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1、OK, good morning, class begin.Our topic today is AIDS (Acquired Immunodeficiency Syndrome), which is caused by HIV (human immunodeficiency virus). As a chronic infectious disease, AIDS was first found and reported as a new disease in United States in 1981 and first diagnosed in 1985 China. From 1981
2、 to 2006, there have been 65 million people were infected with AIDS, among which 25 million were die from AIDS.OK, this is 3 points we should know even if you are not a medical worker.1. Tansmission rout: sex, sexual contact and vertical transmission.2. Pathogenesy: CD4+ T cells disfunction, immunol
3、ogical disfunction, severe opportunistic infection and tumor.3. Clinical features: long course of disease, multisystem disfunction, high case fatality.We will start at HIV etiology. HIV is single strand RNA virus which have 2 groups: HIV-1 and HIV-2, belong to Retrovirus family, Lentivirus subfamily
4、. This slide is showing Virus Morphous: It is around 90140 nm in diameter (about 60 times smaller than a red blood cell) and roughly spherical. And this is Virus Structure: 1. The envelope includes host cellular membrane (protein) and the glycoproteins: gp120 (spike of envelope glycoproteins) and gp
5、41 (trans-membranous glycoproteins). 2. Core of HIV: core protein P24, matrix protein P6 and P9.-Including double positive strands RNA, retroviridase (RT), RNA enzyme H, integrase (INT, 整合酶) and so on.3. P17 protein: between envelope and core. Now, we come to Virus Genome: There are 9 ORFs (open rea
6、ding frame) between two LTRs (long terminal repeat) including that:1. Structure gene: gag (group specific antigen gene, encoding P55), pol (polymerase gene, representing polymerase and encoding RT, RNA enzyme H and INT), env (for envelope, in which genovariations happen usually). 2. Regulatory gene:
7、 tat (transactivator which can activate LTR and other gene expression), rev (regulator of virion proteins which can increase gag and env expression), nef (negative regulator factor which can inhibit HIV proliferation). 3. Other gene: vif (virion infectivity factor which can increase HIV duplication
8、in cells), vpr (virion protein R), vpu (virion protein U), vpx (virion protein X).This slide is introduction of Subgroup and Genovariation: Subgroup： 1. HIV-1: 11 subgroups: A, B, C, D, E, F, G, H, I, J and O.Spread worldwidely.Yunnan Province: B, C and E subgroups.2. HIV-2: 6 subgroups: A, B, C, D,
9、 E, F and G. Restricted in west African. Disease caused by HIV-2 is similar to disease caused by HIV-1, but is generally milder, slower to progress and poorly transmitted vertically. Genovariation (happen usually): In env gene, especially at gp120 coding region. It is so lucky that resistance of HIV
10、 is not well: 1. Completely inactivated at 100 for 20 minutes.2. Suvival for 15 days in fluid and at room temprature. Infectivity will be kept in 3 days on the items contaminated. 3. Inactivated at 37 for 10 minutes in these antiseptics: 75% alcohol, 0.2%NaClO, bleaching powder, 2% GA, 4% formalin,
11、35% avantin, 0.5% cresol and soap solution, 0.3% H2O2.4. Medical devices and injectors can be sterilized by high temperature, boiling and steam sterilization.These slides below are showing HIV epidemiology in world and Chinese.3 periods can be defined in HIV spreading in China: Afferent period: 1985
12、1988 Diffusion period: 19891993Increasing period: 1994AIDS epidemic status in China are: 1. Almost 700,000 HIV infectors and patients were in China by time of 2007, which 85,000 of them were AIDS patients.2. 50,000 New HIV infectors emerged and 20,000 died from AIDS in 2007.These 4 slides will give
13、us a direct impression of HIV and AIDS in China and we can say: HIV is around us!These are HIV epidemic features in China: 1. Upgrade speed of AIDS outbreak were slowing down.2. Sex contact became the main transmission route.3. Endemic distributional differences of AIDS outbreak were conspicuous.4.
