Lectures on HIV and AIDS infection

2021-01-31 12:00 AM

HIV is a Retrovirus of the family Lentivirus. Currently, HIV-1 and HIV-2 are detected, and HIV with nucleic acid is RNA

Define

Infection with HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immunodeficiency Syndrome) is a medical process caused by a virus of the Retroviridae family. HIV severely depletes TCD4 cells, which in turn causes a severe decrease in the immune status leading to opportunistic infections and cancer, depression and death.

HIV: Human Immunodeficiency Virus (human immunodeficiency virus).

AIDS: Acquired Immunol - Deficiency Syndrome (acquired immunodeficiency syndrome).

The average time from HIV infection to progression to AIDS is about 10 years. However, some patients can progress rapidly to AIDS within a few months. Others (5%) can last 15-20 years and still have no AIDS symptoms and the CD4 cell count does not decrease.

The disease progresses in several stages, each of which has a lot to do with the number of CD4 cells.

Research history

In June 1981 in the city of Los Angles (USA), 5 young men of the same sex type were found to have pneumonia caused by Pneumocystis Carini, when treated with high-dose pentamidine does not cure and all patients. all have immunodeficiency states.

In July 1981, in New York and California, 26 patients with Kaposi Sarcoma were also reported to be same-sex and immunosuppressed. Hence, the disease was originally named "GRID: Gay Related Immuno - Deficiency" (GRID: Gay Related Immuno - Deficiency).

Later, it was found that immunodeficiency syndrome does not only occur in same-sex partners. In 1982, this syndrome was renamed AIDS (Acquired Immuno - Deficiency Syndrome).

In 1983, the scientists F. BarrĂ© Sinoussi, L. Montagnier et al. (Pasteur Paris Institute) isolated the virus causing the above disease from people with swollen lymph nodes, so it was named LAV (Lymphadenopathy-Associated Virus: Virus related to lymphatic disease). In 1984, the scientists M. Popovic, RC Gallo et al. at the National Cancer Institute in Bethesda - USA also isolated a virus named HTLV-III (Human T-Lymph cytotropic Virus type III: Virus with affinity to human lymphocytes III); and at the University of California (San Francisco) isolated a virus named ARV from AIDS patients (AIDS-related virus). In 1986, a subcommittee of the International Commission on Virus Classification identified these viruses as one and named them HIV (human immunodeficiency virus) and in 1983 it was identified as discovered. out HIV-1. In 1985, L. Montagnier et al. A virus is isolated from AIDS patients in Guinea-Bissau (West Africa), later known as HIV-2.

Currently, HIV / AIDS infection is considered an epidemic and a global danger. By the end of 2005. According to the World Health Organization, there were more than 40 million people in the world infected with HIV. In 2005 alone, nearly 5 million people were newly infected with HIV, 3.1 million people died of AIDS.

Epidemiology

Pathogens

HIV is a Retrovirus of the family Lentiviridae. Currently, HIV-1 (first isolated in 1983) and HIV-2 (first isolated in 1985) have been detected. HIV has a nuclear acid called RNA. Currently in the world HIV-1 is widespread.

HTLV: Human T Viral Lympho.

HIV: Human Immunodeficiency Virus.

HFV: Human Foamy Virus.

HIV has a spherical structure of 110 nm in diameter with 3 layers:

Envelop: Is a lipid bilayer with many antigens which are Glycoprotein structures (symbol: Gp)

Shell: Consists of 2 layers, the structure is Protein.

Core (core): Cylindrical wrapped in a layer of Protein. Consists of 2 types of antigens denoted: GAG (Group Specific Antigen) and POL (Polymerase) but the nature is all proteins (symbol P).

HIV-1 has many specific antigens such as Gp 41, Gp 120, Gp 160, P24.

HIV has a weak resistance, is easily inactivated by physical, chemical, and common disinfectants.

Inoculum

HIV-infected people, AIDS patients.

Infection

HIV can be found in blood and blood products, semen, vaginal fluids, saliva, tears, cerebrospinal fluid, urine, and breast milk. However, there are only 3 modes of transmission that are identified:

Sexually transmitted transmission: In the world, the rate of heterosexual transmission of HIV accounts for 71%, and through homosexuality (men) 15%. The risk of HIV infection increases when there is a pathology that causes infection in the genitals, there is a wound when having sex or having sex with many people ...

Blood transmission: Due to blood transfusion and blood products, organ transplantation ... HIV uncontrolled, sharing needles and syringes (high risk for injecting drug users), by sharing needles skin tattoo needles, etc.….

Mother-to-baby transmission: An HIV-infected mother can pass it to her baby during pregnancy, during childbirth, and after childbirth (through milk).

In addition to the modes of transmission as mentioned above, at present, it is not known that other modes of transmission such as inhalation, through mosquitoes or insect bites, kissing, sharing bowls, etc.

Sense of the body

Everyone can be sick, regardless of age, sex, natural or social conditions. However, due to the influence of the mode of sexually transmitted transmission, the age group 18-20 is more infected.

The rate of infection differs depending on the region, depending on customs, habits, habits, social evils, lifestyle... The subjects at high risk of infection are: prostitutes, patients with sexually transmitted diseases (STD), intravenous drug addicts, the risk of indiscriminate sex with many people, repeated blood transfusions without screening….

Mechanism of pathogenesis

HIV has a predominant affinity for TCD4 lymphocytes. In addition, HIV can penetrate many other types of cells such as: B-cell lymphocytes, macrophages, source cells, astrocytes, young fibrous cells, etc. HIV causes the destruction of TCD4 cells. leading to impaired immunity including cellular and humoral immunity. Major disorders in the immune response in HIV / AIDS-infected patients include:

Total T-lymphocytosis, especially CD4, is severely reduced, and CD4 / CD8 ratio is decreased (<1).

Decreased function of immune cells: Reduced or unresponsive skin, decreased cell proliferation to mitochondrial and antigenic agents, decreased cytotoxic response due to decreased CD8 and cytoplasmic function NK (natural killer cells).

Increased gamma globulin.

Increases the immune complex, increases autoantibodies and some other proteins in serum.

Reduced primary antibody response to antigens that are recently exposed,

Reduced interferon-gamma.

Consequences of immune response disorders in HIV / AIDS-infected patients are patients with opportunistic infections (often caused by bacteria, viruses, fungi, parasites that reproduce in cells) or of various types. special cancer.

The average time from HIV infection to progression to AIDS is about 10-12 years. Progression varies widely between patients, depending on the patient's body, the viral factor, and the effect of treatment. Each stage of the disease is closely related to the CD4 count.

Clinical HIV / AIDS infection

Clinical classification of HIV / AIDS infection

Progression from HIV infection to AIDS is a long one. So, the clinical manifestations are very complex and depend on different stages. To date, there are many classifications describing the clinical situation of HIV / AIDS infection. The following is the classification by disease course and TCD4 level.

