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HIV-INFECTION AND COMORBIDITIES
HAFFARESSAS Y. Lobachevsky University, Nizhny Novgorod, Russia e-mail: yacinechabani@yandex.ru
Abstract
The Human Immunodeficiency Virus (HIV) targets the immune system and weakens people's defense systems against infections and some types of cancer. As the virus destroys and impairs the function of immune cells, infected individuals gradually become immunodeficient. Immune function is typically measured by CD4 cell count. Immunodeficiency results in increased susceptibility to a wide range of infections, cancers and other diseases that people with healthy immune systems can fight off. The most advanced stage of HIV infection is Acquired Immunodeficiency Syndrome (AIDS), which can take from 2 to 15 years to develop depending on the individual. AIDS is defined by the development of certain cancers, infections, or other severe clinical manifestations. In this article we will try to understand the problem of HIV infection and also know the different comorbidities encountered during HIV infection.
Keywords: HIV Infection, AIDS, CD4+, Antiretroviral therapy (ART), Comorobidities.
HIV (human immunodeficiency virus) is a virus that attacks the immune system, the body's natural defense system. Without a strong immune system, the body has trouble fighting off disease. Both the virus and the infection it causes are called HIV. White blood cells are an important part of the immune system. HIV infects and destroys certain white blood cells called CD4+ cells. If too many CD4+ cells are destroyed, the body can no longer defend itself against infection. The last stage of HIV infection is AIDS (acquired immunodeficiency syndrome). People with AIDS have a low number of CD4+ cells and get infections or cancers that rarely occur in healthy people. These can be deadly. But having HIV doesn't mean you have AIDS. Even without treatment, it takes a long time for HIV to progress to AIDS - usually 10 to 12 years. When HIV is diagnosed before it becomes AIDS, medicines can slow or stop the damage to the immune system. If AIDS does develop, medicines can often help the immune system return to a healthier state. With treatment, many people with HIV are able to live long and active lives. There are two types of HIV: HIV-1, which causes almost all the cases of AIDS worldwide; HIV-2, which causes an AIDS-like illness. HIV-2 infection is uncommon in North America.
Transmission. HIV is transmitted through body fluids: blood, sperm, vaginal secretions and breast milk. These body fluids transmit HIV only if they come into contact with an area that allows it to enter the body, a mucous membrane. Healthy skin is
impervious to HIV. Most often, the virus is contracted during unprotected sexual activity or was in the past through needle exchange among inj ecting drug users. The risk of transmission through kissing with saliva exchange is zero. In most industrialized countries, male intercourse is the most important route of HIV transmission. However, heterosexual transmission has increased significantly since the beginning of the epidemic. HIV is not spread in the following ways:
You cannot contract it with a handshake, sweat or tears. It is not carried by insects. It is not contracted on toilet seats, swimming in public swimming pools, sharing food or using the linen, towels or telephone of an infected person.
The epidemic. In North America, the first signs of the epidemic appeared in the late 1970s. Men who have sex with men (MSM) were the first to be affected; The HIV virus was isolated in 1983; The first antiretroviral therapy, AZT, was discovered in 1987. Triple combination therapy, which was much more effective, became available in the mid-1990s, and increasingly powerful antiretroviral therapy (ART) suggests that an HIV-positive young adult who starts treatment quickly will be able to live to age 80 or older. With these treatments, one often arrives at an undetectable viral load, even if the virus is still not eradicated from the body. Around 35 million people around the world are living with HIV today. Two-thirds of them live in sub-Saharan Africa. In North America, 1.3 million people are living with HIV, 840,000 in Western and Central
Europe, and 22.9 million in Sub-Saharan Africa. The number of people living with HIV is increasing worldwide, with 2.5 million new infections a year and 1.5 million deaths. This is due to the considerable improvement in the effectiveness of the treatments. About 7000 HIV-positive discoveries in France (2012 figures), nearly half of them among men who have sex with men (MSM), and 3000 AIDS deaths in the year. In Canada, 71,300 people were living with HIV in 201136. An estimated 3175 new infections in 2011. This, however, underestimates the actual number of cases, as an estimated 25% of Canadians living with HIV do not know being. We know today that a well-groomed HIV-positive person presents an extremely low risk of transmitting HIV during sex, under certain conditions:
The treatment is taken regularly; It causes an undetectable viral load (or viral load below the threshold of 50 copies / ml in the plasma for more than 6 months and at the last most recent test); The measurement of the viral load is done regularly, at least every 3 or 4 months; Both partners do not have a sexually transmitted infection.
