4b). Therefore, in order to slow down the transition of 4b to AIDS, it is necessary to change drugs.

How long do HIV-infected adults live?

A fairly long period of time may pass before the development of AIDS, the terminal stage of the disease. It is impossible to indicate an exact figure.

In any patient, after the virus enters the blood, the process of immune suppression begins. The duration of this stage varies and depends on the following factors:

• presence of bad habits;
• level of daily activity;
• STD infections;
• features of antiviral therapy carried out for primary manifestations at the initial (early) stage of HIV infection;
• the patient’s compliance with medical recommendations during the period under review and especially the last month of the phase.

Typically, the life of an HIV-positive person from the moment of the first manifestations to the development of the syndrome lasts about 15 years. However, patients with acute HIV infection often die within just a few months. Much depends on the capabilities and health status of the patient during the last month of the stage.

Clinical manifestations

The phase of secondary manifestations is the period preceding the stage of AIDS, characterized by the severity of clinical manifestations. The patient suffers from signs of viral intoxication. We are talking about fever and diarrhea of ​​unknown origin lasting more than 1 month. Sometimes an infected person develops pathologies such as toxoplasmosis and candidiasis esophagitis. At stage 4a, Kaposi's sarcoma is not detected.
Over time, disturbances are observed at the level of cellular immunity. After a month of unexplained fever, the patient is diagnosed with a weight loss of more than 10% of the original weight. A decrease in the number of lymphocytes is detected in a person’s blood, and anemia develops.
Against the background of a weakened immune system, the patient immediately develops mild lesions of the skin and mucous membranes, which over time develop into herpes with damage to internal organs. Bacterial and fungal diseases are diagnosed.
On the approaches to AIDS, the patient suffers from prolonged fungal infections, for example, candidiasis of the esophagus, trachea and bronchi. A person is overcome by severe bacterial infections, recurrent herpes, Kaposi's sarcoma, pneumonia, and central nervous system lesions develop. Other chronic ailments become more pronounced.

Kaposi's sarcoma

The disease is diagnosed in an infected person during the period of manifestation of secondary pathologies. The disease consists of numerous malignant lesions of the dermis. Most often, the development of the disease is accompanied by damage to the oral mucosa and lymph nodes. Kaposi's sarcoma is characterized by bluish-red skin spots, which later transform into tumors up to 5 cm in diameter.

Principles of treatment

To date, medicine does not know a cure for the human immunodeficiency virus. The WHO system provides for the treatment of infected people in two main areas: virological treatment and maintenance of the immune system. This approach does not lead to a cure for a person; however, it allows one to slow down the process of virus replication and improve the person’s condition. In addition, specialists monitor the course of concomitant diseases in case of damage to any organ.

Attention! If appropriate medical care and antiviral treatment for HIV infection are provided, the patient’s life can be extended up to 15 years.

Virological treatment

You cannot self-medicate; be sure to consult a doctor.

HIV treatment is carried out with three types of drugs:

• penetration inhibitors. They have a negative effect on viral particles, preventing them from attaching to T-lymphocytes and penetrating inside;
• viral protease inhibitors. Medicines are responsible for the formation of full-fledged viruses. There is a process of formation of new viruses that are not able to infect other lymphocytes;
• combination drugs.

When taking medications at the same time, the virus is not able to reach cells and mutate them. In parallel, drugs are prescribed that suppress secondary viral, bacterial and fungal diseases.

Important! Therapy does not need to be carried out over a period of several months or years - treatment is carried out for life.

Immunological and clinical treatment

People who are carriers of HIV infection take immunomodulators. Among the agents used are Inosine pranobex, which increases the concentration of lymphocytes (CD4 cells in the blood) of the patient, activating some fractions of leukocytes. However, the antiviral effect of this type of medicine does not apply to HIV, but only applies to the treatment of concomitant infections.
A drug from the interferon group, Viferon, is an antiviral and immunomodulatory medicine. A medication is prescribed if Kaposi's sarcoma or mycosis is diagnosed. When treated with the drug, the activity of T-helper cells is enhanced and the process of lymphocyte production is stimulated.

