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Acquired immunodeficiency syndrome 

 Identification

Acquired immunodeficiency syndrome or AIDS is the last stage of HIV infection (human immunodeficiency virus = human immunodeficiency virus). This stage is terminal and can have a rapid evolution to exitus.

Three stages of HIV infection are recognized:

  • Primary infection = In a few sâptămâni after HIV infection in some cases infected people develop fever, rash, diarrhea. In other cases, no symptoms appear. This first episode lasts one to two weeks.
  • Asymptomatic infection = signs disappear for a few months or several years.
  • The stage associated with the occurrence of opportunistic infections = Subsequently, depending on both the virulence of the HIV subtype with which the patient is infected and the degree of dysfunction of the immune system, opportunistic infections with viral, bacterial, Parasitic and fungal which to a man with Imunintar system can easily heal.

Last stage, final, AIDS, acquired immunodeficiency syndrome, is a chronic pain due to HIV infection. [1]CDC, Heymann D.L. management Manual of communicable diseases. 2012 [2]Callaway C., virology Medical, Ed Medicala 2008.

Diagnosis of pregnant woman

It’s two ways:

  • Indirect (serological) = anti-HIV antibodies are determined by ELISA and Western Blot tests. However, it should be considered that anti-HIV antibodies do not appear immediately after contact with the virus, they appear after 4 weeks-6 months (serological window). That is why such a test should be done after 4 weeks of infectant contact and repeated at 6 months.
  • Direct = with the determination of HIV-RNA in plasma. This determination bears the name of the viral load and is carried out through the RT-PCR molecular tests.

There are several quick tests on the market that use for saliva diagnosis, urine or peripheral blood and can be purchased from the pharmacy. [3] Medical MKD. Rapid Test HIV1 + 2 (2 lines)-Test for HIV, Casetaser/Plasma.. These tests may give false positive or even false negative results and in the case of suspicion of HIV infection it is recommended to test through the techniques listed above in a specialised laboratory. [4]CDC, Heymann D.L. management Manual of communicable diseases. 2012′ [5]Callaway C., virology Medical, Ed Medicala 2008′.

In newborn

 

Note Bene. In this document, the laboratory diagnosis in HIV infection was not treated, but there were several elements related to pregnancy and newborn. For the complete diagnosis of this infection, those interested will be addressing infectionists physicians.

Infectious agent 

Human immunodeficiency virus (HIV) is a retrovirus of the Retroviridae family. There are two distinct serological species: HIV-1 and HIV-2. HIV-1 is subdivided into several groups but the most widespread estegrupa which is subdivided into 11subtypes or “clade”, noted from A to K. The F1 subtype is circulating over 90% in Romania. There are large differences between the HIV-1 subtypes in terms of disease progression and its transmissible.[8] CDC, Heymann D.L. management Manual of communicable diseases. 2012~.

 

Incidence and prevalence

  • AIDS was recognized as a distinct clinic entity from 1981. However, in the world, HIV still exists since 1959, a fact proven by testing in 1998 of a serum from that year (1959) coming from a patient in Africa. [9]Callaway C., virology Medical, Ed Medicala 2008`..
  • The disease is widespread throughout the globe, with an incidence and increased prevalence especially in Africa.
  • Currently, according to WHO, worldwide, there are approximately 36.7 million people infected with HIV (34 – 39.8 million); In the year 2015 died AIDS patients 1.1 million (940,000 – 1.3 million) people. [10] CDC. 2017. HIV Among Pregnant Women, Infants, and Children.. [11] CNLAS, HIV/AIDS statistics 2016...
  • In Romania at the end of the year: 31 December 2016 were 14,349 people infected HIV/AIDS in life, from a cumulative total of 22,095, diagnosed since 1985. Romania still has a large number of long-standing survivors from the age group 20-29 years, which originated from the cohort of the years 1987-1990 (> 6000).
  • The number of people in treatment, in Romania, at the end of 2016, from the data recorded by CNLAS was 10,942 (90%), out of a total of 12,196 actively registered.
  • In the year 2016 in Romania were tested HIV 138,089 pregnant women from which 152 were detected as HIV infected. Also in 2016, in Romania, 230 HIV infected women gave birth to children, at 227, therapeutic prophylaxis was performed and so only 4 children infected HIVprin maternal-foetal transmission were born. [12] CNLAS, HIV/AIDS statistics 2016.`..