There is currently no cure for AIDS or elimination of HIV from the body, even when it becomes undetectable by exams. This does not mean that the virus is eradicated from the body. That said, with the right treatments, an HIV-positive person can now live long. HIV infection has become a chronic disease. HIV-positive people, however, are still likely to transmit HIV throughout their lives, especially if they are not well treated. Untreated HIV infection causes AIDS and eventually leads to death. With HIV infection becoming better and better, some at-risk populations are slowing down their prevention efforts.
Evolution of infection to AIDS.
1st phase - primary infection. In the weeks following infection, about one-third of those affected have symptoms similar to influenza or mononucleosis: fever, headache, sore throat, redness on the skin, fatigue, muscle aches, etc. These symptoms disappear on their own, even without treatment.
2nd phase - asymptomatic infection. The virus can live in the body for many years without causing symptoms. The person may feel that they are not sick, but is likely to transmit HIV. Seroconversion -the time when an HIV-negative person (no antibodies in the blood) becomes HIV-positive (presence of antibodies in the blood) - occurs during this phase, 1 to 3 months after infection.
3rd phase AIDS phase (acquired immunodeficiency syndrome) or symptomatic infections. If left untreated, the person experiences one or more symptoms of HIV infection (fatigue, diarrhea, swollen glands, weight loss, night sweats, fever, etc.).
4th phase - If the number of immune cells (CD4 T cells) becomes very low and the body can no longer fight against other infections or diseases, the diagnosis of AIDS is made. The symptoms of the infection become more apparent and constant. In addition, opportunistic infections can cause significant health problems. Opportunistic infections are infections that are usually not serious, but become so in people with very weak immune defenses. Opportunistic diseases include, for example, candidiasis, pneumonia, tuberculosis, herpes infections, and also cancers (including lymphoma and Kaposi's sarcoma).
Note. Research has shown that cardiovascular disease is more common in people with HIV because their body is subject to a higher degree of inflammation. Inflammation is known to contribute to the formation of plaques in the artery walls, which can impede the flow of blood. In addition, cases of cognitive degeneration (eg, Alzheimer's disease) related to HIV infection have also been reported.
The fact that HIV directly takes control of the immune system makes it particularly dangerous. To find out how the virus manages to enter and multiply in immune cells called CD4 T cells (fig. 1).
The symptoms of AIDS (HIV)
1st phase or primary infection. The symptoms resemble those of influenza or mononucleosis and are present in about one in two cases. Primary infection can go unnoticed. At the moment of their appearance, the person who has just contracted HIV presents a particularly high risk of transmitting the virus, because the number of viruses present in the
body (viral load) is particularly high. These symptoms persist for 1 week to 1 month, then disappear: Fever; Headache; Sore throat; Redness on the skin; Fatigue; Muscular and particular pains.
2nd phase or asymptomatic phase. The HIVpositive person has no symptoms, even though the virus attacks the immune system mute (no symptoms).
3rd phase or AIDS phase. The symptoms appear because the immune system is overwhelmed by the virus. Some symptoms become more frequent, persistent and sometimes chronic, for example:
Fever; Night sweats; Significant weight loss; Swelling of the ganglia; Persistent diarrhea; Skin infections; Persistent dry cough; Shortness of breath.
At this stage, opportunistic diseases appear. Because of the weakening of the immune system, various diseases can occur, particularly infectious diseases or cancers. We talk about opportunistic diseases. This phase occurs on average 10 years after the primary infection.
People at risk and risk factors for HIV / AIDS
People at risk. People living in a country or from a country where HIV-infection is widespread (for example, sub-Saharan Africa and the Caribbean); Children born to an HIV-positive mother who has not been treated. The virus is likely to be transmitted during pregnancy or delivery, but also during breastfeeding; People in jobs that expose to blood or other body fluids (health professionals, police officers, firefighters, etc.); People who received a blood or blood product transfusion or organ transplant from 1979 to November 1985 (when the HIV test was developed).People with unprotected sex with multiple partners. Men having sex with men. It is a population in which the number of cases of HIV transmission increases while it tends to decrease in the rest of the population (INVS). The risk of contracting HIV is 200 times higher for these men than for men who have only heterosexual sex.
