AIDS 中英双语课件

AcquiredImmunodeficiencySyndrome

(AIDS)ZXueDepartmentofLeWFMedicalUniversityIntroductionIntroductionAIDSwasCausedby

HIV(humanimmunodeficiencyvirus).AIDSwasfirstreportedintheUnitedStatesin1981andhassincebecomeamajorworldwideepidemic.概述艾滋病1981年在美国被首次报道，现已成为一种重要的世界性流行病.

Since1981morethan900,000casesofAIDShavebeenreportedintheUnitedStates.Asmanyas950,000AmericansmaybeinfectedwithHIV,one-quarterofwhomareunawareoftheirinfection.TheepidemicisgrowingmostrapidlyamongminoritypopulationsandisaleadingkillerofAfrican-Americanmalesages25to44.In2003,two-thirdsofU.S.AIDScasesinbothwomenandchildrenwereamongAfrican-Americans.Introduction

自1981以来，美国有超过900000例艾滋病病例报告。多达950000的美国人可能感染艾滋病，1/4的人不知道自己感染了。在少数民族人群中，这一流行病正在迅速增长，这是非洲裔美国男性25岁至44岁的主要杀手。在2003，三分之二的美国艾滋病病例中，妇女和儿童都是非裔美国人中的。Introduction

PeoplediagnosedwithAIDSmaygetlife-threateningdiseasescalledopportunisticinfections,whicharecausedbymicrobessuchasvirusesorbacteriathatusuallydonotmakehealthypeoplesick.Introduction

被诊断患有艾滋病的人可能会患上危及生命的疾病——机会性感染，这是由通常不使健康的人生病的病毒或细菌等微生物引起。Introduction

AIDStransmitthroughthefollowingthreeways:sexualtransmission,bloodtransmission

andmother-to-childtransmission.

Thelymphocyte(CD4+Tlymphocyte)isthetargetandattackedcellofHIV.Thefunctionofcell-mediatedimmunityisdestroyedandavarietyofneoplasms,opportunityinfections,andothermanifestationsthreatenedlivesareusuallyconcomitant

inHIVinfection.Introduction

艾滋病病毒通过与感染者的性接触和血液接触传播。淋巴细胞（CD4+T淋巴细胞）是HIV的攻击目标。伴随着艾滋病病毒感染的是细胞介导的免疫功能受到破坏及各种肿瘤、机会感染和其他威胁生命的表现。Introduction

TheAIDSpandemic

hasalteredtheworld’smedicalsystem,people’sbehavior,andprecipitatedanationalandinternationalcrisis.AIDShasreducedthehistoricalapathybetweenrichandpoornations.ThedevelopedanddevelopingworldsareequallyconcernedaboutthespreadofAIDS.

Introduction

艾滋病的流行已经改变了世界的医疗体系，人们的行为，并导致了一个国家和国际的危机。艾滋病减少了富人和穷人之间的历史冷漠。发达国家和发展中国家同样关注艾滋病的传播。IntroductioncachexiaIntroduction

Etiology

病原学

HIVisamemberoftheRetroviridae,Lentivirus,withadiameterof90-140nanometerandagenome

of2single-stranded,positivelysensedRNAsof9749nmsurroundedbyaproteinenvelopeconsistedofhostmembraneandviralglycoprotein,gp120andgp41,gp120isanextracellular

proteinandgp41isatransmembrane

protein.

Etiology

HIV是反转录病毒科慢病毒属的一员，是直径90-140纳米的球形颗粒，由两条长约9749纳米的正链单链RNA和包围在外的蛋白质外壳组成，蛋白质外壳包括宿主细胞膜和病毒糖蛋白—gp120和gp41,gp120的是一种外膜糖蛋白，gp41是一种跨膜糖蛋白。Etiology

Thereare2typesofHIV,HIV-1andHIV-2.HIV-1isresponsiblefortheglobalprevalenceofAIDSandexhibitsastrongtropism

forCD4+Tcells.HIV-2hasbeenfoundtobeendemicinwesternAfricaandisreportedtobelesspathogenic.

Etiology

有2种类型的HIV，HIV-1和HIV-2。HIV-1是艾滋病全球流行的主要毒株，表现出强的嗜CD4+T细胞性。HIV-2局限于西非地区，致病性较低。EtiologyHIVprimarilyinfectsCD4+

Tlymphocytes,macrophage,Bcells,smallneurogliacells

andhemapoieticstemcell

andmayinfectothercellsthatdonotexpressCD4.

