History
Only several decades ago the humanity was convinced that infectious diseases are no longer dangerous for the civilized world. However this confidence was substantially varied with the advent of human immune deficiency syndrome at the beginning of 80th. AIDS is not a rare disease nowadays. Leading specialists determine AIDS as “a global crisis of health”, as the first real huge and unprecedented epidemic of the infectious disease which is still not controlled by medicine and some time or other a lot of affected people die.
The first cases of AIDS were registered in 1981 in the USA. Cit is considered that it was brought to the country by the steward of airlines “Air-Canada”. He was an active homosexual, met his partners in bars, clubs and saunas. The investigation which was conducted by the American doctors showed that he had infected 40 people from the number of the first 250 victims of AIDS in the USA. That is why he was called a “zero” patient. He died in 1984 at age 32 from the “cancer of homosexuals” – Kaposi’s sarcoma.
The isolated instances of illness among homosexuals started to increase with high speed and in a year the cases were registered in 16 countries. In the middle of 1992, according to the data of World Health Organization (WHO), more than 500 thousand of patients were fixed in 165 countries of the world.
In the most developed country of the world – the United States one in 100 or 200 persons was already infected at that time, every 13 seconds one more inhabitant is infected and by the end of 1991 AIDS took the third place on a death rate excelling even cancer diseases.

The today’s facts testify the following: Ukraine occupies the second place after Russia among the countries-members of the CIS according to the amount of infected by HIV.
The first diseased people were exposed in 1981.The distribution of virus was among the certain groups of population, which were named risk groups. They are drug addicts, prostitutes, homosexuals, hemophiliacs (as their life depends on systematic injections of preparations from donor blood).
AIDS is a destructive illness, caused by an infectious agent, belonging to the group of retrovirus. During the years, from 1982 to 1984, the general picture of illness was found out.
The general picture of human acquired immune deficiency syndrome and diseases related to him is already clear while its origin remains a riddle. A few retroviruses of man and monkeys were found out by the modern methods of cultivation of cells. As well as other RNA containing viruses, they are potentially changeable; therefore such changes are fully credible in the spectrum of owners and virulence for them, which would explain the appearance of new pathogen.
Nevertheless, HIV virus out-distanced science in some relations. Until now in fact there are no preparations for treatment or AIDS prevention, and an epidemic meantime continues to spread.
Structure and life cycle of virus of AIDS
The HIV infection is many-sided. At the beginning this virus usually propagates itself intensively, and free virions appear in a liquid, filling cavity of head and spinal brain, and appearing in a blood stream. The first wave of replication of HIV can be accompanied by heat, rash, similar symptoms of flu and sometimes by neurological disorders. Then the amount of virus circulating in blood and cerebrospinal liquid diminishes considerably for a few weeks. Nevertheless a virus still is in an organism. It can found not only in Т-4 lymphocyte which were considered to be its unique target but also in other cells of the immune system, in the cells of the nervous system and intestine, and similarly in some cells of spinal cord. It means that virus deactivates the immune system.
Immune system provides in our body constancy of albumens and fights against the infection and malignantly regenerating cells of an organism. It has special organs and cages. They are thymus, marrow, spleen, lymphatic glands, accumulation of cells in a gullet, small intestine and rectum. The cells of the immune system are tissue macrophages, monocytes and lymphocytes. The last one subdivides into T- lymphocytes and B- lymphocytes.
The so-called cellular immunity is provided by T- lymphocytes. Their variety – Т-killers are able to destroy cells which antibodies were produced against, or to kill foreign cells. Difficult and varied reactions of immunity are regulated with the help of two other T- lymphocytes: T-helpers (Т4), and T-suppressors (Т8).
The life cycle of HIV begins with the connection (joining) of viral particle outside a cell and inserts the core into it. The core of virion contains two identical chains of RNA, structural albumens and enzymes, necessary for the subsequent stages of life cycle. The ferment reverse transcriptase, having a few fermentative activities, carries out the stages of transfer of genetic information of virus – synthesis of DNA.
Genetic information of virus in a form of two-stranded DNA, gets into the karyon. With the help of intergrade activity of the enzyme this DNA builds into the chromosomal DNA. It is called urgent provirus; it will be reproduced together with its own genes at the division of cell and will pass to the next generations.