Attention! The use of this type of medication is not contraindicated during pregnancy.

Treatment of pulmonary manifestations

Being a carrier of HIV means you cannot avoid pneumonia, which develops after stage 3 of the disease.
The main drug used for therapeutic purposes is Biseptol. The active components of the drug are aimed at eliminating the provocateurs of pneumonia. You can replace the drug with Pentamidine. The simultaneous administration of drugs is not typical in the case of treatment of pulmonary manifestations, since the effect of taking the drugs does not increase. If appropriate treatment is carried out, the patient observes improvements already on the 5th day from the start of the course.
In parallel, therapy is carried out for manifested candidiasis and pulmonary tuberculosis.

Basic actions during stage 4 of the disease

In the case of HIV infection, the asymptomatic phase is inevitably followed by stage 3 and then secondary opportunistic pathologies arise. Diagnosing a patient with the described stage of the disease obliges the patient to be under constant supervision at the AIDS Center.
Here, a person is provided with the following types of assistance: prescription of various medication groups, observation at a dispensary, assessment of the need for the patient to transfer to inpatient treatment, and psychotherapy.

In 2001, under the leadership of Academician of the Russian Academy of Medical Sciences V.I. Pokrovsky, a new edition of the domestic clinical classification of HIV infection was implemented.

Clinical classification of HIV infection:

Stage 1– “incubation stage” – the period from the moment of infection until the appearance of the body’s reaction in the form of clinical manifestations of acute infection and/or the production of antibodies. Its duration usually ranges from 3 weeks to 3 months, but in isolated cases it can last up to a year. During this period, HIV actively multiplies, but there are no clinical manifestations of the disease and antibodies to HIV have not yet been detected. Consequently, the diagnosis of HIV infection at this stage cannot be established using traditional laboratory methods. It can only be suspected on the basis of epidemiological data and confirmed during laboratory testing by the detection of human immunodeficiency virus, its antigens, and nucleic acids in the patient’s serum.
Stage 2– “stage of primary manifestations”, is associated with the manifestation of the body’s primary response to the introduction and replication of HIV in the form of clinical manifestations and/or the production of antibodies. The stage of primary manifestations of HIV infection can have several course options:
2A – “asymptomatic”, characterized by the absence of any clinical manifestations of HIV infection. The body's response to the introduction of HIV is manifested only by the production of antibodies.
2B – “acute infection without secondary diseases”, manifested by a variety of clinical symptoms. The most commonly recorded symptoms are fever, rashes on the skin and mucous membranes (urticarial, papular, petechial), enlarged lymph nodes, and pharyngitis. An enlarged liver, spleen, and diarrhea may occur.
Sometimes aseptic meningitis develops, manifested by meningeal syndrome. In this case, lumbar puncture usually results in unchanged cerebrospinal fluid flowing out under increased pressure, and occasionally there is slight lymphocytosis in it. Similar clinical symptoms can be observed in many infectious diseases, especially in so-called childhood infections.
Sometimes this variant of the course is called mononucleosis-like or rubella-like syndrome. In the blood of patients during this period, wide-plasma lymphocytes - mononuclear cells - can be detected, which further enhances the similarity of this variant of the course of HIV infection with infectious mononucleosis.
Vivid mononucleosis-like or rubella-like symptoms are observed in 15-30% of patients. The rest have 1-2 of the above symptoms in any combination. Some patients may experience lesions of an autoimmune nature. With this course of the stage of primary manifestations, a transient decrease in the level of CD4 lymphocytes is often observed.
2B – “acute infection with secondary diseases”, characterized by a significant decrease in the level of CD4 lymphocytes. As a result, against the background of immunodeficiency, secondary diseases of various etiologies appear (candidiasis, herpetic infection, etc.). Their manifestations, as a rule, are mild, short-term, respond well to therapy, but can be severe (candidal esophagitis, Pneumocystis pneumonia) and in rare cases, even death is possible.
In general, the stage of primary manifestations, which occurs in the form of acute infection (2B and 2C), is recorded in 50-90% of patients with HIV infection. The onset of the stage of primary manifestations, which occurs in the form of an acute infection, is usually noted in the first 3 months after infection. It can precede seroconversion, that is, the appearance of antibodies to HIV. Therefore, at the first clinical symptoms, antibodies to HIV proteins and glycoproteins may not be detected in the patient’s serum.
The duration of clinical manifestations in the second stage can vary from several days to several months, but they are usually recorded within 2-3 weeks. Clinical symptoms of the stage of primary manifestations of HIV infection can recur.
In general, the duration of the stage of primary manifestations of HIV infection is one year from the onset of symptoms of acute infection or seroconversion. In prognostic terms, the asymptomatic course of the stage of primary manifestations of HIV infection is more favorable. The more severe and longer (more than 14 days) this stage proceeded, the greater the likelihood of rapid progression of HIV infection.
The stage of primary manifestations of HIV infection in the vast majority of patients becomes subclinical, but in some patients it can immediately pass into the stage of secondary diseases.
Stage 3– “subclinical stage” is characterized by a slow increase in immunodeficiency, which is associated with compensation of the immune response due to modification and excessive reproduction of CD4 cells. The rate of HIV reproduction during this period, compared to the stage of primary manifestations, slows down.
The main clinical manifestation of the subclinical stage is persistent generalized lymphadenopathy (PGL). It is characterized by an enlargement of at least two lymph nodes, in at least two unrelated groups (not counting the inguinal ones), in adults to a size in diameter of more than 1 cm, in children - more than 0.5 cm, persisting for at least 3 years. -x months. Upon examination, usually the lymph nodes are elastic, painless, not fused with the surrounding tissue, and the skin over them is not changed.
Enlarged lymph nodes at this stage may not meet the criteria for PGL or may not be registered at all. On the other hand, such changes in the lymph nodes can be observed in later stages of HIV infection; in some cases, they occur throughout the entire disease, but in the subclinical stage, enlarged lymph nodes are the only clinical manifestation.
The duration of the subclinical stage ranges from 2-3 to 20 or more years, but on average it lasts 6-7 years. The rate of decrease in the level of CD4 lymphocytes during this period averages 0.05-0.07x10 9 /l per year.
Stage 4– “stage of secondary diseases”, is associated with depletion of the CD4 cell population due to ongoing HIV replication. As a result, against the background of significant immunodeficiency, infectious and/or oncological secondary diseases develop. Their presence determines the clinical picture of the stage of secondary diseases.
Depending on the severity of secondary diseases, stages 4A, 4B, 4B are distinguished:
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. Typically, stage 4A develops in patients with a CD4 lymphocyte count of 0.5-0.35x10 9 /L (in healthy individuals, the CD4 lymphocyte count ranges from 0.6-1.9x10 9 /L).
4B most often occurs 7-10 years after infection. Skin lesions during this period are deeper in nature and tend to be protracted. Damage to internal organs begins to develop. Weight loss, fever, localized Kaposi's sarcoma, and damage to the peripheral nervous system may occur. Typically, stage 4B develops in patients with a CD4 lymphocyte count of 0.35-0.2x10 9 /L.
4B is predominantly detected 10-12 years after infection. It is characterized by the development of severe, life-threatening secondary diseases, their generalized nature, and damage to the central nervous system. Typically, stage 4B occurs when the CD4 count is less than 0.2x10 9 /L. Despite the fact that the transition of HIV infection to the stage of secondary diseases is a manifestation of the depletion of the protective reserves of the body of an infected person, this process is reversible (at least for some time). Spontaneously or as a result of therapy, the clinical manifestations of secondary diseases may disappear. Therefore, in the stage of secondary diseases, phases of progression (in the absence of antiretroviral therapy or against the background of antiretroviral therapy) and remission (spontaneous, after previously conducted antiretroviral therapy or against the background of antiretroviral therapy) are distinguished.
Stage 5– “terminal stage”, manifested by the irreversible course of secondary diseases. Even adequately administered antiretroviral therapy and treatment of secondary diseases are ineffective. As a result, the patient dies within a few months. At this stage, the CD4 cell count is usually below 0.05x10 9 /L.
It should be noted that the clinical course of HIV infection is highly variable. The given data on the duration of individual stages of the disease are averaged and may have significant fluctuations. The sequence of progression of HIV infection through all stages of the disease is not necessary. For example, the latent stage can, when a patient develops Pneumocystis pneumonia, go directly to stage 4B, bypassing stages 4A and 4B. There are cases when the latent stage directly passed into the terminal stage.
The duration of HIV infection varies widely. The average duration of the disease from the moment of HIV infection to the development of the final stage of HIV infection (AIDS itself) ranges from 5-8 to 10-12 years, although some patients live 15 years or more.
The fastest progression of the disease from the moment of infection to death is described, which was 28 weeks.
The duration of the disease depends on the type of virus and the individual characteristics of the human body (the body’s susceptibility to the virus, the presence of concomitant diseases, habitual intoxications, etc.). Thus, when infected with HIV type 2, the disease progresses somewhat more slowly. The older you are when you become infected with HIV, the faster the disease usually progresses.
Intravenous administration of psychoactive substances is often accompanied by the development of severe bacterial infections (abscesses, cellulitis, pneumonia, endocarditis, sepsis, tuberculosis, etc.), which can also occur with normal CD4 lymphocyte counts. At the same time, the presence of these lesions contributes to a more rapid progression of HIV infection.
The use of modern antiretroviral therapy regimens can significantly increase the duration and improve the quality of life of patients with HIV infection.
Belyaeva Valentina Vladimirovna,