Etiology

HIV主要感染CD4+的T淋巴细胞、巨噬细胞、B细胞、小神经胶质细胞和造血干细胞，也可能感染其它不表达CD4的细胞。Etiology

Thevirusissensitivetoheat,25%alcohol，etc.

butinsensitivetoultravioletradiation

andγradiation.Etiology

HIV病毒对热,25%酒精和0.2%次氯酸钠敏感，但是对0.1%的甲醛和紫外线和γ射线不敏感。EtiologyEpidemiology流行病学

SourceofInfection

HIVinfectedpeopleandAIDSpatientsistheonlysourceofinfection.

Epidemiology

传染源

艾滋病病毒感染者和艾滋病病人是唯一的传染源。EpidemiologyRoutesofTransmission

HIVisspreadmostcommonlybyhavingunprotectedsexwithaninfectedpartner.Theviruscanenterthebodythroughtheliningofthevagina,vulva,penis,rectum,ormouthduringsex.

Epidemiology

艾滋病病毒最常见的传播途径是与受感染者间无防护的性行为。该病毒可以通过阴道，外阴，阴茎，直肠或口腔粘膜在性交时进入人体。Epidemiology传播途径

HIVhasbeenfoundinsaliva,tears,nervoussystemtissue,blood,semen(includingpre-seminalfluid),vaginal

fluid,andbreastmilkofpatientsandcarriers.However,onlyblood,semen,vaginalsecretions,andbreastmilkhavebeenproventotransmitinfectiontoothers.

EpidemiologyRoutesofTransmission传播途径

艾滋病毒存在于唾液，泪液，神经系统组织，血液，精液（包括预精液），阴道液，以及患者和携带者母乳中。

然而，只有血液，精液，阴道分泌物，和母乳被证实有感染性。EpidemiologyRiskyBehavior

HIVcanbeinfectedtoanyonewhopracticesriskybehaviors，suchas:

Sharingdrugneedlesorsyringes.Havingsexualcontact,includingoral,withaninfectedpersonwithoutusingacondom.HavingsexualcontactwithsomeonewhoseHIVstatusisunknown.Epidemiology风险行为

艾滋病病毒可以感染参与风险活动的任何人，如：

共享药物针头或注射器。

性接触，包括口交，与感染者没有使用安全套。

与艾滋病病毒感染状况不明者的性接触。Epidemiology

HIValsocanbespreadthroughcontactwithinfectedblood.BeforedonatedbloodwasscreenedforevidenceofHIVinfectionandbeforeheat-treatingtechniquesusedtodestroyHIVinbloodproductswereintroduced,HIVwastransmittedmainlythroughtransfusionsofcontaminatedbloodorbloodcomponents.Today,becauseofbloodscreeningandheattreatment,theriskofgettingHIVfromsuchtransfusionsisextremelysmall.

EpidemiologyRoutesofTransmission

艾滋病病毒也可通过接触受感染的血液接触传播。由于献血前HIV感染的筛查及破坏艾滋病病毒热处理技术的引进，现在艾滋病毒主要传播途径是通过被污染的血液或血液成分输血。因为现在血液筛查和热处理，输血感染艾滋病病毒的风险是非常小的。Epidemiology传播途径

MothertoChildWomencantransmitHIVtotheirbabiesduringpregnancyorbirth.Approximatelyone-quartertoone-thirdofalluntreatedpregnantwomeninfectedwithHIVwillpasstheinfectiontotheirbabies.HIValsocanbespreadtobabiesthroughthebreastmilkofmothersinfectedwiththevirus.

EpidemiologyRoutesofTransmission

女性可以在怀孕或分娩时将艾滋病病毒传给婴儿。大约有四分之一到三分之一的未经治疗的艾滋病孕妇会将疾病传染给婴儿。艾滋病毒也可以通过病毒感染母亲的母乳传到婴儿。Epidemiology传播途径

Ifthemothertakescertaindrugsduringpregnancy,herbaby’schanceofgettinginfectedwithHIVwillbesignificantlyreduced.IfhealthcarecentersprovidetreatmenttotheHIV-infectedpregnantwomenanddelivertheirbabiesbycesareansection,thechanceofthebabybeinginfectedcanbereducedto1%.HIVinfectionofnewbornshavebeenalmosteradicatedintheUnitedStatesduetoappropriatetreatment.