The difficult mechanisms of virus reproduction act not in an isolation: they are closely related to metabolism of cell-owner. A virus uses cellular apparatus for the transcription of genes and synthesis of albumens.
Stages of infection
The first step of any viral infection is binding of viral particle to the component of membrane of the infected cell. Antigen CD4 is albumen that plays a role of such receptor component For HIV. (An antigen is a molecular structure which must be recognized by an antibody.) It means that distributing of CD4 in an organism must correspond to the tropism of HIV (to the spectrum of cells and tissues, struck by a virus. The CD4 antigen is found mainly on lymphocytes, which are called Т-4 helpers, as they are an important element of the immune system and on some other cells.
As it was determined earlier, binding together takes a place in a case when CD4 co-operates with the albumen of viral shell gp120, which is distributed on the external surface of the membrane. It was succeeded to define the specific fragments of molecules of CD4 and gp120, participating in binding. These results show a possibility of double fight with HIV: to prevent co-operating of virus with the cellular CD4 receptor by possible blocking of a receptor or screening the viral albumen gp120.
As a result of blood cells affection which carries the antigen of CD4, especially Т-4 lymphocytes concentration indicates possible infectiousness by AIDS. Besides the formation of multinuclear syncytiums in the cellular cultures is one more comfortable research sign of infection. Syncytium is a giant cage, containing the great number of nucleuses inside one membrane. It is formed as a result of confluence of cells, infected by HIV, with healthy cells, carrying the molecules of the receptor.
Binding of viral gp120 with the cellular CD4 is only the first stage of penetration of virus into the cell. The subsequent stages are still less clear. For example, how viral genetic material gets into the cell? The simplest and the most credible possibility consists in the fact that virion shell meets with a cellular membrane and viral particle content (including genetic material) appears in the cell. Other possible way is endocytosis, i.e. formation of small invagination of cellular membrane, which gemmates, growing into the closed diaphragm bubble. A bubble surrounds fully a viral particle and carries it into the cell. A membrane that generated a bubble (now it is called endosome) acidulates there. It results in conformational changes, confluence with a viral membrane and content release of viral particle into the intracellular space. According to this hypothesis, appearing to be fully plausible, binding of gp120 with CD4 causes a change of gp120 albumen conformation and as a result some part of one more albumen gp41 appears there, while normally it is hidden under the molecule of gp120. This area of gp41 is hydrophobic and must be inculcated into the membrane, but not to remain outside in a water environment that surrounds the cell. Being opened, the hydrophobic area of gp41 co-operates with near-by part of cellular membrane and induces its confluence with a viral membrane. It is still not clear, whether another receptor of cellular surface except CD4 is needed for binding with gp41, or gp41 inculcates straight into a cellular membrane with no help.
After HIV gets into the cellular environment and his genetic material integrates into the cellular genome, it can remain nonactive and not to show the signs of presence or it can become apparent in one of three methods.
At first, a viral genome can cause a long-lasting infection; the several viral particles form up at this stage, but not a lot of cells die. Secondly, an infection can result in formation of a syncytium, which perishes soon. Appearance of syncytiums is a main result of HIV influence on the culture of cells. Sometimes syncytiums are observed in the organism of the infected man on the late stages of infection, especially in a brain). However it is not clear whether they play some role in early pathogenesis of AIDS.
The third credible result of HIV infection is a rapid death of cells without formation of syncytiums. And it is still not proved, how HIV kills. Possibly, some of the products, coded by the genes of HIV, have a direct toxic action. Possibly, also the destruction of the cellular membranaceous system takes place there because of the inculcated gp120, which is synthesized as a result of infection, and it co-operates with the available CD4 in a membrane. The fate of the infected cell depends on the immune response, as the immune system is able to recognize viral albumens on the surface of the infected cells and kill these cells.
Distributing of the infected HIV cells in an organism is mainly conditioned by the distribution of cells, carrying CD4. Primordially, this antigen was identified according to its presence on certain T-lymphocytes. Indeed, its normal functions are connected mainly with the difficult network of co-operations between the cells of the immune system.