Primary acute infection (acute seroconversion syndrome)

Following HIV infection, only about 50% of patients exhibit flu-like acute symptoms of infection. Among them, only about 20-30% of the above people went to see doctors. Physicians also only diagnosed as a general viral infection syndrome or "flu". The common symptoms of this period are: Fever, diphtheria, maculopapular erythema, arthralgia, headache, insomnia ... a few patients have diarrhea, nausea, feeling disturbances ... Clinical symptoms usually resolve on their own after a few weeks.

Symptoms of acute infection usually occur 2 - 6 weeks (average 3 weeks) after HIV infection.

During the stage of acute infection, tests show

Decreased cells CD4, CD8, then present in the single-cell marrow CD8 and other lymphocytes. In some patients, the CD4 count is severely inhibited, leading to the rapid progression of the disease.

After HIV exposure, the concentration of virus and P24 antigen increases in serum then decreases (when antibody concentration to HIV increases).

After 1-3 weeks after onset, antibodies to HIV type IGM are detected. IGM antibodies increase at 2-5 weeks and disappear within 3 months. Then antibodies of type IG6 are also formed.

HIV disease in the early stage (silent stage)

CD4 cells> 500 cells / mm3 of blood.

Usually, there are no clinical symptoms (silent period).

There may be systemic lymphadenopathy, usually in the spleen, neck, groin; no lymphadenopathy in the mediastinum and around the aorta.

CD4 cell count decreased (on average, 40-80 cells / mm3 per year). If not treated with antiretrovirals, only <5% of patients progress to AIDS or die within 18-24 months.

Intermediate HIV disease

CD4 cells from 200 to 500 cells / mm3 of blood.

There is an increased risk of developing opportunistic infections.

Lesions to the skin and mouth are more common. Patients with symptoms of the sub-AIDS complex:

Recurrent Herpes simplex infection.

Herpes zoster (shingles) infection.

Diarrheal is recurring, fever lasts long spells.

Unexplained weight loss.

Oropharyngeal candidiasis or vulvar candidiasis.

Other systemic symptoms such as muscle pain, joint pain, headache, fatigue… appeared in waves. Symptoms of sinusitis, bronchitis, bacterial pneumonia ... occur

If not treated with antiretrovirals, 20-30% of patients are at risk of progressing to AIDS or dying within 18-24 months. With treatment, the above risk decreases 2-3 times.

Late-stage HIV

CD4 cells are between 50-200 cells / mm3. According to the CDC - 1993 classification: HIV-infected patients with CD4 count <200 cells / mm3 are considered to be AIDS regardless of clinical manifestation.

The most likely risk of opportunistic infections is pneumonia caused by Pneumocystis carinii (PCP), tuberculosis-infected with Toxoplasma gondii, fungi ... and malignancy lepuphoma, Sarcoma kaposi.

During this period, symptoms of par acidosis (ARC) or AIDS are often seen such as prolonged fever, weight loss, persistent diarrheal, arthralgia, etc.

Neurological diseases such as neuritis, cranial nerve palsy, myelopathy, and peripheral neuropathy tend to be more common.

In patients with low CD4 counts (> 50 cells / mm3) susceptible to CMV retinitis (cytomegalovirus), or possible cervical cancer in women and rectal carcinoma in men or laryngeal papilloma ...

In this stage, symptoms are often caused by decreased red blood cells, agranulocytosis, and thrombocytopenia.

Without treatment 50-70% of patients in this stage turn AIDS and die within 18-24 months.

HIV disease too late stage

CD4 cell count <50 cells / mm 3.

Due to the severe decrease in CD4 count, patients with severe immunosuppression are susceptible to many opportunistic diseases. These are MAC disease (Mycobacterium avium compha complex of Mycobacterium avium), meningitis caused by Cryptococcus, retinitis caused by CMV, fungal invasive aspergillosis, progressive multifocal white matter encephalitis (PML), diffuse Histoplasma ...

Patients with significant weight loss (called wasting syndrome), lose at least> 4.5 kg of body weight without explaining the underlying cause, and have anorexia, diarrheal.

At this stage, treatment with anti-HIV drugs and treatment for opportunistic infections is still necessary to prolong life. With good treatment, some patients with very low CD4 counts (<10 cells / mm3) can still live 5-7 years.

Terminal stage HIV

Patients with too late, untreated HIV disease will die from opportunistic infections.

Classification of HIV / AIDS infection in adults and children over 13 years old 
(according to CDC classification criteria - Atlanta - 1993)

CD4 cells

Clinical classification

 

Amount

CD4 / mm3 cells

The percentage of total lymphocytes

Type A

Asymptomatic or persistent systemic lymphadenopathy or acute HIV infection

Type B

There are clinical symptoms but not types A and C

Type C

The indicator diseases in AIDS

500

> 29%

           A1

B1

C1

200 - 499

14 - 28%

A2

B2

C2

<200

<14%

A3

B3

C3

People of groups A3; B3; C1; C2 and C3 are diagnosed as AIDS patients. Thus, the definition of an AIDS patient includes:

All HIV-infected individuals with CD4 counts <200 cells / mm3 of blood, although there are no clinical symptoms.

There are marker diseases, although CD4 counts> 500 cells / mm3 of blood.

Clinical category A included

HIV infection has no clinical symptoms.

Prolonged systemic lymphadenopathy.

Acute viral retro infection syndrome.

Clinical category B included

Candidiasis of the pharynx, vulva, and vagina recurs many times, with little response to treatment.

Hairy leukoplakia in the mouth.

Bacillary angiomatosis is caused by the bacteria Bartonella Quintana, B.hensenlae.

Moderate to severe cervical dysplasia (CIN) or local intercellular cancer (carcinoma in situ).

Skin shingles recurred.

Immune thrombocytopenic hemorrhage.

Diseases caused by the Listeria bacteria.

Pelvic inflammatory disease, especially ovarian and ovarian abscess.

Peripheral neuritis.

Systemic symptoms: Fever 38.50C; diarrheal lasted for more than 1 month but did not lose 10% of body weight.

Diseases caused by bacteria Nocardia.

Clinical category C

This includes opportunistic infections (AIDS tickers) that identify AIDS in people with HIV.

CD4 cell count <200 / mm3 of blood.

Candida fungal infections in the esophagus, lungs.

Cancer invades the cervix

Fungal infection of Coccidioides immitis (coccidioidomycosis).

Cryptococcus infection outside the lungs.

Cryptosporidium parasite infection causes prolonged diarrheal (more than 1 month).

Toxoplasma parasite infection in brain.

Cytomegalovirus retinitis or cytomegalovirus infection outside the liver, spleen, or lymph nodes.

HIV encephalopathy

Herpes virus infection causes ulcers of the skin, mucous membranes lasting more than 1 month or bronchitis, pneumonia, esophagitis.

Histoplasma fungal infection spreads outside the lungs.

Infection with isospora parasite lasts more than 1 month

Sarcom Kaposi.

Non-Hodgkin's lymphoma, primary immunoblast lymphoma of the brain.

Infection with Mycobacterium avium or M. Kansaii bacteria in the lungs or spreads.

Tuberculosis in the lungs or in the lungs.

Pneumocystis carinii pneumonia.

Recurrent bacterial pneumonia

Pathology in the white brain progresses.