Epidemiology

如果母亲在怀孕期间接受某些药物治疗，她的孩子的感染机会就会显著减少。如果医疗中心给予艾滋病毒孕妇一定的治疗并施行剖宫产，婴儿被感染的几率可以降低到1％。因为恰当的治疗，美国差不多已经根除新生儿感染HIV这一现象。Epidemiology

AlthoughresearchershavefoundHIVcanexisitinthesalivaofinfectedpeople,thereisnoevidencethattheviruscanbespreadbycontactwithsaliva.LaboratorystudiesrevealthatsalivahasnaturalpropertiestolimittheinfectivityofHIV,andthevirusamountinsalivaappearstobeverylow.ResearchonpeopleinfectedwithHIVhasfoundnoevidencethattheviruscanbespreadtoothersthroughsalivabykissing.EpidemiologyRoutesofTransmission尽管研究人员已经发现感染者唾液中存在HIV，但没有证据表明，病毒可通过与唾液接触传播。实验室的研究表明，唾液具有天然的属性来限制艾滋病毒的感染性，并且病毒量在唾液似乎是非常低的。研究HIV感染者发现，没有证据表明该病毒可以通过接吻传播给他人。Epidemiology传播途径ContaminatedNeedlesHIVisfrequentlyspreadamonginjectiondrugusersbysharingneedlesorsyringescontaminatedwithverysmallquantitiesofbloodfromsomeoneinfectedwiththevirus.Itisrare,however,forapatienttogiveHIVtoahealthcareworkerorvice-versabyaccidentalstickswithcontaminatedneedlesorothermedicalinstruments.

EpidemiologyRoutesofTransmission

共用沾有微量病毒感染者血液的针头或注射器便可以造成HIV在静脉吸毒者间的传播。

健康的卫生工作者通过被患者污染的针头或其他医疗器械刺伤而感染HIV病毒是罕见的，反之亦然。Epidemiology传播途径Theliningofthemouth,however,canbeinfectedbyHIV,andtheinstancesofHIVtransmissionthroughoralintercoursehavebeenreported.Scientistshaven’tfoundanyevidencethatHIVcanbespreadthroughsweat,tears,urine,orfeces.EpidemiologyRoutesofTransmission但是，HIV可以通过在口腔粘膜传播，既往曾有通过口腔性交传播HIV的报道。

没有证据表明艾滋病病毒可以通过汗液，泪液，尿液或粪便传播。Epidemiology传播途径CasualContactStudiesaboutfamiliesofHIV-infectedpeoplehaveshownclearlythatHIVcannotspreadthroughcasualcontactsuchassharingfoodutensils,towelsandbedding,swimmingpools,telephones,ortoiletseats.HIVcannotspreadbyinsectsbitingsuchasmosquitoesorbedbugs.

EpidemiologyRoutesofTransmission

艾滋病病毒不会通过日常接触传播，如共用餐具食物，毛巾和床上用品，游泳池，电话，或马桶座。

艾滋病毒不能通过昆虫叮咬传播，如蚊子、臭虫。Epidemiology传播途径HighRiskPopulations

Thoseathighestriskincludehomosexual

orbisexual

menengaginginunprotectedsex,intravenous

druguserswhoshareneedles,thesexualpartnersofthosewhoparticipateinhigh-riskactivities,infantsbornbymotherswithHIV,andpersonswhoreceivedbloodtransfusionsorclottingproducts

between1977and1985(priortostandardscreeningforthevirusintheblood).Epidemiology易感人群

高风险包括同性或双性恋男子从事无保护的性行为，共用针头，有高风险活动的性伴侣，艾滋病病毒母亲诞生的婴儿，1977年和1985年之间接受输血或凝血制品的人。EpidemiologyEpidemiologyEpidemiologyPathogenesis

andpathology发病机制和病理GeneralProcess

HIV-1entersitstargetcellsbyinteractionofthevirion

glycoproteins,gp120andgp41,withtheCD4molecule.Oncethevirusentersthecell,uncoatingoccurs.AreversetranscriptaseenzymetranscribesviralRNAintodouble-strandedDNA,whichisinsertedintothehostcellchromosome.Withactivationofthecellbyantigenic

orviralstimulation,DNAtranscription

occursandnewviralparticlesareassembled

atthecellsurfaceafter2-10yearstoinfectothercells.