Pokrovsky Vadim Valentinovich,
Professor, Academician of the Russian Academy of Medical Sciences, Head of the Russian Federal Scientific and Methodological Center for the Prevention and Control of AIDS
Kravchenko Alexey Viktorovich,
Doctor of Medical Sciences, leading researcher at the Russian Federal Scientific and Methodological Center for the Prevention and Control of AIDS

Which is characterized by a critical decrease in the level of CD4 lymphocytes, in which various secondary infectious and oncological diseases become irreversible, that is, specific treatment is ineffective. AIDS inevitably leads to unfortunate death.

In 2012, more than 69 thousand “fresh” cases of HIV infection were identified in Russia, among which 20 thousand had a registered HIV infection, and the rest had an asymptomatic HIV-positive status. More than 800 children under 17 years old were registered among the new cases. Data for 2012 is 12% more than the previous year. The number of deaths from AIDS continues to rise. In 2012, their number was 20,511 people, which is 11.5% more than in 2011.

Causes of AIDS in humans

This syndrome, like HIV infection, is caused by the human immunodeficiency virus (several types), which can be read in more detail in the article: “HIV infection”. HIV is an RNA virus. A feature of the pathogenic effect of HIV is the ability to infect immune cells that have certain receptors on their surface (CD4) - these are T-lymphocytes, macrophages, and dendritic cells. By infecting a cell, HIV causes its death. The natural result of HIV multiplication is the development of severe immunodeficiency - AIDS.

The source of AIDS is a person who becomes infectious already during the incubation period (the period from the moment of infection until the appearance of clinical symptoms), the infectious period continues into the febrile stage of HIV infection, the latent stage of secondary diseases. The patient releases the greatest amount of virus with all biological media precisely during the AIDS stage (terminal stage).

HIV infection is a blood-contact disease, that is, infection occurs through the blood, but the virus can also be isolated from the secretions of the cervix, seminal fluid, cerebrospinal fluid, urine, saliva, tears, etc. The content of HIV in secretions depends on the degree of viral load in the patient’s body .