Risk factors. Here are the risky behaviors. Have unprotected sex with someone who is infected with HIV. This includes vaginal or anal sex without condoms (condoms) and oral sex without condoms (condoms). People, who have mouth ulcers (cold sores) or sexually transmitted infections such as gonorrhea, syphilis, genital herpes, etc., are more likely to contract or transmit HIV. Having sex with multiple partners, with a partner who has or has had multiple partners, or with a partner who consumes or has used intravenous drugs and has used needle exchange. Share syringes for injecting drug users.
Get tattooed or "pierced" with equipment that is not for single use or non-sterile.
HIV / AIDS prevention
Screening measures. How is HIV diagnosed? HIV testing can only be done with the consent of the person being tested. It must therefore be aware. The HIV test is to detect the seropositivity, that is, the presence of anti-HIV antibodies in a blood sample. The reference method used is the combined ELISA test, performed from a blood test. This test is reliable as early as 6 weeks after taking a risk for HIV transmission. Because of the risk of false positives (positive result in the absence of HIV in 0.5% of cases), in case of a positive result this test must be completed by another test, the Western Blot. There is also a rapid screening test or TROD (Rapid Diagnostic Orientation Test for HIV), carried out in some anonymous and free testing centers or in associative sites in France and in medical, clinical and hospital practices in Canada. The result of this test is reliable three months after taking a risk for HIV transmission. The result is obtained in 20 to 30 minutes. If this test is positive, it must be confirmed by a standard test performed in an analytical laboratory or an Anonymous and Free Screening Center (CDAG).
Who should be tested? People who have been in a situation at risk of contracting the virus; People whose symptoms may be due to HIV infection (to discuss with a doctor);
All women before starting a pregnancy or early in pregnancy to implement a treatment to prevent transmission to the unborn child; People donating tissues, sperm, milk, and organ are routinely screened;
People who are in a good relationship and want to stop using condoms, making sure that they are not HIV-positive; And everyone can get tested because 30-50% of people with HIV do not know it. However, it is people who are at the origin of the transmissions. Do not hesitate to ask for a screening if you have never done so.
When to take the test? The best time for a reliable HIV test is 3 months after you think you have taken a risk of HIV exposure.
Basic preventive measures. For HIV-negative people who do not have HIV. Use condoms for all sexual intercourse regardless of the modality. Do not share your toothbrush, razor, file or any other personal item that may be in contact with blood; For injection drug users, do not share syringes or injection equipment.
For HIV-positive people. Use condoms for every sexual relationship. Thus, not only will HIV not be
transmitted to the partner, but it will also prevent you from being exposed to HIV. Re-contracting HIV can worsen the already present infection and accelerate progression to AIDS. In addition, protecting yourself helps reduce the risk of contracting a sexually transmitted infection (STI). HIV-positive people are at increased risk of contracting sexually transmitted infections (STIs) and this can be more difficult to treat. Under certain circumstances, in case of zero viral load for a moment and closely followed by the examinations, in case of absence of STIs (sexually transmitted infection) of you and your partner, and of taking regular treatment, the doctor can allow not to use a condom. Do not share needles or devices associated with drugs; Do not share your toothbrush, razor, lime, or any other personal item that may carry traces of blood; Cover all wounds with a bandage; Clean any area contaminated by your blood with bleach (1 part bleach to 9 parts water); Do not give blood, organs or semen for artificial insemination; If you are pregnant, you should receive immediate treatment that will prevent the child from being infected with HIV. If your partner has been exposed to HIV, see a doctor as soon as possible, within 72 hours. Preventive treatment may be given ("postexposure prophylaxis").
Note. Researchers are working to develop a vaccine that would prevent HIV infection. However, the obstacles are numerous and cannot be expected to be available until 20203. It is very difficult to find molecules that completely neutralize the virus at its site of entry. In addition, HIV often mutates, that is, its genes change and therefore the duration of action of the vaccine can be very limited.