 

Source

  • People are the only source known.
  • HIV-1 evolved from simian immunodeficiency viruses, adapting from monkey to human and thereby passing the species barrier.

Method of transmission

  • Parenteral, i.e. by contact with blood or blood derivatives infected HIV
  • by unprotected sexual contact
  • Vertical transmission = from mother to Child:

1. The transmission of antepartum, before birth, in the uterus, appears in 25% – 35% of cases, in the absence of a prophylaxis, of a mother’s antiretroviral treatment.

 – HIV can infect the placenta at any time of pregnancy. HIV was isolated in the conception product and 14-20 weeks of gestation.

– HIV can infect Trofoblastul and macrofagic cell line.

– Neither the presence of infection nor the amount of virus in the placenta is correlated with congenital infection. [13]Callaway C., virology Medical, Ed Medicala 2008’`.

2. The transmission of intrapartum, during delivery, can be avoided if the birth is achieved by caesarean. If the birth is carried out naturally, the risk of transmission is up to 70%.

3. Postpartum transmission, after birth, is achieved by breastfeeding and the risk of transmission increases with the period during which the child was breast-feeding, a 14% risk to evolving infection and a 29% risk to the mother’s primary infection. Prolonged breastfeeding over 1 year doubles the risk of transmission. [14]Callaway C., virology Medical, Ed Medicala 2008`' [15] AIDS info. Recommendations for Use of Antiretroviral drugs in Pregnant HIV-1-Infected Women … HIV Transmission in the United States.”..

 

Risk groups

  • People who have unprotected sex
  • Children born from HIV infected mothers
  • Persons working in the field of health: physicians, nurses, nurses, paramedics
  • People who make tattoos, piercings, manicure with properly sterilized instruments
  • People who drug intravenously or even intranasal
  • Blood transfusions untested

 

Incubation period

Variable. May vary from one year to 15 years or more. In infants, the period of development of AIDS is shorter than in adults. [18] CDC, Heymann D.L. management Manual of communicable diseases. 2012:|.

Infectiousness Period

 

Prophylaxis

  • Nonspecific
    • Educate the population,
    • Abstinence,
    • Monogamous sex with an uninfected partner,
    • The proper use of condoms by both men and women,
    • Avoiding the use of intravenously administered drugs,
    • Avoiding tattoos with properly sterilized instruments,
    • Avoid piercing with properly sterilized instruments,
    • Avoid manechiurii with properly sterilized instruments.
  • Specific:
    • By administering antiretroviral medicinal products;
    • To be effective, prophylaxis should start within a few hours of infectant contact and take 28 days.
  • Prophylaxis of maternal-foetal transmission:

 

Vaccination

There’s no vaccine. [21] CNLAS, HIV/AIDS statistics 2016.|”..
 

Birth to HIV infected woman

Childbirth is compulsory by caesarean. [22] Callaway C., virology Medical, Ed Medicala 2008.`~..

 

Breastfeeding

  • HIV is excreted in breast milk.
  • HIV infected mother can transmit the infant virus through breastfeeding.
  • Breastfeeding is strictly prohibited. [23] CDC. 2017. HIV Among Pregnant Women, Infants, and Children.`~’..

 

Treatment

Treatment is complex. It is performed only on the indication and under the monitoring of the infectious physician with specific antiretroviral medication. [24] AIDS info. Recommendations … to Reduce Perinatal HIV Transmission in the United States. ..

 

 Bibliography

 

  1. CDC, Heymann D.L. management Manual of communicable diseases. 2012
  2. Callaway C., virology Medical, Ed Medicala 2008
  3. AIDS info. Recommendations for Use of Antiretroviral drugs in Pregnant HIV-1-Infected Women for maternal Health and interventions to Reduce Perinatal HIV Transmission in the United States. Retrieved: https://aidsinfo.nih.gov/guidelines/html/3/perinatal-guidelines/0
  4. CDC. 2017. HIV Among Pregnant Women, Infants, and Children. Retrieved: https://www.cdc.gov/hiv/group/gender/pregnantwomen/index.html
  5. CNLAS, HIV/AIDS statistics 2016. Retrieved: Http://www.cnlas.ro/images/doc/31122016_rom.pdf
  6. Medical MKD. Rapid Test HIV1 + 2 (2 lines)-Test for HIV, Casetaser/Plasma, retrieved: https://www.mkd-medicale.ro/test-rapid-hiv-12.html

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