PathogenesisandPathology

HIV-1通过有CD4分子的病毒体糖蛋白gp120和gp41的相互作用进入其靶细胞。

一旦病毒进入细胞，即发生脱壳。病毒RNA在逆转录酶作用下转录为双链DNA，后者被插入到宿主细胞染色体中。

HIV病毒感染其他细胞2-10年后，抗原或病毒刺激使被感染的细胞激活，脱氧核糖核酸开始转录，并且新病毒颗粒在细胞表面进行组装。PathogenesisandPathologydynamicimitationPathogenesisandPathologyPathogenesisandPathologyHuman’sT-lymphocyteandVirusAttackingT-lymphocyteHIVinLymphTissueHIVinfectthehumannormalcellHuman’sT-lymphocyteMechanismsofdepletionofCD4+Ｔlymphocytes

PotentialmechanismsforCD4+celldestructionmayincludedirectlysisbecauseofvirusreproduction,killingofstemcells

ofbonemarrow,syncytium

formationbetweenuninfectedandinfectedcells,apoptosis,andfreegp120mediatedantibodydependentcytotoxicity.

PathogenesisandPathology

CD4+T淋巴细胞的损耗机制

对CD4+细胞破坏的潜在机制包括病毒复制造成的细胞直接裂解、骨髓干细胞的破坏、未感染和感染的细胞之间的合胞体形成、凋亡细胞和游离的gp120介导的抗体依赖性细胞毒性作用。

PathogenesisandPathology

Functionalabnormalityofmono-phagocytes

HIVcanreplicateinprogenitorcells

ofmono-phagocytesofbonemarrowinhighlevels.Functionofmono-phagocytesisabnormal.Virusdisseminates

throughthebloodstream

andlymphatics

tothegerminalcenter

oflymphnodes.Theinfectedmono-phagocytesserveasalargereservoir

ofHIVandplayavitalroleofvirusspreadtonervoussystem.

PathogenesisandPathology

单核-吞噬细胞功能异常

HIV能在单核-吞噬祖细胞中高水平复制。单核吞噬细胞出现功能异常。病毒通过血液和淋巴管到淋巴结的生发中心。受感染的单核吞噬细胞作为艾滋病毒的一个储存库，是感染神经系统的一个主要因素。

PathogenesisandPathology

AbnormalitiesofBlymphocytes

1.Bcellsaremulticlonal

activated,2.IgGandIgAincrease,3.Circulatingimmunecomplexexist,4.ThenumbersofperipheralbloodBlymphocytesincrease,

5.Theresponsetothestimulationofnewantigensdecrease.

PathogenesisandPathology

B淋巴细胞异常

1.B细胞多克隆激活，

2.IgG和IgA的增加，

3.循环免疫复合物存在，

4.外周血B细胞及淋巴细胞的增加，

5.新的抗原刺激反应

的降低。PathogenesisandPathologyAbnormalitiesofNKcells

NKcellcountisalmostnormalbutfunctionallydeficient.Itmayrelatetothedeficiencyofcytokine

production,suchasIL-2.

PathogenesisandPathologyNK细胞异常

NK细胞数量几乎是正常的，但在功能上有缺陷。

它可能涉及细胞因子产生的缺乏，如IL-2的缺乏。PathogenesisandPathologyImmuneresponsepostHIVinfection

HIVInfectioncausesmanyimmuneresponse,includingproductionofneutralizingantibodies,antibodydependentcomplement-mediatedcytotoxicity,Tlymphocyte-mediatedcytotoxicity,NKcell-mediatedcytotoxicity,etc.AlthoughHIVenvelope-bindingantibodiescanbedetectedinseraofinfectedindividualsafter2to3weeksfollowinginfection,mostoftheseantibodieslacktheabilitytoeliminatethevirus.ThereplicationofHIVisinhibitedbytheinfectedindividuals’immuneresponseduringtheseveralyearsofpostinfectionandactivatedbyseveralfactorsthatareunclear,suchasTNF-a,TNF-BandIL-6(interleukin-6),especiallyTNF-a.PathogenesisandPathology

HIV感染导致许多免疫反应，包括生产中和抗体，抗体依赖性补体介导的细胞毒性，T细胞介导的细胞毒作用，NK细胞介导的细胞毒作用等等。尽管HIV包膜结合抗体可以在感染的个体的血清中在被感染后的2到3周被检测，但这些抗体并不能消除病毒。在感染后的数年内，受感染个体的免疫应答能抑制HIV的复制，几个不明确细胞因子对病毒的复制有激活作用，如TNF-α，TNF-β和IL-6（白细胞介素-6），尤其是肿瘤坏死因子。PathogenesisandPathologyClinicalManifestations临床表现Clinicalstages

Classifiedinto4stagesbyUnitedCentersforDiseaseControl(CDC).

ClinicalManifestation临床阶段

CDC(美国疾病控制中心)将临床阶段分为4期.