That said, some researchers believe that research for the vaccine should not overshadow progress: knowing that with effective treatment leading to undetectable viral load, HIV-positive people are almost no longer at risk of transmission ... it would be enough to treat ALL HIV-positive people so that the epidemic goes out in about forty years. This means that rich countries must help the most affected countries to eradicate this virus together. It also implies that screening is better deployed to treat each HIV-positive person quickly and to let as few people as possible get through the cracks. Other measures to delay the onset of AIDS and prevent opportunistic diseases. To support the body and the immune system, it is recommended to have healthy lifestyle: eat well, exercise, get enough rest, do not smoke, have a moderate consumption of alcohol etc. The use of emotional and spiritual support also
helps to cope better with stress. Since life expectancy with HIV has increased dramatically over the past 30 years, physicians are placing even greater emphasis on the importance of caring for one's health. To learn more, consult our sheet Strengthening your immune system. Several vaccinations may be indicated, depending on the case (against pneumococci, influenza, tetanus, diphtheria, hepatitis A and B, etc.). Despite the immune depression and less efficacy, it is possible to vaccinate an HIV-positive person. with a vaccine that does not contain a live infectious agent, that is, no bacteria or virus. Vaccines containing a live virus or bacteria with attenuated virulence are most often contraindicated (eg chicken pox, tuberculosis, yellow fever, measles, mumps ...) It is up to the doctor to determine useful and beneficial vaccines.
In order to avoid foodborne infections and intoxications, people living with HIV / AIDS should be particularly cautious and avoid certain raw foods (eggs, poultry, rare meat and tartars, fish and seafood) as well. Than unpasteurized dairy products. Great caution is also needed with pets or others, which can lead to serious opportunistic infections. Wash hands thoroughly after touching animals.
Medical treatments for AIDS / HIV
HIV-positive people should at all times take precautions not to transmit HIV. We know that this is the case because people who disseminate HIV in the population are essentially those who do not know their HIV status, hence the importance of screening. None of these treatments cure the disease, but thanks to them, the majority of people living with HIV can live for a very long time. In addition, the side effects of drugs are less troublesome than before. There are two main components of HIV / AIDS treatment: immediate treatment with antiretroviral therapy (ART) and opportunistic diseases.
Antiretroviral treatment (ART)
HIV is generally treated with highly active antiretroviral therapy (HIV being a retrovirus), a potent combination of at least 3 drugs. These antiretrovirals slow the progression of HIV by attacking the virus to minimize the viral load, which is the number of viruses (HIV) in the blood. The price of this ART has fallen considerably, reaching 139 to 172 dollars a year per person in 2013, or even less for countries purchasing large quantities. This allows the poorer countries to better treat their HIVpositive inhabitants. However, this price is that of treatments called front-line treatments. In case of resistance to treatment, there are second-line
treatments that are much more expensive and often difficult for everyone to access, particularly in countries without public or private health insurance systems. There are several classes of antiretroviral drugs, and several slightly different molecules in each of them.
Nucleoside reverse transcriptase inhibitors (NRTIs) (AZT or zidovudin) are part of this class of drugs, or abacavir, d4T or stavudin, ddl or didanosin, 3TC or lamivudin; Non-nucleoside reverse transcriptase inhibitors (NNRTIs); for example, nevirapin, delavirdin and efavirenz, rilpivirin, etravirin; Protease inhibitors (PIs); such as saquinavir, atazanavir, arunavir, lopinavir-ritonavir, nelfinavir, ritonavir, tipranavir; Inhibitors of entry and fusion. Used later in the disease, when the patient has already taken several other drugs; for example, enfuvirtide or T20; Inhibitors of integrase. Used later in the disease, when the patient has already taken several other drugs. dolutegravir, raltegravir; Inhibitors of CCR5 receptors, such as maraviroc.
The treatment is adapted to each person and it is a combination of several drugs. The goal of the treatment is to obtain in 6 months an undetectable viral load. Most people are treated with a combination of three drugs, and there are several possible choices depending on the effectiveness, immediate or long-term tolerance, the living conditions of each...
To be effective, the treatment must be followed to the letter, that is to say that you must take the tablets every day at the times prescribed by the doctor, and therefore be ready to adapt his lifestyle. Many of these medications are now available in a single daily dose. Fidelity to treatment is extremely important, as it also prevents the development of drug resistance (if the dosage of a drug drops in the body, it increases the risk that the virus is transformed or mutated to "survive"). In addition, we must find the best possible balance between the effectiveness of the treatment and the maintenance of a good quality of life. Adverse drug reactions can be significant: fatigue, headache, loss of appetite, rash, diarrhea, etc. Unique tablets have emerged (eg Atripla®, Eviplera®, or Stribild® combining 4 molecules). Instead of taking 3 or 4 antiretroviral drugs, for example, they are combined into a single tablet, taken once a day.