Preparations and remedies
Every therapeutic mean against an infection regardless of pathogen nature (it may be viruses, bacterium, funguses or protozoa) must either cause death of the pathogen or stop its reproduction.
A situation with viruses is more difficult and intricate. Viruses are simply a genetic material, dressed in a shell of glycoprotein and lipids. They are not able to propagate themselves independently and that is why they infect the cells of another organism and usurp their apparatus of biosynthesis which provides reproducing of virus. When active replication of virus occurs, it is frequently difficult to distinguish viral albumens, interacting with a cell and proteins of a cell. Close connection of many stages of virus life cycle with the metabolism of cell-owner hampers the creation of preparations which repress separately the replication of virus and at the same time affect the cell marginally.
It is also substantially, that practically any preparation (including penicillin) possesses a side action (by-effect) and toxicity at a variable degree. Therefore it is always necessary to take into account not only the effect of the influence on pathogen but also its harm, caused in the organism of man. The major description of potential therapeutic preparation is its “therapeutic index”: ratio of toxic dose to an effective dose. However in the case of illnesses, presenting a threat for life, such as AIDS, it is possible to use preparations at least with the comparatively low values of therapeutic index, while the more perfect are not created.
A difficult life cycle allows HIV to infect the cells of the immune system and slip away from their action. But such complication can be not only a distress but also blessing for the fight against the infection, as it gives a lot of possibilities to influence the virus with the help of antiviral facilities on different stages of its life cycle.
For example, sometimes oligonucleotides are used as a medicine, but they are bad as many of them can break up in the cells under the action of enzymes. But they can be done steady to the fermentative breaking up by modifying of certain phosphodiester bonds between nucleotides.
In principle, it is possible to prevent a formation of viral particles by blocking genes or albumens which carry out regulation of HIV replication.
Moreover, the albumens of a cell and even viruses, which infected it by chance, can influence HIV replication. For example, it was shown that the cellular albumen of NF-kB, which plays a role of intracellular signal of activating in some lymphocytes, is able to initiate replication of HIV. Infection with some herpes viruses promotes a formation of albumen in the cell, known under the name ICPO, which also can be the initiator of HIV replication. That is why, patients infected by HIV and herpes virus at the same time, possibly, i succeed to hamper the development of AIDS, controlling a herpes infection, for example, with a help of acyclovir.
Presently researchers should not pin their hopes with one exact method of treatment or medicinal preparation, quite the contrary, it is necessary to make all possible and impossible attempts to develop the great number of different agents, which can be able to attack HIV on different stages of its life cycle. The experience of azidothymidin studies is a good example for perfecting of preparations at the stage, when they can be use for patients treatment. Undoubtedly, so rapid progress is explained by careful, scientifically grounded clinical tests.
Common data
HIV infection flows long, has several stages. The last one is indicated with a term “acquired immunodeficiency syndrome” (AIDS) with all its various clinical presentations. The term “syndrome” marks the aggregate of symptoms of illness.
A purpose of HIV treatment is a maximal extension of life of a patient and saving its quality. And today this purpose is more frequently reached with the help of modern medicinal preparations.
One of main groups of medications from HIV are antiviral preparations which interfere in the life cycle of HIV or hinder its reproduction. Preparations of such action are used in medicine since 1987. The number of such medications broadened since that time, but an action remained the same: medicinal preparations affect the albumens, which form virus structure, because they are vitally necessary for virus reproduction. Medications against HIV do not let albumen function and in that way break reproduction of virus.
Treatment of AIDS, when one preparation is used, is called monotherapy or so called single-drug therapy. The days of monotherapy in a fight against HIV infection went away to the past generations. Modern treatment requires the combined therapy – simultaneous application of two, three or even more antiviral preparations. Monotherapy is used nowadays only in one case – for expectant mothers, to prevent passing of HIV to a new-born.
Combined preparations, which are actively used at present moment, affect both albumens, which form up human immunodeficiency virus. Such AIDS medicine allows to return patients to life with the heavy forms of AIDS and to repress activity of virus to such a degree that no one can find it even in the most sensible analysis.
Together with undoubted positive properties, antiviral preparations unfortunately have the substantial disadvantages. High cost of treatment which makes these medications inaccessible for many thousands of patients, origin of heavy side effects and finally gradual development of so-called resistance (adaptation of virus to preparation) are among them.