ClinicalManifestation1.AcuteHIVInfection(PhaseI)

Flu-likesymptomsarepresentinsome

patients.Fever,lethargy,headaches,lymphadenopathy,sorethroat,andmacularrash

arethemostcommonsignsandsymptoms.Thesesymptomsusuallylastfor3-14days.Duringthisperiod,patientshavehighinfectivity,andHIVispresentinlargequantitiesingenitalfluids.

ClinicalManifestation急性期

部分患者出现类似流感的症状，如发烧，嗜睡，头痛，淋巴结肿大，咽喉痛和斑疹。这些症状通常持续3-14天。在此期间，患者有较高的传染性，艾滋病大量存在于生殖器的体液内。ClinicalManifestationAcuteHIVInfection(PhaseI)

Laboratoryabnormalitiesincludelymphopenia,thrombocytopenia,andelevatedhepaticenzymes.HIVandp24antigencanbedetected.CD4+/CD8+reversesfollowingtheincreaseofCD8+TlymphocytescountandthenormalcountofCD4+cells.

ClinicalManifestation急性期

实验室检查异常包括淋巴细胞减少，血小板减少和转氨酶升高。HIV和p24抗原可以被检测。CD4+/CD8+比值降低，CD8+T淋巴细胞的增加计数和CD4+细胞的正常计数。ClinicalManifestationtherashAcuteHIVinfection((phaseI)Folliculitis(phaseI)Pruriticdermatitis(phaseI)Genitalherpes（GH）(phaseI)ClinicalManifestation2.Asymptomatic

HIVInfection(PhaseII)

ThisstageoriginatesfromprimaryHIVinfectionimmediatelyorfollowingthedisappearanceofthesignsofphaseI,havingcommunicabilityandlastingfor2-10yearsorevenmore.

Therearenotanyclinicalsymptoms.HIV,p24andantibodiestoglycoproteinsaredetectable.ClinicalManifestation2.无症状感染期

这个阶段从HIV感染初期立即出现或I期症状消失后出现，有传染性，持续2-10年甚至更长。没有任何临床症状。

可检测到HIV，p24和抗体糖蛋白。ClinicalManifestation

ThemostobviouseffectofHIVinfectionisthedeclineofthenumberofCD4+Tcellsfoundintheblood.虽然没有症状Duringthisperiod,thevirusismultiplying,infecting,andkillingthecellsoftheimmunesystemactively.Asymptomatic

HIVInfection(PhaseII)ClinicalManifestation

艾滋病毒感染的最明显变化是在血液中的CD4+T细胞数量的减少。在此期间，虽无症状，病毒仍繁殖，感染并杀伤免疫细胞。2.无症状感染期ClinicalManifestationLymphnodeenlargement

iscommon.Generalizedlymphadenopathy

involvesmorethan2areasoflymphnodesenlargementexcludingtheinguinalarea.Thisphaseusuallylastsmorethan3months.3.Persistent

GeneralizedLymphodenopathy

(PGL,PhaseIII)ClinicalManifestation淋巴结肿大是常见的。全身淋巴结肿大是指2个以上的区域淋巴结肿大，不包括腹股沟区域。这个阶段一般持续3个月以上。

持续性全身淋巴结肿大ClinicalManifestationNecklymphadenopathy(phaseIII)ClinicalManifestationClinicalManifestation4.AIDS(PhaseIV)

Thereare5groupsofmanifestations1）Constitutionaldisease

includes:fever,fatigue,rash,pharyngitis,diarrhea,weightloss,nightsweats,lymphadenopathy,hepatosplenomegaly,andetc.2)Nervoussystemsymptomsincludes:progressivedementia,hemiparesis,blindness,headaches,andepilepsyseizure.93ClinicalManifestationAIDS期

5组表现

1）常见症状包括：发热，乏力，皮疹，咽炎，腹泻，消瘦，盗汗，全身淋巴结肿大，肝脾肿大，等。

2）神经系统症状包括：进行性痴呆，偏瘫，失明，头痛和癫痫发作。94AIDS(PhaseIV)AIDS(PhaseIV)

3)Opportunisticinfectionsincludes:awidevarietyofbacteria,viruses,fungiandotherpathogensuchaspneumocystic

carinii,penicilliummarneffei,tuberclebacillus,cytomegalovirus

(CMV),EBvirus(EBV),candidaalbicans.ClinicalManifestation3）机会性感染包括：各种各样的细菌，病毒，真菌等病原体如pneumocystic囊虫，马尔尼菲青霉菌，结核杆菌，巨细胞病毒（CMV），EB病毒（EBV），白色念珠菌。ClinicalManifestationOpportunisticinfection:infectedbyCandidaalbicans.Leukoplakia（phaseIV）Opportunisticinfection:infectedbycytomegalovirus