There are three main transmission mechanisms:

1) Sexual (0.1% of infection with a single vaginal contact and 1% with anal contact, but if there is regular contact, the percentage of infection increases significantly). Uninhibited sexual behavior without the use of barrier protection (condoms) poses a significant risk of infection.
2) Parenteral (intravenous, intramuscular) injections and transfusion of infected blood (the risk of infection with intravenous drug use is about 30%, with transfusion of infected blood - up to 90%).
3) Transplacental (from mother to fetus), in which the risk of infecting the child reaches up to 30%. It is also possible to transmit HIV during childbirth and breastfeeding.

Susceptibility to HIV is quite high. In the female population, the risk was previously thought to be high among women who provide sexual services. Currently, HIV is detected with a certain frequency among wives of patients with HIV and drug users who neglect protection during sexual relations.

Video about what HIV tests you need to take and why:

Changes in the human immune system during the AIDS stage

This syndrome develops when the number of CD4 lymphocytes decreases to less than 200 cells in 1 μl (or less than 0.2 per 109/l). The course of the disease becomes irreversible when it drops below 50 cells in 1 µl. These are profound disorders of the human body’s immunity, in which there is no ability to resist secondary diseases. That is, the main barrier of protection has been destroyed.

Dependence of HIV stages on CD4 lymphocytes

Symptoms of AIDS in humans

Manifestations of the AIDS stage are usually preceded by signs of the development of HIV infection and, like the first symptoms of HIV, they are very diverse. These can be various infectious bacterial, viral, fungal infections, malignant neoplasms. Their distinctive feature is rapid progression with the development of generalized forms (that is, with damage to many organs and systems), as well as low effectiveness of the treatment.

There are certain opportunistic diseases characteristic of AIDS:

1) Candidiasis of the esophagus, trachea, bronchi, lungs (caused by fungi of the genus Candida - representatives of the normal flora of the mucous membranes, but which acquire an aggressive course during AIDS)
2) Extrapulmonary cryptococcosis (caused by yeast-like capsular fungi, cryptococci, which are not capable of infecting a healthy person, and with AIDS, severe forms of damage to the nervous system, skin, and lungs are observed).
3) Cryptosporidiosis (protozoal disease with damage to the digestive tract and the development of severe diarrhea).
4) Cytomegalovirus infection with damage to the liver, spleen, lymphatic system, central nervous system (type 4 herpesvirus in an immunologically strong organism causes a latent form - asymptomatic; in AIDS, the changes are of an aggressive generalized nature).
5) Herpetic infection caused by the herpes simplex virus in its widespread form and damage to internal organs (bronchitis, pneumonia, esovagitis).
6) Kaposi's sarcoma (a systemic malignant tumor caused by herpesvirus type 8, appearing on the skin and internal organs - bone tissue, gastrointestinal tract, nervous system and others).
7) Primary brain lymphoma
8) Lymphoid interstitial pneumonia
9) Mycobacteriosis (including tuberculosis), acquiring the character of disseminated or widespread forms with damage to internal organs (lungs, skin, lymphatic system, bone tissue)
10) Pneumocystis pneumonia (caused by pneumocystis and characterized by severe lung damage with a persistent course)
11) Toxoplasmosis of the central nervous system (toxoplasma - intracellular microorganisms - causes latent or asymptomatic forms in healthy people; in AIDS, this is damage to the central nervous system with the development of meningoencephalitis and other manifestations).
12) Progressive multifocal leukoencephalopathy.

The manifestations of this stage of HIV infection are diverse and depend on the complex of diseases that develop at a particular point in time in a particular patient. These can be mixed viral infections (for example, cytomegalovirus and herpes caused by the herpes simplex virus), the development of a systemic fungal infection against the background of severe mycobacteriosis is possible, it can be the occurrence of Kaposi's Sarcoma in a young man against the background of chronic hepatitis and pneumonia of various etiologies.

Features of the stage of AIDS are, of course, the severity of secondary diseases that have arisen, persistent course (that is, the lack of effect on the specific treatment being carried out), progression of the disease (that is, the addition of new symptoms, which aggravates the patient’s condition) and, ultimately, the irreversibility of symptoms.