However, medicine does not stop half-way with no results. The development of medications against AIDS goes on nonstop day by day. But even now the quality of live of different HIV patients became considerably higher, and it is discussed more frequently that AIDS becomes not a simply mortal illness, but an illness with chronic and incurable clinical course from, and anyway it can be treated and fully assumes long-term full-fledged life of patients.
Certainly, for achievement of these aims, treatment of HIV infection must be started on a possibly earlier stage of the disease. It underlines a benefit of early diagnostics of HIV. However, speaking about HIV infection more than about any other disease one rule is really correct: prevention of illness is much easy, than to treat it.
One of generally recognized features of HIV is his highest capacity for mutations. Today there is an information in an international database about genomes of more than 25 thousand variants of HIV, discovered in different distant regions of the Earth. It is set that different subtypes of immunodeficiency virus prevail in different countries of the world. However these subtypes are steady enough; changes take place only in the subtypes of virus and they do not pass from one to another. Obviously, it reflects certain regularity in the laws of evolution of HIV. Such features of immunodeficiency virus can play a negative role in the development of vaccine from HIV infection: it is possible that a virus will change itself depending on vaccine composition and action.
Speaking about viability of immunodeficiency virus, the information about it is contradictory enough. However presently on the basis of great number of laboratory experiments, a lot of scientists agree that HIV can not live on air longer than a few minutes. Actually, this condition exactly proves absence of cases of domestic HIV infection. Viability of virus is much longer saved in a syringe or hollow needle. In this case it is necessary to take into account a lot of factors, including amount of blood in a needle, amount of virus in the blood, the temperature of the environment. However it is accepted to consider that HIV can save viability in a needle or syringe for a few days.
The fact that AIDS is caused by immunodeficiency virus (HIV) is discussed among the scientists even now. More than 5000 the scientists of the whole world signed the Durban declaration, where the confirmation that HIV is reason of AIDS is written. Their opponents or as they are frequently named, “AIDS-DISSIDENTS”, deny viral nature of AIDS. Expressed opinions are different. Some consider that HIV exists, but disbelieve that it causes AIDS. Others assume that HIV is one of the reasons of AIDS, but not a unique and not a main one. Finally, there is opinion that immunodeficiency virus does not exist in general, and all victims of AIDS died because of
antiviral preparations which they used. Now there are more publicists, than serious scientists among AIDS-DISSIDENTS. In most scientific circles the viral nature of AIDS is considered to be beyond controversy proved.
Symptoms of AIDS and HIV infection
HIV infection is considered to be very «insidious». It is linked with the fact that introduction of immunodeficiency virus in the organism of a man and its reproduction causes no symptoms of HIV-infecting.
The first signs of HIV are non-obvious. For example, in a few weeks after HIV infecting temperature can rise to 37,5 – 38, lymphatic glands enlarge, sometimes there is the unpleasant feeling in a throat, pain at swallowing, red spots appear on a skin, diarrhea in many cases.
HIV patients take no the notice to the origin of similar symptoms, recognizing them as the signs of cold or insignificant poisoning. It is difficult to distinguish them from the symptoms of ordinary cold or flu. All the more, all of infected have these primary symptoms of HIV and they disappear quickly. However, in case if they were really caused by HIV infection, their disappearance means that development of the infection goes along headily.
Presence of HIV infection in an organism can be absolutely unnoticeable during 10-12 years: this is the time, as a rule, that passes from a moment an HIV infection to the development of AIDS with no treatment.
Sometimes an infection let the patient know about it with such almost unnoticeable signs of HIV, as the enlargement of a few lymphatic glands on the back side of neck, above a collar-bone, sometimes on the front side of neck, in underarm, in the groin. In this case it is necessary check up not only those diseases, traditionally accompanied with glands enlargement (for the unique sign of lymphogranulomatosis), but also HIV infection.
The first signs of AIDS appear when the development of the infection progresses and weakening of the immune system of HIV infected patient become obvious. Those signs can pass or be easily cured among healthy people. On this stage any infection can result in the mortally dangerous condition, illnesses of internal organs, gradually resulting in death.