(CMV)Iridocyclitis（phaseIV）Opportunisticinfection:infectedbyfungi.Ringwormofnailsandkeratitis（phaseIV）Opportunisticinfection:infectedbybacteriaandvirusesSuperficialinfection（phaseIV）Opportunisticinfection:infectedbytuberclebacillus（TB）

andHerpeszostervirus（HZV）.Crewelsandherpeszoster（phaseIV）ClinicalManifestation4)Neoplasia

include:Kaposi’ssarcoma(KS),non-Hodgkin’slymphoma(NHL),andprimarycentralnervoussystem(CNS)lymphoma,andinvasivesquamouscellcarcinoma

ofthecervix.5)Othersincludediseasesotherthanopportunisticinfectionsandneoplasia.103ClinicalManifestation4）瘤形成包括：卡波济氏肉瘤（KS），非何杰金氏淋巴瘤（NHL），和原发性中枢神经系统（CNS）淋巴瘤，和子宫颈的侵袭性鳞状细胞癌。5）其他疾病

其它机会致病感染和肿瘤104ClinicalManifestationKS（tongue)KS（skin)KS（smallintestine)KS（leg)KS（upperlimb)KS（face)ClinicalManifestationWHATISAIDS?ThetermAIDSappliestothemostadvancedstageofHIVinfection.CDChasdevelopedofficialcriteriaforthedefinitionofAIDSandisresponsiblefortrackingthespreadofAIDSintheUnitedStates.109WHATISAIDS?该术语适用于艾滋病感染艾滋病毒的最后阶段。CDC已经为艾滋病的定义制定了官方标准，并负责跟踪美国艾滋病的传播情况。110CDC‘sdefinitionforAIDSincludesallHIV-infectedpeoplewhoseCD4+Tcellsisfewerthan200percubicmillimeterofblood.(HealthyadultsusuallyhaveCD4+T-cellcountsof1,000ormore.)Inaddition,thedefinitionincludes26clinicalconditionsthataffectpeoplewithadvancedHIVdisease.Mostoftheseconditionsareopportunisticinfectionsthatgenerallydonotaffecthealthypeople.InpeoplewithAIDS,theseinfectionsareoftensevereandsometimesfatalbecausetheimmunesystemissoravagedbyHIVthatthebodycannotfightoffcertainbacteria,viruses,fungi,parasites,andothermicrobes.ClinicalManifestation疾病预防控制中心的定义为艾滋病包括所有艾滋病病毒感染者的CD4+T细胞是少于200个每立方毫米。（健康成人通常有1000以上的CD4+T细胞计数）。此外，这个定义包括影响晚期艾滋病毒疾病的26个临床条件。大多数的这些情况是不影响健康的人的机会性感染。而在艾滋病人，因为免疫系统被HIV破坏，身体无法抵御某些细菌，病毒，真菌，寄生虫等微生物，这些感染往往是严重的，有时甚至是致命的。ClinicalManifestationSymptomsofopportunisticinfectionscommoninpeoplewithAIDSinclude:CoughingandshortnessofbreathSeizuresandlackofcoordinationDifficultorpainfulswallowingMentalsymptomssuchasconfusionandforgetfulnessSevereandpersistentdiarrheaFeverVisionlossNausea,abdominalcramps,andvomitingWeightlossandextremefatigueSevereheadachesComaClinicalManifestation在艾滋病常见机会性感染的症状包括：

咳嗽和气短

癫痫发作和缺乏协调

困难或吞咽疼痛

精神症状，如混乱和健忘

严重和持续性腹泻

发热

视力减退

恶心，腹部绞痛，呕吐

减肥和极度疲劳

剧烈头痛

昏迷ClinicalManifestationRespiratorysystem

Pneumocystiscariniipneumonia(PCP),Kaposi’ssarcoma(KS),TB.Themostcommonsymptomsandsignsaresinusitis,coughandfever,dyspnea,andetc.ClinicalManifestationSystematicManifestations呼吸系统

卡氏肺囊虫肺炎（PCP），卡波济氏肉瘤（KS），TB。最常见的症状和体征鼻窦炎，咳嗽和发烧，呼吸困难等ClinicalManifestationSystematicManifestationsDigestivesystem