Septicaemia caused by recurrent Salmonella (not typhoid).

Worsening wasting syndrome caused by HIV.

Classification of HIV / AIDS among children (13 pounds)

Clinical classification of HIV / AIDS in children (CDC - 1994)

Type N - asymptomatic:

Children with HIV have no symptoms or only one of the symptoms listed in type A.

Type A - Mild Symptoms:

Children with 2 or more of the following symptoms have no symptoms in either type B or C:

Lymph node enlarged (0.5 cm above 2 areas).

Dermatitis.

Big liver.

Big spleen.                     

Inflammation of the parotid gland.

Persistent or recurrent upper respiratory infections, sinusitis, or otitis media.

Type B:

Symptoms are moderate, the child exhibits symptoms other than those of types A and C:

Anemia (hemoglobine <8g / 100 ml), neutropenia (<1000 / mm3) or thrombocytopenia (<100,000 / mm3), persists for ³ 30 days.

Meningitis, bacterial pneumonia, or septicemia (1 episode).

Candidiasis in the mouth - throat lasts more than 2 months in children over 6 months old.

Cardiomyopathy.

Cytomegalovirus infection occurs in children over 1 month of age.

Chronic or recurring diarrheal.

Hepatitis.

Oral herpes simplex recurs (more than 2 times in 1 year).

Bronchopulmonary, oesophageal herpes simplex occurs at 1 month of age.

Smooth muscle sarcoma (leiomyosarcoma).

Lymphoid interstitial pneumonia or pulmonary lymphoid hyperplasia.

Kidney disease.

Diseases caused by Nocardia (Nocardiosis).

Fever lasts more than a month.

Disease caused by Toxoplasma, before 1 month old.

Chickenpox spread (complications of chickenpox).

Type C - Severe Symptoms:

Children have any of the following symptoms:

Severe and recurrent bacterial infections: Sepsis, pneumonia, meningitis, osteoarthritis, internal abscesses or body cavities.

Candidiasis of the esophagus, bronchi, trachea, lungs.

Fungal disease Coccidioides immitis (coccidioidomycosis) is widespread.

Cryptosporidiosis or isosporiasis with diarrheal that lasts more than 1 month.

The disease is caused by Cytomegalovirus at over 1 month of age (in addition to liver, spleen, or lymph nodes).

Brain diseases: 1) Impaired intellectual development; 2) Acquired brain development disorder or atrophy; 3) Loss of symmetry movement, manifested by two or more of the following manifestations: failure, pathological reflexes, ataxia, gait disorder.

Herpes simplex causes skin-mucosal ulcers that last for more than 1 month; bronchitis, pneumonia, esophagitis in children over 1 month old.

Disease caused by Histoplasma, diffuse (more or combined in the lung, top lung, neck lymph node)

Sarcom Kaposi.

Primary lymoho in the brain.

Small cell lymphoma or immunoblastoma (Burkitt) or large cell, B cell lymphoma

Classification of HIV / AIDS infection in children by TCD4 cells (CDC - 1994)

Immunity

Year old

 

<12 months

15 years old

6 - 12 years old

 

CD4 / mm3

%

CD4 / mm3

%

CD4 / mm3

%

1. No deterioration

2. Slight decline

3. Severe decline

³ 1500

750-1499

<750

³ 25

15-24

<15

1000

500-999

<500

³ 25

15 - 24

<15

500

200 - 499

<200

³ 25

15 - 24

<15

Opportunistic infections found in AIDS

Opportunistic infections in the lungs

The lungs are the most commonly damaged organ in AIDS patients. The most frequent opportunistic infections in the lungs are:

Pneumocystis Carinii pneumonia:

It is the most common manifestation in the lungs accounting for 50-60% in patients. The disease is caused by protozoa with the following clinical symptoms: The disease usually starts slowly, dull with dry cough, fever, fatigue, weight loss, gradually the patient develops difficulty in breathing. Lung examination only showed dry ran. Chest X-ray showed heterogeneous infiltration images, dotted throughout the 2 fields. In severe cases, individual infiltrates can be seen. Blood tests can show a decrease in all 3 lines (erythrocytes, white blood cells, platelets), CD4 T-cell severe decrease <200 mm3. The definitive diagnosis of Pneumocystis Carinii pneumonia must be based on sputum test or bronchial cleanser to find Trophozoid (conformation) by gram staining method (positive results up to 70-80%).

Tuberculosis:

Because tuberculosis bacillus (Mycobacterium tuberculosis) often causes disease in the lungs and some other organs at the same time. The clinical manifestations of pulmonary tuberculosis in AIDS patients are also varied. Sometimes the radiograph is atypical. Need to look for TB extracellular lesions such as tuberculosis, pericardial, effusion ...

Pneumonia - chronic bronchitis caused by Mycobacterium avium:

The disease progresses seriously and leads to death due to bacteria that cause pneumonia, bronchitis and also cause illnesses in the digestive tract, bone marrow, lymph nodes ... Diagnosis must be based on isolation of bacteria from sputum, bone marrow., blood or stools (if you have loose bowel movements).

Fungal pneumonia - bronchitis:

Usually Candida, Aspergillus ... spreads in the throat, bronchi or causes interstitial pneumonia, which can be combined with sinusitis or salivary gland inflammation.

Opportunistic infections in the nervous system

Toxoplasma encephalitis:

Usually manifested by signs of the meningeal - brain. Patients with consciousness disorders range from memory disorders to somatic, semi-comatose, comatose, present with seizures, or have the focal neurological syndrome and intracranial hypertension syndrome. The disease progressed seriously and recurred many times to death. Brain tomography can reveal one or more slippery clouds or calcifications - these are progressive focal foci of Toxoplasma in the organ.

Cryptococcus neoformans meningitis:

The illness is like tuberculosis meningitis. Patients with high fever, clear meningeal syndrome, accompanied by disorders of consciousness such as confusion, psychosis, severe coma. The disease progresses to death if not treated, even with correct treatment with Amphotericin B many patients still do not survive. Diagnosis is based on microscopy and cerebrospinal fluid culture to find Cryptococcus neoformans.

Cytomegalovirus (CMV) encephalitis:

Progressive encephalitis that causes rapid collapse and death of the patient. In addition to encephalitis, CMV also causes pneumonia, gastrointestinal mucosa, retinitis leading to blindness.

Progressive multifocal white matter encephalitis:

It is likely caused by Papovavirus. Symptoms vary from frequent headaches to behavioral disorders, mental disorders ...

Opportunistic infections in the digestive tract

Diarrheal caused by Cryptosporidium:

This fungus invades the endothelial cells of the gastrointestinal mucosa causing diarrhea like in cholera patients. The patient has diarrheal to water several times and lasts for many weeks leading to the water, electrolyte disorders, acidosis and exhaustion, and death. Diagnosis is confirmed by fungal fecal examination.

Inflammation of the gastrointestinal tract mucosa caused by Mycobacterium avium:

Bacteria work directly on the lining of the gastrointestinal tract, causing inflammation of the stomach, intestines and gradually atrophy of the villi. Patients with abdominal pain and diarrheal have many times water discharge and at the same time poor absorption of food, so leading to depletion very quickly. A confirmed diagnosis is also by fecal culture for bacteria.

