10級(jí)大5染病學(xué)hiv2012年下改

1、2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智Gottlieb MS NEJM 2001;344:1788-91Gottlieb MS NEJM 2001;344:1788-91Gottlieb MS NEJM 2001;344:1788-912022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智The

2、 replication cycle of HIVThe replication cycle of HIVThe replication cycle of HIV 2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智吸附吸附吸附吸附吸附吸附 脫衣殼脫衣殼脫衣殼脫衣殼脫衣殼脫衣殼 逆轉(zhuǎn)錄逆轉(zhuǎn)錄逆轉(zhuǎn)錄逆轉(zhuǎn)錄逆轉(zhuǎn)錄逆轉(zhuǎn)錄 環(huán)化環(huán)化環(huán)化環(huán)化環(huán)化環(huán)化 前病毒前病毒前病毒前病毒前病毒前病毒, , ,整合整合整合整合整合整合 轉(zhuǎn)錄轉(zhuǎn)錄轉(zhuǎn)錄轉(zhuǎn)錄轉(zhuǎn)錄轉(zhuǎn)錄, , , 翻譯翻譯翻譯翻譯翻譯翻譯 核心顆粒裝配核心顆粒裝配核心顆粒裝配核心顆

3、粒裝配核心顆粒裝配核心顆粒裝配 出芽出芽出芽出芽出芽出芽2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智Sepkowitz K NEJM 2001;344:1764-72Sepkowitz K NEJM 2001;344:1764-72Sepkowitz K NEJM 2001;344:1764-722022-2-222022-2-222022-2-22周智周智周智Source : National AIDS case surveillance

4、data, CDCSource : National AIDS case surveillance data, CDCSource : National AIDS case surveillance data, CDCMonths after OI diagnosisMonths after OI diagnosisMonths after OI diagnosis0.20.20.20.40.40.40.60.60.60.80.80.81.01.01.00 0 01981-19871981-19871981-1987Proportion survivingProportion survivin

5、gProportion surviving1010103030304040405050506060602020200 0 02022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智Estimated number of people newly infected with HIV globally,Estimated number of people newly infected with HIV globally,Estimated number of people newly infected with HIV g

6、lobally, 19902007 19902007 19902007 2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智bSecond phase (1989 1993) identification of HIV infection in 146 drug users in southwestern Yunnan Province.2022-2-222022-2-222022-2-22周智周智周智Sources of infectionSources of infectionSemenSemenSemen11

7、,00011,00011,000Vaginal Vaginal Vaginal FluidFluidFluid7,0007,0007,000BloodBloodBlood18,00018,00018,000Amniotic Amniotic Amniotic FluidFluidFluid4,0004,0004,000SalivaSalivaSaliva1 1 1Average number of HIV particles in 1 ml of these body fluidsAverage number of HIV particles in 1 ml of these body flu

8、idsAverage number of HIV particles in 1 ml of these body fluids2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智2022-2

9、-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智Kaposis sarcoma in a patient with AIDSKapo

10、sis sarcoma in a patient with AIDSKaposis sarcoma in a patient with AIDS 2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智bsporotrichosis2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智bOral cavity hairy leukoplakia herpesvirus infection2022-2-222022-2-222022-2-22周

11、智周智周智Various oral lesions in HIV-infected individuals. Various oral lesions in HIV-infected individuals. Various oral lesions in HIV-infected individuals. A. A. A. ThrushThrushThrush 2022-2-222022-2-222022-2-22周智周智周智Barium swallow of a patient with Barium swallow of a patient with Barium swallow of

12、a patient with CandidaCandidaCandida esophagitis. esophagitis. esophagitis. 2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智Central nervous system toxoplasmosisCentral nervous system toxoplasmosisCentral nervous system toxoplasmosis Central nervous system lymphomaCentral nervous sy

13、stem lymphomaCentral nervous system lymphoma 2022-2-222022-2-222022-2-22周智周智周智bherpes pudendalis,cauliflower excrescence2022-2-222022-2-222022-2-22周智周智周智bRetinitis choroiditis2022-2-222022-2-222022-2-22周智周智周智1. Routine examinations: Anemia, leucocytopenia, proteinuria.2.Immunological examinations: T

14、 lymphocytopenia, especially CD4+ T lymphocytes(healthy T cell levels range from 500 to 1500), decrease in CD4CD8 ratio,less than 1(normal 1.75-2.1). 2022-2-222022-2-222022-2-22周智周智周智b3. Serological findings: Positive anti-HIV by ELISA and Western blot（anti-gp24, anti-gp120 and anti-gp41, anti-gp64

15、and anti-gp31）.b4. Plasma HIV RNA Assays: RT-PCR, branched DNA (bDNA)bIsolation Virus2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智Diagnosis1Diagnosis12022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周周周 智智智 2022-2-222022-2-222022-2-22周智周智周智(5)opportunistic infections,

16、 needing to follow anti- HIV。 2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智TreatmentTreatmentb1. Antiretroviral therapy When used in combinations, these medications are termed Highly Active Antiretroviral Therapy (HAART). HAART combines three or more anti-HIV medications in a da

17、ily regimen, sometimes referred to as a cocktail.2022-2-222022-2-222022-2-22周智周智周智Fusion Inhibitors.2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智2022-2-222022-2-222022-2-22周智周智周智bReview facility policy and report the incidentbMedical follow-up is necessary to determine the expos

18、ure risk and course of treatmentbBaseline and follow-up HIV testingbFour week course of medication initiated one to two hours after exposure bLiver function tests to monitor medication tolerancebExposure precautions practiced2022-2-222022-2-222022-2-22周智周智周智Prevention b1. Isolation of patients and concurrent disinfection.b2