Fungalandviralinfectionsarecommon.Orallesions,dysphagia

andodynophagia,acuteabdominalpain,diarrheaandweightlossarecommonsigns.ClinicalManifestationSystematicManifestations消化系统

真菌和病毒感染是常见的。口腔溃疡，吞咽困难和吞咽疼痛，急性腹痛，腹泻和体重减轻是常见的体征。ClinicalManifestationSystematicManifestationsNervoussystem

Opportunisticinfections;neoplasia;HIVmeningitis.Skin

KS,fungalandviralinfections.Oralhairyleucoplakia,wart.Eyes

Cytomegalovirus(CMV)infections,KS.ClinicalManifestationSystematicManifestations神经系统

机会性感染;肿瘤;艾滋病毒性脑膜炎。

皮肤

KS，真菌和病毒感染。口腔毛状白斑，疣。

眼睛

巨细胞病毒（CMV）感染，KSClinicalManifestationSystematicManifestationsLaboratory

Examinations实验室检查Routinetests

Bloodtest，UrinetestImmunologicaltest

CD4+Tlymphocytecountdecreases:CD4+/CD8+<1.0;

LaboratoryExaminations

常规试验

血液检查，尿液检查

免疫学试验

CD4+T淋巴细胞计数下降：正常（0.8-1.2）×109/L;CD4+/CD8+<1.0;

LaboratoryExaminationsSerologicaltest1.HIVantibodydetection:Antibodyforp24andgp120detection.ELISA,Westernblot(WB).

2.HIVantigendetection:ELISAforp24antigen.3.HIVnucleicaciddetection:NorthernblotorRT-PCRforHIVRNAassay,PCRforHIVDNAassay,bDNAforHIVquantification.

LaboratoryExaminations血清学检查

1.艾滋病病毒抗体检测：对p24和gp120的检测。ELISA，免疫印迹（WB）。

2.HIV抗原检测：ELISA检测p24抗原。

3.艾滋病毒核酸检测：Northern杂交或RT-PCR检测HIVRNA检测，PCR检测HIVDNA，bDNA艾滋病毒定量检测。LaboratoryExaminationsDiagnosisEpidemiologyfeatureClinicalmanifestationsLabexaminations

BecauseearlyHIVinfectionoftencausesnosymptoms,yourhealthcareproviderusuallydiagnoseitbytestingyourbloodforthepresenceofantibodies(disease-fightingproteins)toHIV.HIVantibodiesgenerallydonotreachnoticeablelevelsinthebloodfor1to3monthsfollowinginfection.Itmaytaketheantibodiesaslongas6monthstobeproducedinquantitieslargeenoughtoshowupinstandardbloodtests.

Diagnosis由于早期的艾滋病病毒感染常无任何症状，通常是通过检测血液中HIV抗体来诊断艾滋病。在感染后的1到3个月，HIV抗体水平不会显著升高。它可能携带抗体长达6个月，到抗体数量足够大时，才可检测到。

DiagnosisHence,todeterminewhetheryouhavebeenrecentlyinfected(acuteinfection),yourhealthcareproviderwillscreenyouforthepresenceofHIVgeneticmaterial.DirectscreeningofHIVisextremelycriticalinordertopreventtransmissionofHIVfromrecentlyinfectedindividuals.

Diagnosis通过对HIV遗传物质的进行筛查的方式可确定是否在最近感染（急性感染）。为了防止艾滋病毒从近期感染者传播传播病毒，艾滋病毒直接筛选是至关重要的。

DiagnosisIfyouhavebeenexposedtothevirus,youshouldgetanHIVtestassoonaspossible.Youarelikelytodevelopantibodiestothevirus-within6weeksto12monthsafterexposuretothevirus.Youshouldbetestedearly,ifinfected,youcandiscusswithyourhealthcareproviderwhenyoushouldstarttreatmenttohelpyourimmunesystemcombatHIVandpreventtheemergenceofcertainopportunisticinfections(seethetreatmentbelow).

Diagnosis如果你已经接触到病毒，需要尽快进行HIV检测。在接触病毒后的6周到12个月内可产生病毒抗体。应该及早检测，如果被感染，应该开始治疗，以帮助免疫系统抗击艾滋病毒，并防止某些机会性感染的出现。

DiagnosisEarlytestalsoalertsyoutoavoidhigh-riskbehaviorsthatcouldspreadthevirustoothers.