Opportunistic infections of the skin

In the stage of acute infection: There may be a maculopapular rash or measles papules ... accompanied by acute infection symptoms.

The following stages: possible types of lesions:

Macular papules or folliculitis.

A butterfly-shaped rash is similar to that seen in lupus erythematosus and dermatitis.

Herpes simplex or shingles (Herpes zoster).

Molluscum contagiosum: This usually occurs in patients infected with HIV / AIDS in the late-stage or AIDS. Lesions are dark papules, irregular in size (1-10 mm in diameter). The papule is concave in the middle and is scattered over a large area.

Genital warts: Genital warts are an organ of the genitals and anus. Genital warts lesions are caused by a virus of the group Papovaviruses. Genital warts also develop in patients with late HIV / AIDS or AIDS.

Leukoplakia (hairs) in the mouth: Leukoplakia are slightly raised, the limits are not pronounced, the surface is wrinkled and there are small hairs appearing on the tongue - especially the lower margins of the tongue. - in people who are homosexual.

Disease caused by oral candidiasis.

Yellow nail Syndrome: in AIDS patients, yellow nails can be seen at the end, the nail surface has longitudinal or horizontal ripples and nail destruction may occur. There is the author's comment that AIDS patients with yellow nail syndrome often have pneumonia caused by Pneumocystis carinii.

Hyperalgesia Pseudo-thrombophlebitis Syndrome: The disease presents symptoms similar to deep thrombophlebitis.

Hemorrhagic inflammation due to immune complexes (Immuno-complex vasculitis) accompanied by bleeding under the skin ...

Cancer found in AIDS

Sarcoma Kaposi:

Cancer of the vascular wall, mainly lymphatic vessels is manifested by red lumps on the surface of the skin, oral mucosa, and throat with a diameter of 1-2cm, no itching, no pain. Lesions can be found everywhere and they grow rapidly. It is divided into 4 degrees:

Grade 1: Limited skin damage (less than 10 lesions or localized).

Grade 2: Invasive skin lesion (over 10 lesions and localized in many regions).

Grade 3: Only damage in internal organs (common indigestion, lymph nodes).

Grade 4: Lesions both on the skin and internal organs.

Lymphoma:

Malignant tumors are commonly found in the brain, lymph nodes, and bone marrow, of which the brain is the most common organ and causes localized syndromes (paralysis), psychosis, convulsions, and death.

Factors and prognosis of HIV / AIDS

On average, from HIV infection to progression to AIDS lasts 10-12 years. However, some patients progress quickly from AIDS within a few months. Others (about 5%) after 15-20 years still do not progress to AIDS and TCD4 cells still do not decrease.

Clinical prognostic factors

Patients with oral candidiasis are often at risk of developing pneumonia caused by P. carinii.

Patients with oral hairy leucoplakia and shingles are often at risk of progression.

Homosexual male patients with systemic lymphadenopathy, shingles, leucoplakia, and systemic symptoms have 2 years of AIDS development, respectively 22%, 25%, 39, 42, and 100 %. Meanwhile, asymptomatic patients only had 16% after 2 years of developing AIDS.

Prognostic factors for testing

TCD4 cell count is the most obvious prognostic factor. The rapidly declining number of TCD4, the higher the risk of progression to AIDS. Patients with> 7% reduction in TCD4 count in one year have a 35-fold increased risk of developing AIDS compared to patients with stable TCD4.

Patients with high viral load (HIV - RNA) or serum P24 antigen are also at increased risk of developing AIDS faster. Mellor’s and CS followed the progress of HIV-infected people for 6 years in a large number of patients, finding:

If HIV concentration is £ 500 copi / ml, then 5.4% = AIDS.

If HIV concentration is £ 500 - 3,000 copi / ml, then 16.6% = AIDS.

If HIV concentration is £ 3000 - 10,000 copi / ml, then 55.2% = AIDS.

If HIV concentration> 30,000 copi / ml, then 80% = AIDS.

HIV test diagnosis

Currently, there are many techniques to test for HIV infection

Anti-HIV antibody detection techniques: Serodia, ELISA, Western Blot, Latex agglutination, immunological radiation (RIA), immunofluorescence (IFA) ... In anti-HIV antibody detection techniques, screening tests and definitive tests (like the Western Blot) are divided.

Tests to detect HIV and HIV antigens

 HIV isolation, P24 antigen detection, PCR (HIV-RNA detection). These techniques require very modern laboratories, making it difficult to implement.

Currently, our country mainly using anti-HIV antibody detection techniques. According to the document "Guidelines for diagnosis and treatment of HIV / AIDS" of the Ministry of Health in May 2000, the current regulations on HIV infection diagnostic testing in our country are as follows:

HIV antibody detection test for adults and children ³ 18 months old

A blood sample known as an HIV antibody is positive when all three tests with three different antigen products and different reaction principles are positive.

Diagnostic tests for HIV infection in children under 18 months of age

Children <18 months old when antibodies to HIV (+) need to be sent serum samples to the National Institute of Hygiene and Epidemiology or Pasteur Institute of Ho Chi Minh City for testing P24 antigen or PCR technique.

Treatment of HIV / AIDS infection

Treatment of HIV / AIDS infected people

Currently, we do not have conditions to measure the concentration of the virus in the serum, so all treatment decisions are based on the clinical manifestations and the number of CD4 cells in the blood.

Hospitals (treatment facilities) provide treatment for HIV / AIDS-infected people according to instructions, and at the same time coordinate with relevant agencies to organize the monitoring and good management of HIV / AIDS-infected patients in the community.

Direction of treatment

Targeted treatment

Antiretroviral (anti-HIV) treatment.

Treatment against opportunistic infections.

Care, nutrition, improve health.

Antiretroviral therapy.

Current groups of antiretroviral drugs: (3 types)

The nucleoside reverse transcriptase inhibitors (NRTLs) include: Zidovudine (ZDV, AZT); Didanosine (ddI); Lamivudine (3TC); Zalcitabile (ddC); Stavudine (Zerit, d4T) ...

Non-nucleoside reverse transcriptase inhibitors (NNRTLs) of this group include Nevirapine (Viramune); Delaviridine; Loviride ...

Protease inhibitors (Pis), drugs of this group include Indinavir (Crixivan); Nelfinavir; Ritronavir; Saquinavir ...

Criteria for initiation of treatment for people living with HIV 

Proceed with treatment when:

HIV infection has clinical symptoms, including recurrent mucosal candidiasis, hairy leukoplakia, fever lasting more than one month, persistent diarrheal, weight loss. etc ...

HIV infection has no clinical symptoms but has a CD4 count <500 / mm3 of blood.

HIV infection has no clinical symptoms and has a CD4 count> 500 / mm3 of blood. If it is possible to measure the concentration of HIV in the blood, then initiate treatment for:

Patients with 30,000 - 50,000 copies / mm3 or

Patients with TCD4 decrease rapidly, although only 5,000-10,000 copies / mm3.