Non-infectious manifestations of AIDS

1) Exhaustion or cachexia of patients (critical decrease in body weight by more than 10-15% of the original). Typically, weight loss is accompanied by chronic bowel movements up to 2-3 or more times a day. The cause of exhaustion is persistent opportunistic infections that cause loss of appetite and impaired absorption in the intestines.

Cachexia

2) Peripheral polyneuropathy (severe pain in the limbs, aggravated by standing, walking, and other movements).
3) Dementia (cause – neurotoxic effect of the virus). It is manifested by the patient's slowness, inattention, memory impairment, slow response, apathy, difficulty concentrating, passivity, and aloofness. Develops in 10-15% of cases.
4) Cardiomyopathy (cause of focal myocardial damage) - weakness of cardiac activity, shortness of breath during physical activity, pain, rhythm disturbances.
5) Myelopathy (damage to the spinal cord) is manifested by spastic paraparesis of the limbs, which is manifested by gait disturbances, weakness in the limbs, the inability to perform normal movements, and possible dysfunction of urination.
6) Non-Hodgin lymphoma (painless enlargement of lymph nodes of different groups).

Lethal outcome can occur in case of severe damage to vital organs
(lungs, brain, etc.), circulatory disorders and complications. The AIDS stage lasts from 1 to 3 years.

Diagnosis of the AIDS stage in HIV infection

1) Clinical and epidemiological diagnosis. Almost all patients who reach the stage of AIDS are registered with regional AIDS Centers and undergo regular medical examinations. Epidemiological data on HIV infection have already been collected. The appearance of various opportunistic infections with a severe course allows us to suspect this stage and further examine the patient.
2) Laboratory diagnostics.
- specific – decrease in the level of CD4 lymphocytes to 50 cells per μl; increase in viral load;
- specific laboratory criteria for a particular infection (blood and other biological fluids for antigens and antibodies, PCR diagnostics);
- general laboratory data (blood, urine, biochemical tests).
- instrumental diagnostics of lesions of certain organs and systems (ultrasound, X-ray, MRI).

A. Organizational and routine measures– creation of a protective regime. All patients in the AIDS stage are subject to mandatory hospitalization in special hospitals at AIDS Centers or in infectious diseases hospitals. Bed rest and proper nutrition are indicated.

B. Drug treatment. Includes:

1) Antiretroviral therapy - ART (aimed at suppressing the replication of HIV) Examples of drugs: azidothymidine, zidovudine, zalcitabine, didanosine, saquinavir, nevirapine, lamivudine and many others. Drugs can be prescribed in combinations that are determined only by a doctor based on the patient’s viral load and the severity of immunodeficiency. Indication for ART is a decrease in CD4 lymphocytes below 350 cells per μl. When their number approaches 50 cells/µl, therapy is carried out continuously.

2) Chemoprevention of secondary opportunistic diseases
For candidiasis and cryptococcosis, antifungal drugs (nystatin,
fluconazole, amphotericin B, isoconazole, ketoconazole). For toxoplasmosis, a combined regimen of pyrimethamine, sulfadimezine and calcium folinate is prescribed. For herpes infection, antiviral drugs (acyclovir, famciclovir, valacyclovir) are used. Cytomegalovirus infection in AIDS requires the administration of a parenteral form of ganciclovir - cymevene or foscarnet if there are contraindications to ganciclovir. The occurrence of Kaposi's sarcoma requires the inclusion of specific drugs in the treatment regimen (prospidin, vincristine, vinblastine, etoposide). For tuberculosis, ART includes drugs from the standard treatment regimen for this disease (isonioside and others).
For pneumocystosis, Biseptol and Bactrim are prescribed.
3) Syndromic therapy (depending on the severity and manifestations of disease syndromes)

Prevention of AIDS stage in HIV infection

Prevention of the onset of AIDS largely depends on the consciousness of the patient himself. A timely visit to a trusted doctor at the AIDS Center with regular blood donation for viral load and immunogram, as well as timely diagnosis of opportunistic diseases greatly facilitates this task. A decrease in CD4 lymphocyte count below 350 cells/μl is an indication for highly active antiretroviral therapy (HAART). At the same time, the attending doctor prescribes preventive courses of specific drugs to prevent secondary opportunistic infections.