Diagnosis早期的检测提示你避免把病毒传染给其他人的高危行为。

DiagnosisHealthcareprovidersdiagnoseHIVinfectionbyusingtwodifferenttypesofantibodytests:ELISAandWesternBlot.IfyouarelikelytobeinfectedwithHIVbuthavebeentestednegativeforbothtests,yourhealthcareprovidermayrequestadditionaltests.Youalsomaybetoldtorepeatantibodytestsatalaterdate,thenantibodiestoHIVaremorelikelytohavedeveloped.

DiagnosisELISA和WesternBlot：使用两种不同类型的抗体检测可确诊感染艾滋病毒。如果有可能被感染艾滋病毒，但测试均为阴性，可要求额外的测试。也可在以后的日子重复抗体试验，这样艾滋病毒抗体更容易被发现。

DiagnosisBabiesbornbymothersinfectedwithHIVmayormaynotbeinfectedwiththevirus,butallcancarrytheirmothers'antibodiesagainstHIVforseveralmonths.Ifthesebabieslacksymptoms,adoctorcannotmakeadefinitivediagnosisofHIVinfectionusingstandardantibody.HealthcareprovidersareusingnewandmoreaccuratetechnicstodetermineHIVinfectionininfantsbetweenages3monthsand15months.TheyareevaluatingmanybloodteststodeterminewhichoneisbestforthediagnoseofHIVinfectioninbabiesyoungerthan3months.

Diagnosis由感染了艾滋病病毒的母亲所生的婴儿可能会感染病毒，但都可以随身携带来自母亲的抗HIV抗体数月。

如果这些孩子没有症状，医生不能使艾滋病病毒感染标准来诊断艾滋病。

新的和更精确的工艺可以确诊感染艾滋病毒的3岁个月至15个月的婴儿。他们正在评估多种血液测试，以确定哪一个是最适用于年龄小于3个月婴儿的诊断。

DiagnosisTreatment治疗AntiretroviraltherapiesSincetheapprovalofthefirstantiretroviralagent,therehasbeencontinualdebateovertheoptimaltimetoinitiateantiretroviraltherapy.AtthistimethereisageneralconsensusthatanypatientwithanAIDSdiagnosisisathighriskforprogressingtomoreadvanceddisease,hospitalization,evendeathforanyfurtherdelayinthera

Treatment

抗逆转录病毒疗法

随着第一个抗逆转录病毒药物的批准，对于启动抗逆转录病毒治疗的最佳的时间的争论就从未停止。现在的普遍共识是从确诊艾滋病到发展为更严重的疾病，住院治疗，甚至死亡的任何进一步开始治疗。

TreatmentAntiretroviraltherapies

Aplasma

HIVRNAlevelofgreaterthan1000to10000copies/mlisthought

tobegiven

therapy,regardlessofCD4+lymphocytecount.TheasymptomaticpatientswithCD4+Tlymphocytecountlowerthan0.5*109/Landsymptomaticpatientsmustreceivetreatment.

Treatment抗逆转录病毒疗法

血浆HIVRNA水平大于1000至10000/毫升时给予治疗，不管CD4+淋巴细胞计数多少。无症状患者的CD4+T淋巴细胞计数低于0.5×109/L和有症状的患者必须接受治疗。

TreatmentCurrentlyavailableantiretroviraltherapeuticagents

canbedividedinto3categories:

1.Thenucleosideanalogue

reversetranscriptaseinhibitors(NRTIs).2.Non-nucleosidereversetranscriptaseinhibitors(NNRTIs)3.Proteaseinhibitors

(PIs).

Treatment目前可用的抗逆转录病毒的治疗剂，可分为3类：

1.核苷类似物逆转录酶抑制剂（NRTI类药物）。

2.非核苷逆转录酶抑制剂（NNRTIs）

3.蛋白酶抑制剂（PIS）。

TreatmentHighlyactiveantiretroviraltherapy(HAART)isatreatmentregimenthatusesacombinationofreversetranscriptase

inhibitorsandproteaseinhibitorstotreatpatients,suchastwoNRTIswithaPI,ortwoNRTIswithaNNRTI,ortwoPIswithaNRTI,etc.Theprimaryagentsasfollows:

Treatment高效抗逆转录病毒疗法（HAART）是逆转录酶抑制剂和蛋白酶抑制剂的组合，如两种NRTI使用PI，或两种NRTI与NNRTI，或两个PI与NRTI等

TreatmentNucleosideanaloguereversetranscriptaseinhibitors(NRTIs)Thereare6agentsinthisclass.TheyactonHIVreversetranscriptasethroughcompletitivebinding

toreversetranscriptaseinplace

ofendogenous

nucleosidesandbyinducingthetermination

oftheelongating

viralDNA.