Combination of 2 drugs

For HIV-infected people with clinical manifestations, those whose CD4 count is 200 - 499 cells / mm3; RNAs of 5,000 - 10,000 copies / mm3 (bDNA), use one of the following combinations:

Zidovudine + Lamivudine:

Zidovudine 600 mg/day in 3 divided doses (every 6 hours).

Lamivudine 300 mg/day in 2 divided doses.

Currently, the combination of these 2 drugs is Combivir (1 tablet includes Lamivudine 150 mg and Zidovudine 300 mg; 2 tablets per day)

Didanosine + Stavudine:

Didanosine 250 mg/day in 2 divided doses 1/2 hour before meals.

Stavudine 80 mg/day in 2 divided doses.

Zidovudine + Didanosine:

Zidovudine 600 mg / day in 3 divided doses.

Didanosine 250 mg/day in 2 divided doses 1/2 hour before meals.

Combine 3 drugs

Applicable to HIV-infected people with marker diseases (clinical category C according to CDC classification) or CD4 cell less than 200 cells / mm3 or HIV RNA above 10,000 copies / mm3, applicable 1 in the following combinations:

Combivir + Indinavir:

Combivir take 2 capsules a day

Indinavir 2400 mg/day in 3 divided doses, once every 8 hours; drink 1 hour before meals or 2 hours after meals; drink a lot of water.

Zidovudine + Didanosine + Indinavir:

Zidovudine 600 mg / day.

Didanosine 250 mg / day.

Indinavir 2400 mg / day.

Zidovudine + Zalcitabine + Indinavir:

Zidovudine 600 mg / day.

Zalcitabine: Tablets 0.75 mg orally 3 tablets every 8 hours, avoid taking with antacids or drugs containing albumin.

Indinavir 2400 mg / day.

Stavudine + Lamivudine + Indinavir:

Stavudine + Didanosine + Indinavir:

Note Dosage of protease inhibitors: indinavir: 2400 mg/day; saquinavir: 1800 mg/day in 3 divided doses during the day; ritonavir: 1200 mg/day in 2 divided doses during the day.

Drug interactions

During treatment do not use a combination of drugs such as:

Zidovudine + stavudine.

Didanosine + zalcitabine.

Stavudine + zalcitabine.

Zalcitabine + lamivudine.

Because the combination of the above formulas will increase the toxicity of the drug.

Interactions between antiretroviral drugs and opportunistic infectious drugs:

Zidovudine:

Increased toxicity when used with co-trimoxazole, acyclovir, ganciclovir, interferon alpha, fluconazole, amphotericin B, flucytosine, vincristine, probenecid, if necessary, in combination with the above drugs, renal function, blood count, and, if necessary, reduce the dose.

Medicines that reduce zidovudine levels are rifampin, trimethoprim, ribavirin, indomethacin:

Didanosine:

Reduce absorption of ketoconazole, itraconazole, dapsone, tetracycline, fluoroquinolone, so Didanosine should be used 6 hours before or 2 hours after taking the above drugs.

When used with diuretics thiazide, furosemide, with drugs azathioprine, methyldopa, pentamidine, oestrogens, will increase the risk of pancreatitis.

When used with drugs dapsone, ethambutol, INH, metronidazole, nitrofurantoin, vincristine, zalcitabine may increase the risk of peripheral neuropathy. Do not take Diagnosing while on rifampicin.

Zalcitabine:

Use with drugs dapsone, ethambutol, INH, metronidazole, nitrofurantoin, vincristine, phenytoin can increase toxicity causing peripheral neuropathy.

Use with drugs pentamidine, alcohol, Diagnosing can increase the risk of pancreatitis.

Lamivudine:

Lamivudine increased effects when using co-trimoxazole.

Indinavir:

Rifampin drugs reduce indinavir levels, so do not use them in combination.

The drug ketoconazole increases the indinavir effect, so when used in combination, the dose of indinavir must be reduced (600 mg/time), 3 times, every 8 hours).

Ritonavir:

Contraindicated to use with drugs such as pain reliever: meperidine, piroxicam (Feldene), propoxyphene (darvon); ciozapine sedatives; antiarrhythmic drugs such as quinidine, amiodaron, encainide; antidepressants such as bupropion; barbiturates such as diazepam, clorazepate, midazolam (versed) trizolam (halcion), anti-mycobacterium rifabutin damage.         

Saquinavir:

Combination drugs that will reduce the concentration of saquinavir such as rifampin, rifabutin phenobarbital, dexamethasone, carbamazepine, phenytoin

Drugs that increase saquinavir levels such as fluconazole (increase saquinavir levels by 150%), itraconazole, ritonavir, indinavir.

Toxic drug reactions

When using antiviral drugs, it is important to pay attention to adverse drug reactions and when this reaction requires replacement with another drug or temporarily discontinue the drug.

Toxic reactions of zidovudine (azidothymidine):

Common

Less common

    Diphtheria

    Anemia

    Vomit

    Tired

    Insomnia

   Skin hyperpigmentation

    Muscle disease: muscle weakness, muscle atrophy

    Peripheral neuropathy

    Esophageal ulcers

    Fever

    Convulsions

Treatment with zidovudine requires a complete blood count once a month:

If the granulocyte is lower than 1000 / mm3, the drug should be stopped and the white blood cell count returns to normal, then continue using the drug. Neutropenia caused by zidovudine inhibits bone marrow, reduces bone marrow cells.

If anemia, decreased hemoglobin less than 8g / 100 ml, then stop zidovudine treatment. Weekly monitoring of the amount of hemoglobin in the blood, when hemoglobin returns to normal, continues with zidovudine.

If muscle disease, muscle atrophy, or muscle weakness appear to make walking difficult, temporarily stop the drug or replace it with another medicine.

If vomiting is severe, temporarily stop the medicine until the vomiting stops, then use the medicine again or replace it with another medicine.

Toxic reactions of didanosine:

  Common

 Less common

    Diarrheal

    Increased amylase

    Jitter

    Headache

    Insomnia

    Pancreatitis

    Vomit

    Increased blood transaminases

    Agranulocytosis

    Anemia

    Rash

 

Pancreatitis: When using didanosine, but feel abdominal pain, vomiting, it is necessary to test for serum amylase. If amylase is elevated, temporarily stop the drug or replace it with another medicine.

Peripheral neuropathy such as pain, numbness in the legs, loss of reflexes, if severe it can damage motor. When there are signs of numbness or pain, temporarily stop the drug or replace it with another drug.

If the used long-term can increase blood uric acid, so the uric acid test is required.

Toxic reactions of zalcitabine:

Common

Less common

Peripheral neuropathy

Stomatitis

Rash

Anemia

Neutropenia

Tired

Headache

Pancreatitis

Vomit

Diarrheal

Increased blood transaminases

Toxic reactions of lamivudine:

Headache, fatigue, nausea, abdominal pain, diarrhea, peripheral neuropathy, lower neutrophils, elevated transaminases, pancreatitis.

Toxic reactions of stavudine:

Peripheral neuropathy with prolonged treatment, anemia, decreased leukocytes, pancreatitis, headache, increased transaminases.