AIDS and its symptoms are constantly appearing diseases: pneumonia, tuberculosis, cytomegalovirus infection, herpes and many others, which are named opportunistic infections. Exactly these diseases result in heavy consequences more frequently than all. This stage of development of HIV infection is accepted to name the human acquired immunodeficiency syndrome, so called AIDS.
On this stage HIV infection regenerates in a serious, painful illness, when patient sometimes even can not independently stand up, move and carry out elementary independent actions. The care of such patient is usually carried out by native people, relatives in home terms.
Presently, in time diagnosed and competent treatment of HIV can move away the development of HIV infection to the stage of AIDS on an indefinitely long term, and to save life of a patient and its quality in such a way.
It is necessary to mark that HIV infection frequently combines with other infectious diseases, transmissible by sexual way. In these cases both the danger of AIDS and danger for life of a patient rises, caused by presence of concomitant infections. Today, such “associations” of HIV and other pathologies are the large problem of medicine.
I can not help saying that AIDS belongs to those diseases, information about which for the great number of people is equivalently to information about capital sentence. It is caused both by the real danger and incurability of HIV infection, and no doubt by that psychological atmosphere which surrounds AIDS patients. Therefore the consequences of HIV infection touch not only physical but also psychical health of a man.
In a physical plan an HIV infection can have the most different consequences. Having adequate treatment with modern antiviral preparations patient can live for many years practically without worsening of quality of life, certainly, except those problems which are caused by treatment: necessity of constant medical examinations and necessary medicine therapy.
Psychological trauma which is got by a man on receiving the information about the diagnosis of HIV, as a rule, is like a physical illness. Only during the last years public opinion and the relation to sick people changed, now they are not social outcasts. But work in this direction must be conducted during a lot of years just to achieve good results. SO it is necessary to say that a problem of AIDS is a problem not only medical but also psychological, and social.
In regard to mutual expectations between HIV infected people and society the term of “stigmatization” is often used. It means rejecting of one people by others, and those senses which are experienced by the rejected people, their expectations of those negative reactions from the side of surrounding people, which result in discrimination. In order that to avoid similar discrimination of HIV infected people it is very important to know, what HIV is, and how it is transmitted and how is not.
HIV spreads through the liquid environment of an organism. It can be found in blood, sperm, vaginal liquid, human milk. Some liquids of body can be treated. They are liquids, surrounding brain and spinal cord, joint (articular) liquids and last liquid around a future child.
HIV transmits from one man to other by having all kinds of sex (vaginal, anal or oral) with a man which is infected by HIV. The risk of HIV infection rises when ignorant people use one syringe with a drug addicts or patients which are infected by HIV. The two more cases are blood transfusion medical practice, which is HIV infected and during pregnancy, deliveries or breast-feeding, when HIV can transmit from a mother which is infected HIV.
HIV does not spread through the rim of toilet, embrace, handshakes or kisses with the closed mouth (there is a little chance to get the HIV infection because of the “French” kiss or kiss with the opened mouth, if there is a contact with blood), food intake together with the infected person, work, intercourse and communication with HIV infected, the use of telephones, bites of insects, through tears or by swimming in one reservoirs.
It is rather sad to notice that HIV spreads among women. Every year, the level infected HIV women grows, especially among colored women. Women are infected HIV mostly through a sexual contact with men. The second most widespread method of infection is through injections with the use of one needle.
Many people have no signs, when they are HIV infected at the beginning, and some do not have in general signs during many years. The display of signs depends only on a man. But some people have the signs of flu during a month or two after an infection of HIV. Similar to the flu signs are a fever, head pain, fatigue (you get tired faster and in a small periods of time), exaggerated lymph nodes (tonsils in a neck and in the groin). These simple signs show up within a week. Even if there are still no signs of the infection, HIV can already be passed to other man.
People should also know that HIV is never diagnosed on the base of degraded symptoms. You can have all of these signs, but to be non-infected. These symptoms and organic disorders can be caused by some other diseases. To know, whether you have HIV, you must pass through several analyses and pass testing. If you know that you have HIV, there are no means to cure it, but there are some methods to support the healthy condition.