Note. Researchers are working to create "therapeutic vaccines" that would help the immune system fight infection and this research is advancing as clinical trials are underway. The goal of these vaccines will be to boost the immunity of HIV-
positive people to help their bodies fight HIV and opportunistic conditions.
Prevention and treatment of AIDS-related opportunistic diseases
When one is HIV-positive, it is necessary to undergo regular examinations to detect certain diseases at their early stage. You also need to receive certain vaccines and take medication to prevent frequent infections in people with HIV / AIDS. If an opportunistic infection occurs, the doctor may recommend continuing treatment even after healing to prevent recurrence. In case of cancer, chemotherapy or radiotherapy is used.
Other
Vitamin and mineral deficiencies are more common among HIV-positive people30. Some medicines can cut appetite, and fighting the virus requires more energy and nutrients. According to scientific studies, these deficiencies may accelerate the progression of infection to AIDS31-33. This effect was especially noticed in a disadvantaged environment. Many health professionals believe that taking a multivitamin and mineral supplement daily can be beneficial for people with HIV, especially if the diet is deficient. All people infected with HIV should be monitored for their sex hormone levels. In case of disability, hormone replacement therapy can be undertaken. In men, for example, hormone therapy can help maintain muscle mass or restore libido. Some people take marijuana (Cannabis sativa) to stimulate their appetite. Indeed, in Canada and the United States, Dronabinol (Prescription Synthetic THC) is approved to stimulate appetite for anorexia in people with AIDS. This medicine is obtained on prescription.
AIDS / HIV: complementary approaches
The herbs, supplements and therapies mentioned below can not replace medical treatment. They have all been tried as adjuvants, that is to say, in addition to the main treatment. HIV-infected people use complementary therapies to enhance their general well-being, reduce the symptoms of the disease, and combat the side effects of triple therapy.
In support of and in addition to medical treatments
Probable effectiveness Stress management. Many studies indicate that the use of different stress management or relaxation techniques not only improves quality of life by reducing anxiety and stress and improves mood, but also has a positive impact on people's immune status. living with HIV or AIDS [1, 2, 11, 14, 16]; Effectiveness possible Physical exercise. Several studies indicate that
physical activity in HIV-positive people gives positive results in several areas: quality of life, mood, stress management, resistance to effort, weight gain, immunity [13, 19, 22, 23]; Uncertain efficacy Acupuncture. A few controlled studies have looked at the effects of acupuncture on people with HIV or AIDS.
The results of a trial of 23 HIV-infected individuals with insomnia indicate that 2 acupuncture treatments per week for 5 weeks significantly improved the duration and quality of their sleep [21]. In a study conducted by Chinese researchers, a 10-day daily acupuncture treatment reduced several of the symptoms of 36 hospitalized patients: fever (in 17 out of 36 patients), limb pain and numbness (19 / 26), diarrhea (17/26) and night sweats (12/33) [28]. In another trial of 11 HIV-infected subjects,2 acupuncture treatments per week for 3 weeks resulted in a slight improvement in quality of life in treated patients compared to patients who received "false treatment" [4].