Toxic reactions of stavudine:

Common

Less common

Indirect increase in bilirubin

Kidney stones, haematuria (so every day when taking the drug, drink plenty of water).

Increased transaminases

Headache

Nausea

Tired

Insomnia

Tinnitus

Blurred vision

Diarrheal

Rash

Thrombocytopenia

Toxic reactions of saquinavir:

Abdominal pain, diarrheal, headache, jaundice, elevated transaminase enzymes, rash sometimes confusing convulsions.

Toxic reactions of ritonavir:

Vomiting, diarrheal, headache, dizziness, vasodilation, pharyngitis, increased transaminases, hypercholesterolemia, hypertriglyceridemia.

Treat opportunistic infections

Agent

Preferred drug regimen

Alternative medicine regimen

1. Bacteria

Campylobacter Jejuni

Erythromycin 2g / day in 4 divided doses for 5 days

Ciprofloxacin 1g / day in 2 divided doses for 5 days or Norfloxacin 800 mg/day in 2 divided doses, orally, for 5 days

Chlamydia trachomatis

Erythromycin 2g / day in 4 divided doses for 7 days or Ofloxacin 300 mg/day for 7 days.

Doxycycline 200mg / day in 2 divided doses for 7 days.

Tuberculosis bacteria

(Mycobacterium tuberculosis)

INH 5mg / kg

Rifampicin 10 mg / kg

Ethambutol 15 - 20 mg / kg

Pyrazinamide 20-30 mg / kg

 

Mycobacterium avium complex (MAC)

Clarithromycin 1g / day in 2 divided doses, combined with ethambutol 15mg / kg / day

Rifabutin 300 mg / day in combination with ethambutol 15 mg / day

Salmonella

Ciprofloxacin 1 gram/day in 2 divided doses for 7-14 days

If isolating strains sensitive to ampicillin or co-trimoxazole, use ampicillin 2g / day in 2 divided doses or Cotrimoxazole (480 mg tablets) orally 4 tablets per day.

2. Fungal infections

Aspergillus

(fungal lung infection)

Amphotericin B 0.8 mg / kg / day intravenously until response

Itraconazole 200 mg / day in 2 divided doses

Pharyngeal albicans

Fluconazole 100 mg / day for 10-14 days

Itraconazole 200 mg/day in 2 divided doses for 10 to 14 days

Cryptococcosis neoformans (meningitis)

Amphotericin B 0.8 mg/kg / day intravenously for 10-14 days, then use fluconazole 400 mg twice a day for 2 days, then reduce to 400 mg/day for 10-14 weeks

Fluconazole 400 mg / day orally for 10-14 weeks, then maintenance therapy 200 mg / day or fluconazole 400 mg / day in combination with flucytosine 100 mg / kg / day

Histoplasma capsulatum

Amphotericin B 0.8mg / kg / day intravenously for 10-14 days, then use itraconazole 400 mg / day for 3 days and then reduce to 200 mg / day

Itraconazole 300 mg orally twice daily for 3 days then reduced to 100 mg/day

Penicillium marneffei

Amphotericin B 0.7-1mg / kg / day intravenously for 10-14 days, then use itraconazole 400 mg / day orally for 4 weeks, then maintain 200 mg / day

 

Itraconazole 300 mg orally twice daily for 3 days followed by 400 mg/day for 12 weeks

3. Parasitic infections

Trichomonas vaginalis

Metronidazole 2 grams orally a single dose

Metronidazole 0.5 grams orally 2 times/day for 7 days

Pneumocystis carinii (PCP)

Sulfamethoxazole 75 mg / kg / day in combination with Trimethoprim 15 mg / kg / day in 3 divided doses for 3-4 weeks

Trimethoprim 5 mg / kg / day in combination with dapsone 100 mg / day for 21 days or pentamidine 4 mg / kg / day intravenously for 21 days or clindamycin 600 mg intravenously or 300 mg orally every 8 hours combined with oral primaquin 15 mg / day for 21 days

Izopora belli

Cotrimoxazole (480 mg tablets) orally 4 capsules a day, divided into 4 times for 10 days, then 2 tablets/day for 3 weeks.

Pyrimethamine 75 mg/day in combination with folinic acid 5 - 10 mg/day orally for 3 weeks

Toxoplasma gondii

Pyrimethamine 50 mg/day in combination with sulfadiazine 1g / day in 2 divided doses and folinic acid 10-20 mg/day for 8 weeks

Pyrimethamine 50 mg/day in combination with folinic acid 10-20 mg/day and clindamycin 2 g / day for 8 weeks or Sulfamethoxazole 800 mg Trimethoprim 160 mg and (Co-trimoxazole tablet 960 mg) 4 tablets orally for 8 weeks, then maintain 1 capsule per day

4. Virus infection

Zona

Acyclovir 30 mg / kg / day IV or 800 mg orally 5 times / day for 10 days or famciclovir 500 mg orally 3 times / day or Valacyclovir 1g orally 3 times / day for 7-10 days

Foscarnet 40 mg/kg IV, given every 8 hours for 2-3 weeks

Herpes

Acyclovir 400 mg orally 3 times / day for 7-10 days or Acyclovir 5 mg / kg intravenously every 8 hours for 10 days

Famciclovir 250 mg orally 3 times/day for 7-10 days or Foscarnet 40 mg/kg intravenously every 8 hours for 21 days

Cytomegalovirus (CMV)

Foscarnet 60 mg / kg IV, given 8 hours apart for 14 - 21 days or ganciclovir 5 mg / kg infusion 2 times / day for 14 - 21 days

 

Preventive treatment of people exposed to HIV in occupational care

General principles

Counseling for people exposed to HIV (+) infected blood and body fluids.

Need to get blood to test HIV immediately and treat immediately without waiting for test results.

Try HIV again 1 month after taking the drug; 3 months and 6 months.

Lesions do not close the skin without treatment but just wash the skin.

Evaluate local exposure and treat the wound

Assessment of exposure properties:

Needlestick:

Need to locate lesions.

See the needle size (if the needle is large and hollow, the risk of infection is high).

See the depth of the needle stab.

Visible bleeding from the needle.

The wound caused by a scalpel, a test tube containing blood and fluid from an HIV-infected patient is broken into the skin:

It is necessary to determine the depth and size of the wound.

Pre-damaged skin and mucous membranes:

Skin lesions due to Melaleuca, burns, or pre-existing ulcers.

Eye or nasopharyngeal mucosa.

Treatment on the spot

Skin: Wash thoroughly with soap and clean water, then disinfect with 1/10 dilute solution of Dakin or Javel water or 700 alcohol, leave in contact with the affected area for at least 5 minutes.

Eyes: Rinse the eyes with distilled water or isotonic saline serum (0.9%), then administer with distilled water continuously for 5 minutes.

Mouth, nose: Wash the nose with distilled water, rinse with isotonic saline serum (0.9%).

Preventive treatment

The best treatment time is from the first hours (2-3 hours after the accident), no later than 7 days.