Infectious disease doctor N.I. Bykova

IV. Stage of secondary diseases (4a, 4b, 4c);

V. Terminal stage.

1. “Incubation stage” - the period from the moment of infection until the appearance of the body’s reaction in the form of clinical manifestations of “acute infection” and/or the production of antibodies. Its duration usually ranges from 3 weeks to 3 months, but in isolated cases it can last up to a year. During this period, HIV actively multiplies, but there are no clinical manifestations of the disease, and antibodies to HIV have not yet been detected. The diagnosis of HIV infection at this stage is made on the basis of epidemiological data and must be confirmed in the laboratory by the detection of human immunodeficiency virus, its antigens, and HIV nucleic acids in the patient’s blood serum.

2. “Primary manifestation stage.” During this period, active replication of HIV in the body continues, but the body’s primary response to the introduction of this pathogen is already manifested in the form of clinical manifestations and/or the production of antibodies. The early stage of HIV infection can occur in several forms.

2A “Asymptomatic”, when there are no clinical manifestations of HIV infection or opportunistic diseases developing against the background of immunodeficiency. The body's response to the introduction of HIV is manifested only by the production of antibodies.

2B “Acute HIV infection without secondary diseases” may manifest with a variety of clinical symptoms. Most often this is fever, rashes (urticarial, papular, petechial) on the skin and mucous membranes, swollen lymph nodes, pharyngitis. There may be an enlargement of the liver, spleen, and diarrhea. Sometimes the so-called “aseptic meningitis” develops, manifested by meningeal syndrome. Lumbar puncture usually results in normal cerebrospinal fluid flowing out under increased pressure; occasionally, slight lymphocytosis is noted in the cerebrospinal fluid. Such clinical symptoms can be observed in many infectious diseases, especially in so-called “childhood infections”. Therefore, acute HIV infection is sometimes called “mononucleosis-like syndrome” or “rubella-like syndrome”. Broad plasma lymphocytes (mononuclear cells) can be detected in the blood of patients with acute HIV infection. This further reinforces the similarity of acute HIV infection to infectious mononucleosis. However, clear “mononucleosis-like” or “rubella-like” symptoms are observed only in 15-30% of patients with acute HIV infection. The rest experience 1-2 of the above symptoms in any combination. Some patients may experience lesions of an autoimmune nature. In general, acute clinical infection occurs in 50-90% of infected individuals in the first 3 months after infection. The beginning of the period of acute infection, as a rule, precedes seroconversion, that is, the appearance of antibodies to HIV. Therefore, when the first clinical symptoms appear in the patient’s blood serum, antibodies to HIV proteins and glycoproteins may not be detected. During the acute infection stage, a transient decrease in the level of CD4 lymphocytes is often observed.

2B “Acute HIV infection with secondary diseases.” In 10-15% of cases of acute HIV infection, against the background of a decrease in the level of CD4 lymphocytes and the resulting immunodeficiency, secondary diseases of various etiologies appear (sore throat, bacterial pneumonia, candidiasis, herpetic infection and others). These manifestations, as a rule, are mild, short-lived, respond well to therapy, but can be severe (candidal esophagitis, Pneumocystis pneumonia) and in rare cases even be fatal. The duration of clinical manifestations of acute HIV infection varies from several days to several months, but usually it is 2-3 weeks.