It is important to remember that HIV actively operates in your organism, even when you do not have signs. As soon as HIV infection spreads in your organism, you will begin to feel ill. For many people, first sign of illness which they notice are enlarged lymph knots (exaggerated tonsils). Other signs which can follow this state are unbearable fatigue, sharp loss of weight, prolonged fevers, sharp sweating at night, head pain, nausea, vomiting, diarrhea, buzzing of muscles, ulcers in the mouth and other mucous membranes, quinsy and pour.
There are also other signs, which are more widespread, serious, and practically can not be treated among women with HIV. They are vaginal infections of “fermentation”, other vaginal infections, such as bacterial vaginitis, gonorrhoea, chlamidiosis, trichomoniasis and other illnesses, transmissible by sexual way, pelvic illness, or infection of woman genital organs, menstrual changes of cycle, and also absence of periods or presence of the permanent bleeding; human papilloma virus (HPV), infections which cause sexual warts and can result in a cervical cancer.
As an immune system continues to “relax”, other illnesses and infections, which affect eyes, digestive system, kidneys, lungs, skin and brain can develop.
Diagnosing of AIDS
The centers of Control and Prevention of Illness (center of control of diseases) determine AIDS, as the infection and presence less than 200 cells of CD4 on the cube millimeter of blood (Healthy people must have CD4 cells and T cells at the rate of 1000 and more) or presence of at least one problem with a health, characteristic for people with AIDS, some of which are called adjusted to the infections. But these problems usually do not make a healthy man a patient. People who have AIDS can have serious accomodating infections which can be fatal, because their antibodies can not overcome them.
Three stages from HIV to AIDS are mainly determined. HIV infection makes progress gradually. These stages of development of signs depend on the amount of virus in blood. The first stage is the initial stage.
An incubation period is the time, when a man is infected HIV, and when early signs begin to develop. Such period can last a few days or weeks. Signs, similar to the flu quite normal in the period of the first stage of infection which is named a sharp retroviral syndrome. The signs of sharp retroviral syndrome are often similar to the signs of other viral infection, flu or mononucleois infection, and can include the cramps of stomach, nausea or vomiting, diarrhea, enlarged lymphatic glands in a neck, arm-pits and in the groin, fever, head pain, pain is in muscles and joints, eruption on the skin, quinsy, loss of weight.
These first signs can be varied from tolerant to unbearable and usually disappear in 2 or 3 weeks.
The adjusting stage goes then.
Since a man is infected HIV, a lot of years without the display of other signs of illness can pass. When the signs return, they can be indefinite and difficult for description (although some people complaint about feeling of tiredness or sickly state along the whole period). A doctor can suspect that the man has HIV infection, if signs are saved or if reason of these signs can not be identified. HIV can be also suspected, when a few followings signs are present: diarrhea or other changes in an intestine; difficulties with the concentration of attention; dry cough; fatigue; fever; loss of appetite; wounds in to the mouth, changes in the structure of nails; nightly sweating; enlarged lymph knots in a neck, arm-pits, and in the groin; pain at swallowing; change in personality of man; repeated flashes of simple herpes; shortness of breath; pricking, insensitivity, and weakness in the extremities; unexplained loss of weight; trush.
Moreover, HIV can be suspected, when a woman has at least one of the present followings changes: More than 3 vaginal infections during the year, which can not be connected with the use of antibiotics; current stimulant pelvic illness; bad results of the tests Papanikolau or cervical cancer.
Children with HIV often have other signs than teenagers or adults (for example, decelerations in growth or increased irritability).
And the third stage of HIV infection is the last one. During the last stage of HIV infection, illness makes a progress to AIDS. Some of the signs of AIDS include fatigue, loss of weight, diarrhea, fever, nightly sweating and trush. In this period it is very simple to hook on any infections or illnesses, for example pneumonia or cancer, which will more probably develop in the organism when the immune system is weakened so much.
If HIV flows without some treatment, AIDS develops after it and most people have all it symptoms in 12 – 13 years. Treating HIV infection, the progression to AIDS stage can be deferred or prevented. A lot of people which are infected HIV reach AIDS stage during approximate 3 years, if they do not get the proper treatment. It is not known why an infection makes quick progress among some group of people.
To cut the long story short I should say that HIV is the most dangerous infection in the world and every person should know some simple rules how to prevent it and be careful, how to act in such situations and how to act with the infected people.

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