If the lesion only scratches the skin and does not bleed or the patient's blood or fluid is shot into the nose and throat, combine 2 drugs for 1 month according to the instructions above.

If the damage is deep, bleeding a lot, then combine 3 drugs for 1 month according to the instructions above.

Preventive treatment of HIV transmission from mother to child

Treatment of HIV-infected pregnant women to prevent mother-to-child transmission

Treatment of HIV-infected pregnant women with the aim of reducing mother-to-child transmission, if the mother and her family, after counseling, still want to keep the pregnancy.

Treatment before and during childbirth:

Depending on the conditions, one of the following two regimens can be chosen:

Regimen using Nevirapine.

Indications: At the beginning of labor or before cesarean section.

Treatment: Take 1 tablet of nevirapine 200 mg once.

Monitor labor and continue to deliver as normal.

Regimen for Zidovudine:

Zidovudine 600 mg/day, in 2 divided doses, starting from 36 weeks gestation until labor. In the case of late pregnant women (after 36 weeks), also give the above dose until labor.

During labor, continue to take zidovudine 300 mg/time, once every 3 hours until the time of pairing and cutting umbilical cord, stop taking the drug.

It is necessary to add anti-anemia medication by supplementing with iron or folic acid tablets.

If the mother has an accompanying OI, treat it like any other OI or send it to a specialist for correct and reasonable medication indications.

Points to take during delivery

For pregnant women:

Absolutely guaranteed when giving birth.

Wipe the vagina several times with a cotton pad soaked in Chloruretic Benzalkonium or 0.2% Chlorhexidine solution.

Do not shave your guard area.

Cesarean section only when indicated obstetric.

Counsel the mother on the benefits of breastfeeding, if possible, to reduce the risk of transmission.

For newborn babies

Do not place the electrode in the fetal head.

Do not take blood on the fetal scalp as pH.

Bathe your baby right after birth.

Right after the baby is born, the medical staff in the delivery room must notify the Pediatric Department so that the baby can receive special care in the Obstetrics and Pediatrics departments of the hospital.

Treatment after giving birth

Treatment for children:

If the mother is taking nevirapine, give the infant a single dose of nevirapine syrup 2 mg/kg body weight, within 72 hours of birth.

If the mother takes zidovudine, give the child zidovudine syrup 2 mg/kg/6 hours, starting about 8-10 hours after birth, lasting for 6 weeks. Where zidovudine syrup is not available, use nevirapine syrup as in section 3.1.1.

Treatment for the mother:

If necessary and possible, specific treatment will be applied according to one of the regimens introduced in part B.

Indications for termination of pregnancy

For babies who are still small (under 3 months), after being counseled, if the pregnant woman and her family agree to have an abortion, the abortion will be resolved by suction or abortion according to the gestational age. These cases will be performed at a surgical facility (with an obstetrician, operating room).

After the abortion, continue treatment as other HIV-infected patients.

If the woman wants to keep the pregnancy, the primary health care provider should send it to the obstetrics department of the provincial hospital or a higher technical level for management.

Treatment of children with HIV/AIDS

Antiretroviral treatment

Points:

Children infected with HIV have clinical symptoms according to classification A, B, C.

HIV-infected children are immunocompromised according to classifications 2, 3 (classification based on CD4 lymphocytes).

Babies born to HIV (+) mothers within 6 weeks of birth, definitive pending diagnostic testing.

Treatment mode:

Treatment with 1 drug zidovudine.

Babies 0-6 weeks old.

Syrup of zidovudine 2 mg/kg/6 hours, starting about 8-10 hours after birth.

Treatment with combination drugs for children under 13 years old

The method of drug combination as directed above, the drug dosage is as follows:

Zidovudine: 5 mg/kg orally 3-4 times/day.

Didanosine: 5 mg/kg used 3-4 times/day.

Zalcitabine: 0.01 mg/kg x 3 times/day.

Lamivudine: 4 mg/kg x 2 times/day.

Treatment of common opportunistic infections

Respiratory tract infections:

Pneumocystis carinii pneumonia:

Trimethoprim 20 mg/kg/day + sulfamethoxazole 100 mg/kg/day, 14-21 days

Cryptococcal pneumonia:

Amphotericin B: 0.25 mg/kg/day, intravenously later increased to 0.5 mg/kg/day, for 6 weeks.

Pulmonary tuberculosis or generalized tuberculosis:

According to the instructions in section E.

Cytomegalovirus pneumonia:

Ganciclovir 5 mg/kg/time, 2 times/day, 14-21 days.

Pneumonia is caused by common bacteria such as Hemophilus influenzae, S.pneumoniae, Klebsiella… Choose appropriate antibiotics.

Gastrointestinal infections:

Oral and pharyngeal candidiasis.

Nystatin (Myconistine) topical.

Herpes simplex causes mouth and anal ulcers.

Acyclovir: 5 mg/kg/time, 3 times/day, 5-14 days, orally or intravenously.

Enteritis caused by Salmonella, Shigella, Campylobacter:

Restore water and electrolytes.

Nutrition.

Appropriate antibiotics.

Skin infections:

Herpes zoster:

Acyclovir 5-10 mg/kg/time, 3 times/day, for 7 days, orally or intravenously.

Due to bacteria, fungi: Choose the appropriate antibiotic.

Nerve infections:

Cryptococcal meningitis. Amphotericin B: 0.25 - 0.5 mg/kg/day, used for 6 weeks.

Toxoplasma in the brain. Pyrimethamine 25 - 50 mg/day in combination with sulfadiazine 150 mg/kg/day in combination with sulfadiazine 150 mg/kg/day, for 3-6 weeks.

Treatment of other diseases

Treatment of people with TB/HIV/AIDS

Treat HIV/AIDS infection according to these guidelines in combination with TB treatment.

Guidelines for the treatment of HIV-infected TB patients according to the formula:

2HRZE/6HE.

Two months of daily induction therapy with four drugs: izoniazid (H), rifampicin (R), pyrazinamide (Z), and ethambutol (E). Six months of consolidation therapy with 2 drugs izoniazid and ethambutol daily. The dose is as follows:

Isoniazid (H): 5 mg/kg.

Rifampicin (R): 10mg/kg.

Pyrazinamide (Z): 25 mg/kg.

Ethambutol (E): 15 mg/kg.

If good anti-infection protocols are ensured, the same regimens can be used for TB patients without HIV, which are:

2SHRZ/6HE is indicated for newly discovered cases:

In the first two months, use 4 drugs streptomycin (S) 15 mg/kg, izoniazid, rifampicin, pyrazinamide daily, the dose as above.

Six months later, taking 2 drugs izoniazid and ethambutol daily, the dose as above.

2SHRZE / 1HRZE / 5H3R3E3 is indicated for cases of relapse after treatment according to the following formulas:

The first two months of taking 5 drugs: Streptomycin, izoniazid, rifampicin, pyrazinamide, ethambutol daily, dose as above.

3rd-month use 4 drugs: izoniazid, rifampicin, pyrazinamide, ethambutol daily, dose as above.