Note. The risk of acquiring HIV infection during acupuncture treatments is minimal, but it exists. Patients should therefore require their acupuncturists to use single-use (disposable) needles, a practice that associations or professional orders in some countries or provinces have made mandatory (this is the case of the Order of Acupuncturists of Quebec). Uncertain efficacy Coenzyme Q10 because of its action on the cells responsible for the immune activity in the body, coenzyme Q10 supplements were used in various conditions where the immune system was weakened. Results from preliminary clinical studies indicate that taking 100 mg twice daily may help increase the immune response in people with AIDS [8, 9]; Uncertain efficacy Glutamine many people living with HIV / AIDS experience significant weight loss (cachexia). The results of two doubleblind, placebo-controlled studies in people with AIDS indicate that glutamine can promote weight gain [24, 6]; Uncertain effectiveness Homeopathy. Authors of a systematic review [17] published in 2005 found positive results of homeopathic treatments, such as an increase in the number of T cells, an increase in body fat percentage and a decrease in stress symptoms;
Uncertain efficiency Lentinan. Lentinan is a highly purified substance extracted from shiitake, a fungus used in traditional Chinese and Japanese medicine. In 1998, US researchers administered lentinan to 98 AIDS patients in two clinical trials (Phase I and II). Although the results did not show a significant therapeutic effect, there was a slight
improvement in the immune defenses of the subj ects [10];
Uncertain efficacy Melaleuca (Melaleuca alternifoli). The essential oil extracted from this plant could be useful against the infection of the oral mucosa by the fungus Candida albicans (oral candidiasis or lily of the valley). The results of a trial of 27 patients with thrush-resistant louse of the valley (Fluconazole) indicated that a solution of essential oil of melaleuca, with or without alcohol, helped to stop the infection or to alleviate symptoms [26]; Uncertain efficacy N-acetylcysteine. AIDS causes a massive loss of sulfur compounds, especially glutathione (a powerful antioxidant produced by the body), which could be offset by taking N-acetylcysteine. The results of the studies that have verified its effect on the immunological parameters of affected individuals are, however, mixed to date [1, 5, 7, 15, 22, 25, 27].
Comorbidities specific to patients living with HIV
Comorbidities: The presence of one or more diseases in addition to a condition or primary disease.
HIV-positive patients have a significantly higher prevalence of age-increasing comorbidities than seronegative patients.
Any CV Bone Renal
Figure ¿.Health care cost among HIV-positive patients with at least one comorbidity per patient per year
9th IAS Conference on HIV Science, 23-26 July 20171 Paris, France
Frequent Comorbidities Cardiovascular Diseases - Risk Factors Antiretrovirals: influence the metabolism of lipids (hyperlipidemia) or glucose =diabetes, Antiretrovirals with cardiac signal ex. Abacavir, Smoking, Hypertension, Age.
The prevalence of atherosclerosis (78 vs 42%, p <0.05) and markers of activation immune> elite controllers versus negative controls. Controls (P <0.05). These data suggest a significant degree of coronary atherosclerosis and activation monocytes in the elite controllers [20]. Early treatment of HIV and lifestyle interventions, such as that smoking cessation (reference program of cessation) and the
prevention of obesity, better control of diabetes, lipids, blood pressure can help mitigate effects of inflammation with regard to cardiovascular diseases in PLHIV (People living with HIV).
Bone Problems - Risk Factors
Bone pain and softening or thinning bones = fractures; Avoid Tenofovir and use TAF or Abacavir;
Osteonecrosis caused by loss of blood flow to the bone. The signs are joint stiffness, body aches or pain (especially in the hips, knees and shoulders) and difficulty moving. Factors risks: long-term anti-HIV treatment, system highly weakened immune system, overweight, drinking or taking medications called corticosteroids.
Preventive interventions
Exercise; Avoid overweight; Reduce alcohol consumption; Avoid corticosteroids; Bone densitometry;
Vitamin D supplements; Calcium, bisphosphonates; Avoid Tenofovir. Use TAF (Tenofovir alafenamide).
Renal Problems - Risk Factors
Already suffering from a disease of the circulatory system; HIV-focal segmental glomerulosclerosis;
Diabetes; Hypertension; Antiretrovirals ex. Tenofovir.
Preventive interventions
Better diabetes control, blood pressure, Avoid Tenofovir, Urine analysis, biochemistry, Consultation with nephrology, Consultation with the pharmacy team, Monitor for muscle abnormalities, weakness muscle, destruction of muscle tissue rhabdomyolysis, Treat blood potassium and phosphate levels low.
Metabolic Syndromes: Multifactorial
Diabetes; Dyslipidemia; Nonsalic fatty liver disease.
Prevalence of diabetes
Dibetes is a common condition [18].
8,5% in the general population, 14% in HIV-infected patients, ART therapy, lipoatrophy, inflammation?
Odds of Diabetes higher in ART-exposed patients
Odds ratio 3,85 Cl 2,93-5,07 (10 studies), Particulary of ART duration >18 months, First generation ART agents (stavudine and indinavir) more strongly related, More recent ART such as efavirenz and atazanavir less so.