14、AIDS epidemic factors were diverse.These are HIV epidemic features in Guang dong: 1. HIV infectors: 21,966.2. AIDS patients: 2,352.3. Died of HIV/AIDS: 962.4. HIV infectors in Guang dong (accumulative total): 49,000.Now, next is infection sources including AIDS patients and Symptomless HIV carriers,
15、 especially HIV infectors in window phase (26 weeks). We can see HIV virus load is maximum in the blood and semen. Then, routes of transmission are: Sexual contact, Injection (drug and blood transfusion), Vertical transmission and Others (organ transplantation, artificial fertilization). And we shou
16、ld know that these behaviors will not cause HIV transmission: embracing, handshaking, coughing or sneezing and sharing daily-used public facilities. As we all know, sexual contact is the main route of HIV transmission (global: 75% and in China: 4554%) (7080%: Heterosexual and 510%: Homosexual). It i
17、s interesting that oral sex may be associated with lower risk. Of course it can not be the excuse for unprotected sex. So I think it is a wise way to provide free condoms in public place like hotel and Olympic village. And genital ulceration will enhance risk. Injection including drug using and bloo
18、d transfusion is the second important route. So I think it is essential to provide disposable injection equipments for drug addicts. OK, this is Chinese Mother Teresa (德兰修女), we should express our greatest respect to her, only I want to show you is the most dangerous transmission: blood from lots of
19、 people were collected, mixed and centrifuged, then the plasma were collected and sent to biotechnology company for production of Human serum albumin, gamma globulin and so on. And the blood cells were re-transfused to people who sold their blood. This picture is showing vertical transmission includ
20、ing: in utero (placenta), at birth (birth canal) and breast feeding (milk). OK, this is high risk factors: homosexuality (especially for male), promiscuity, drug addict, blood transfusion receptors (many times). The age of onset is : 0.5109/L, lymphocytes2.0109/L, CD4+ T cells/ Total lymphocytes: 29
21、%.Grade 2. CD4+ T cells: 0.20.49109/L, lymphocytes 1.01.9109/L, CD4+ T cells/ Total lymphocytes: 1428%.Grade 3. CD4+ T cells: 0.2109/L, lymphocytes 1.0109/L, CD4+ T cells/ Total lymphocytes: 14%. This is Clinical classification of HIV infection (classified and admitted by CDC and WHO).Now, manifesta
22、tions of different systems will be shown:First is pulmonary manifestations: PCP (肺孢子虫性肺炎,卡氏肺囊虫性肺炎, 肺孢子菌肺炎), CMV and Tuberculosis infection, Kapposi sarcomaThis is X-ray and pathological appearances of PCP.Second is Digestive system: Infection of oral cavity and esophagitis, hairy leukoplakia in oral
23、 cavity (this picture showing), infectious diarrhea, herpesvirus infection in rectum and crissum and hepatic lesionNervous system manifestations are: Opportunistic infection (cryptococcal meningitis), Opportunistic tumor (primarily leucoma) and HIV direct infection (chronic brain syndrome).This is S
24、kin and mucosa manifestations: Kaposis sarcoma, Monilia infection, Herpes vulvaris and Venereal wart. -1 and 2: Kaposis sarcoma. 3, 4 and 5: Venereal wart.Ocular region manifestations are: Amphiblestritis and Eyeground flocc white patch (CMV infection), Toxoplasma choroiditis and Kaposis sarcoma.The
25、se slides are to give us a direct impression: TB infection, Pulmonary toxoplasma infection, Toxoplasma brain abscess and Kaposis sarcoma on skin. OK, these are Laboratory Findings:1. Normal examination: Blood routine (WBC and HB degression).2. Immunologic test: T cells and CD4+T lymphocyte degressio
26、n, CD4/CD81.0.3. Serologic examination: 4. Pathogen detection: detection of antibody and antigen, viral isolation, protein array examination. OK, we have had a roughly impression of HIV infection, but how to diagnosis it? First is Clinical Diagnosis including Final Diagnosis and diagnosis of Doubtfu
27、l case. Final DiagnosisHIV infectors:1. Epidemiology evidence (+).2. Anti-HIV (+) and be final diagnosed by WB.3. Acute HIV infectors: high-risk group whose anti-HIV seroconversion emerge in follow-up visit and is proved by confirmatory test.AIDS patients:1. Epidemiology evidence and clinical manife
28、station (+).2. Anti-HIV(+), CD4+ T cells 0.2109/L or 0.20.5109/L.3. Opportunistic infection pathogen (or its antibody), or patho-evidences of tumor were found.Doubtful case1. Epidemiology evidence and clinical manifestations (+), but anti-HIV(-).2. Anti-HIV(+) persons children.3. Epidemiology evidence with clinical manifestations (), CD4+ lympholeukocyte 0.2 109/L4. Oral Candida, multiple hemorrhagic sarcoma on skin and mucosa, PCP (pneumocystis carinii pneumonitis), cryptococcal meningitis, pulmonary tuberculosis with promt advancement, -anti-HIV should be detected.Second is