For the next five months took 3 drugs: izoniazid, rifampicin, ethambutol 3 times in a week. The dose is as follows:

Isoniazid (H): 3 times/week intervals: 10 mg/kg.

Rifampicin (R): 10 mg/kg/24 hours.

Ethambutol (E): 3 times/week intervals: 30 mg/kg.

Warning points

Medical staff must directly supervise treatment in the first 2 months.

Streptomycin is not indicated to treat tuberculosis in HIV-infected people to avoid HIV transmission through injection. However, if it is possible to use a disposable syringe, streptomycin can be used because streptomycin is a very good bactericidal drug for treatment in the early stages.

Thiacetazone (T) is not indicated for the treatment of tuberculosis in HIV-infected people because of the risk of many side effects, even death.

Formulas containing streptomycin or thiacetazone are replaced with ethambutol.

Treatment of sexually transmitted diseases

Treatment of HIV/AIDS infection according to these guidelines is combined with treatment for sexually transmitted diseases.

Professional regulations on handling and taking care of HIV/AIDS patients

Management of people living with HIV and AIDS patients

For people living with HIV:

Health authorities at all levels, hospitals, and clinics need to master the list of people living with HIV (+) under their management.

People living with HIV need to be consulted and advised by medical staff.

HIV-infected people should be managed, not given blood, organs, and semen. When having sex, use a condom.

HIV-infected people do not need inpatient treatment but should be checked periodically (3-6 months) for early detection of AIDS. Outpatient treatment is possible.

Spouses of people living with HIV should be tested for HIV.

For patients with AIDS or suspected AIDS:

People living with HIV need to be tested periodically (every 3 - 6 months) for early detection of AIDS.

HIV-infected people with symptoms of AIDS must:

Examined by experts from the AIDS Clinical Subcommittee.

If there are signs of suspicion of AIDS then:

Get tested for HIV if you haven't already.

Check CD4 CD8.

Check for opportunistic diseases.

In the immediate future, all patients with suspected AIDS must be admitted to the hospital to confirm the diagnosis, if AIDS is excluded, they will be returned to the old treatment facility and cared for as normal patients.

AIDS patients must be counseled so that the patient can rest assured not to be pessimistic.

AIDS patients need to be kept in a separate room, a separate area in the Department of Infectious Diseases.

When there is a case of HIV infection, it must be reported immediately to the superior management agency and the AIDS prevention and control committee.

Ensure the safety of medical staff and caregivers

AIDS patients, HIV-infected people when entering inpatient treatment need to stay in a separate room, a separate area in the Department of Infectious Diseases. All household tools, as well as professional tools, must be used separately.

It is necessary to limit the patient's contact with other patients when not necessary. Pay attention to isolation to prevent the spread, not to isolate the sick person.

Encourage relatives to take care of the sick person.

There are no indications for separate use of books, tables, chairs, and chopsticks.

Medical staff taking care of patients:

There is dedicated staff.

Wear gloves when handling blood and other specimens. Disposable gloves.

In case of skin contact or contamination with blood smear, wash hands immediately with soap, or alcohol 700 or alcohol iodide.

Do not give mouth-to-mouth breathing.

Relatives caring for the patient must have professional permission:

Caregivers need to wear gloves and masks like staff.

Caregivers and medical staff directly serving pregnant women must pay close attention.

Staff directly serving patients and caregivers:

Must be tested for HIV periodically.

Prevention of HIV transmission to others in the treatment facility

Use of blood and blood products:

Limit blood transfusions and blood substitutes as much as possible.

HIV testing of blood donors.

Strictly abide by the regulations of the blood transfusion room.

It is forbidden to use the blood, tissues, organs, semen, and placenta of HIV-infected people.

Using tools in diagnosis and treatment

Limit infusion to patients, when single-use syringes are required. Do not use the automatic press to draw blood (an instrument used for many people). When using a pipette to draw blood, use a squeeze ball, not a suction mouth. Do not use acupuncture needles for HIV-infected patients.

Floors, countertops that are soaked with the patient's excreta or blood must be covered with disinfectant, then wiped with a cloth or absorbent paper, then scrubbed with soap.

The cloth used by the patient must be collected and placed in a plastic bag and treated with chemicals for 20 minutes before being sent to the laundry.

Cotton, bandages, gauze after each use must be burned without re-steaming.

Collecting and transporting specimens

Only authorized personnel may have blood drawn for HIV testing.

Must have a separate patient vial

When taking blood, use a squeeze ball, not aspirate.

Specimens are stored in sealed containers with tight-fitting lids when transported.

Information about the examiner must be kept confidential.

Handling and autopsy

In the clinical department:

Wash the cadaver with 0.5% Na hypochlorite (very difficult in practice). Insert cotton into natural holes.

Wrap the corpse with white cloth and yellow nylon on the outside.

Put the corpse in a sealed plastic bag.

The body stretcher has to be covered with plastic, then the plastic is left in the morgue.

Employees doing martyrdom work: wear hats, masks, gloves, boots, work clothes.

In the pathology department:

No autopsies of AIDS patients.

Universal incarnation is the best.

If an autopsy is required:

Cloth and yellow nylon unfolded on the operating table.

The mortuary staff has their own clothes.

After the surgery, wrap the body with white cloth and yellow nylon and put it in a clear plastic bag.

Soak the specimen in the fixative for no more than 48 hours.

Disinfection Disinfection:

Dissection tools: soap washing, sterilization.

Walls and floors of the operating table: Wipe the antiseptic solution and wait for 60 minutes before cleaning.

Fabrics are put in plastic bags for separate handling.

Sterilize the environment and medical instruments used to serve HIV/AIDS patients

Disinfection method:

Steam (steamed by automatic boiler):

Suitable for reusable tools.

The minimum time is 15 minutes from the time the autoclave reaches 121 0C.

The steamer is not too thick.

Autoclaves should be periodically validated against biological indicators.

Drying:

Dry heat sterilization is a suitable method for tools that can withstand temperatures of 170 °C, not suitable for plastic tools that cannot withstand heat.

Standard: 2 hours since the instruments reach 170 0C.

High level disinfection method:

Boil:

Boil only when there is no condition for steaming or drying. Time 20 minutes from boiling.

Soak in chemicals:

Many chemicals can kill HIV, but this chemical can be neutralized by blood and organic substances.

Chemical cleaners are not used for syringes and needles.

Instruments soaked in chemicals must be wiped clean before soaking.

Commonly used chemicals are:

Glutraldehydum 2%:

Soak the tool for 30 minutes to kill viruses, fungi, bacteria for 10 hours to kill spores.

Each time the solution is mixed with no more than 2 options, if it is cloudy, it must be removed immediately.

After soaking, wash the instruments with sterile water to remove glutaraldehyde, then put the instruments in a sterile container.

Hydroperoxide solution 6%:

Immerse the tool for 30 minutes.

After soaking, wash the instrument with sterile water, then put the instrument in the sterile box

Disinfect surfaces (tables, chairs, beds, walls, floors) with a chlorinated compound:

Sodium hypochlorite (Javel water).

Calcium hypochlorite.

Sodium dichlororisocyanurite (Na Dcc).

Chloramine.