Non Alcoholic Hepatic Steatosis
By 2020, it will be the leading cause of liver failure requiring transplantation in the general population;
The accumulation of fat in the liver causes fibrosis ^ cirrhosis ^ liver failure; Factors such as poor diet, lack of exercise, diabetes, dyslipidemia and metabolic changes induced by some HAART (highly active antiretroviral therapy) are causes. Metabolic syndromes Lifestyle-oriented interventions Prevention of obesity (exercise, nutritionist), Better control of diabetes and lipids (Endocrinologist),
Better control of blood pressure, Fibroscan (Pulse Impulse Elastography Controlled), ultrasound, HCC monitoring, Hepatologist reference, Changes for antiretrovirals more favorable ex, Integrase. Cognitive Disorders (Memory Disorder and concentration etc.), Seen in all age groups, regardless of the number of CD4 and the suppression of viral load of HIV, May affect adhesion, Security problem, Need to understand the privileged reservoirs.
Interventions Need an occupational therapist, psychologist, psychiatrist, neurologist, pharmacist,
neurocognitive assessment and nurse intervention. Cognitive exercises and physical activity are interventions used. Psychiatric diseases
Depression; Anxiety; Posttraumatic stress disorder; Substance abuse Interventions
Assessment with psychologist and psychiatrist, social worker, outreach; Medicated and psychosocial therapies; Detoxification Program, Methadone, Suboxone; Harm reduction; Interactions between medication and street drugs. Avoidable cancer
Human papillomavirus (HPV) f cervix of the uterus cancer rate and anal with HIV / HPV co-infection; The lower the number of CD4 nadir, more the risk is higher
Interventions Need to vaccinate, especially MSM; Need to screen for anal, cervical and oral cancers; Recommend safer sex practices. Co infections: Hepatitis B and C Co infection doubles the progression rate of cirrhosis ^ liver failure ^ hepatocellular carcinoma (HCC).
Need to treat to prevent: insufficiency hepatic, HCC and viral cancers, cardiovascular risks, kidney failure, insulin resistance and diabetes.
Curable hepatitis C: same success rate that mono-infected.
Intervention Pro-treatment of hepatitis C; Reduce reinfection; Truvada, TAF, Emtricitabine used in the treatment of HIV and hepatitis B; Alcohol reduction and nutritional advice even after healing.
Conclusion HIV-positive patients have a significantly higher prevalence of age-increasing comorbidities than seronegative patients and the promoting healthy behaviors in patients living with HIV requires a multidisciplinary team. The role of
health personnel is to educate, prevent, facilitate coordination with multidisciplinary team and advocate for our Patients. Preventive ART treatment is potentially effective in occupational accidents of inoculation and in accidents by sexual exposure. Early treatment is probably the key element in experimental models (a few minutes) and in cohort studies for occupational accidents (less than a few hours). The Primary prevention remains the main protective factor for avoid risk situations: Professional (needle recapping, no container) and Sexual (no condom; lack of ART treatment).
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ВИЧ-ИНФЕКЦИЯ И КОМОРБИДНЫЕ СОСТОЯНИЯ
ХАФФАРЕССАС Я. ННГУ им. Н.И. Лобачевского, Нижний Новгород, Россия e-mail: yacinechabani@yandex.ru
Аннотация
Вирус иммунодефицита человека (ВИЧ) нацелен на иммунную систему и ослабляет защитные системы людей от инфекций и некоторых видов рака. Поскольку вирус разрушает и нарушает функцию иммунных клеток, инфицированные люди постепенно становятся иммунодефицитными. Иммунная функция обычно измеряется количеством клеток CD4. Иммунодефицит приводит к повышенной восприимчивости к широкому спектру инфекций, раковых заболеваний и других заболеваний, с которыми могут бороться люди со здоровой иммунной системой. Наиболее прогрессирующей стадией ВИЧ-инфекции является синдром приобретенного иммунодефицита (СПИД), для развития которого может потребоваться от 2 до 15 лет в зависимости от индивидуума. СПИД определяется развитием определенных видов рака, инфекций или других серьезных клинических проявлений. В этой статье мы попытаемся понять проблему ВИЧ-инфекции, а также узнаем о различных сопутствующих заболеваниях, встречающихся во время ВИЧ-инфекции.
Ключевые слова: ВИЧ-инфекция, СПИД, CD4 +, антиретровирусная терапия (АРТ), коморбидные состояния.