3. "Latent". It is characterized by a slow progression of immunodeficiency, compensated by modification of the immune response and excessive reproduction of CD4 cells. Antibodies to HIV are detected in the blood, the rate of viral replication slows down compared to the stage of primary manifestations. The only clinical manifestation of the disease is enlarged lymph nodes, which may be absent. The duration of the latent stage can vary from 2-3 to 20 or more years, on average - 6-7 years. During this period, there is a gradual decrease in the level of CD4 lymphocytes, on average at a rate of 0.05-0.07x10 9 / l per year.

4 . "Stage of secondary diseases." Continued replication of HIV, leading to the death of CD4 cells and depletion of their population, leads to the development of secondary (opportunistic) diseases, infectious and/or oncological, against the background of immunodeficiency. Clinical manifestations of opportunistic diseases, along with lymphadenopathy, which persists in most patients, determine the clinical picture of the stage of secondary diseases.

4A - usually develops 6-10 years from the moment of infection. It is characterized by bacterial, fungal and viral lesions of the mucous membranes and skin, and inflammatory diseases of the upper respiratory tract. Typically, stage 4A develops in patients with a CD4 lymphocyte count of 0.35-0.5x10 9 /L.

4B (7-10 years from the moment of infection) - skin lesions are deeper in nature and tend to be protracted. Damage to internal organs develops. In addition, localized Kaposi's sarcoma, moderate constitutional symptoms (weight loss, fever), and lesions of the peripheral nervous system may be observed. Typically, stage 4B develops in patients with a CD4 lymphocyte level of 0.2-0.35x10 9 /L.

4B (after 10-12 years) is characterized by the development of severe, life-threatening secondary (opportunistic) diseases, their generalized nature, and damage to the central nervous system. Typically, stage 4B develops in patients with a CD4 lymphocyte level of less than 0.2x10 9 /L.

In general, the transition of HIV infection to the stage of secondary diseases is a manifestation of the depletion of the protective reserves of the macroorganism. Viral replication accelerates, as does the rate of decline in CD4 cell counts. However, this process is still reversible (at least for some time) in nature. Spontaneously or as a result of therapy, the clinical manifestations of secondary diseases may disappear. Therefore, in the stage of secondary diseases, there are phases of progression (against the background of the absence of antiretroviral therapy or against the background of antiretroviral therapy, with its insufficient effectiveness) and remission (spontaneous, after previously conducted antiretroviral therapy, against the background of antiretroviral therapy).

5. "Terminal stage". In stage 5, secondary diseases present in patients become irreversible. Even adequate ongoing antiretroviral therapy and therapy for secondary diseases are ineffective, and the patient dies within a few months. For this stage, a decrease in the number of CD4 cells below 0.05x10 9 /l is typical.

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:

• cachexia – loss of body weight by at least 10% of initial weight;
• lung lesions: cryptococcosis;
• repeated or persistent 37.5°C for a month;
• lasting more than a month and accompanying cryptosporidiosis;
• viral or bacterial and: herpes, mycoses, cytomegalovirus infection, salmonella septicemia;
• candidiasis of various internal organs: lungs, pharynx, esophagus, trachea, bronchi;
• , among which Kaposi's sarcoma occupies a special place;
• diseases associated with persistence of the herpes virus in the body: herpes zoster in localized or generalized form;
• an increase in the size of lymphoproliferative organs: spleen and;
  encephalopathy;
• reduction in functionality to level 4: the patient spends more than half of his daytime in bed.

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.

Stage 4a

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:

• viral;
• bacterial;
• fungal;
• protozoans.

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.

Stage 4b

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.

Stage 4c

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.

Basic actions during stage 4 of the disease

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:

• destination ;
• dispensary observation;
• determining the need for inpatient treatment;
• psychocorrection and psychotherapy with the participation of qualified specialists.

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:

• nucleoside transcriptase inhibitors – Didanosine, Abacovir;
• non-nucleoside inhibitors – Nevirapine, Delavirdine;
• inhibitors of viral particles - Indinavir, Ritonavir.

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.

How long do HIV infected adults live?

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:

• presence of bad habits;
• infection with infectious sexually transmitted diseases;
• compliance with medical recommendations for treatment, diet and lifestyle.

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.