Until now, scientists still do not know what treatment for HIV infection will help to completely cleanse the human body of this virus. The current tactic of the existing therapy is to slow down the progression of the infection and prevent the disease from progressing to the AIDS stage. By adhering to this tactic, a person with this disease will be able to lead a fulfilling life for decades.
Treatment of this disease requires the intervention of qualified specialists. When treating HIV-infected patients, the most important thing is to maintain the health and stable condition of the patient. The best remedies to combat this virus are stress avoidance, eating well, maintaining a healthy lifestyle, and seeing your registered doctor regularly.
Many people very often ask themselves the question, how does HIV infection manifest itself? Initially, the virus weakens the body, and against the background of this weakening of a person, various colds are increasingly being pursued. This is due to the fact that a person's immunity becomes noticeably weakened. You should also be aware that after the first analysis, it is not always possible to determine HIV and make an accurate diagnosis, since there is a high percentage of false-negative and false-positive results.
HIV viral disease
HIV stands for Human Immunodeficiency Virus. This disease is a type of retrovirus. They are also called delayed viruses. This type of disease is specific, because it does not appear immediately after infection, but can occur after several years.
Penetrating into the blood of a person, HIV infection selectively attaches to blood cells, which are responsible for the state of immunity. This process of attachment is due to the presence on the surface of cells of peculiar molecules that are identified by this particular disease. Inside these cells, the disease starts the process of reproduction of a virus similar to itself even before the person's immunity has time to react to its presence, as a result of which a rapid infection of the whole organism occurs. The first thing that this virus infects are the lymph nodes, because they have a large number of immune cells. How to recognize HIV? Determining it in the early stages is rather difficult. The only signal is the emerging weakness and weakening of the immune system, manifested by an increase in the development of acute respiratory infections and acute respiratory viral infections.
With the development of the human immunodeficiency virus, an increasing infection of lymphocytes occurs, which leads to their significant decrease and ultimately the disease passes into a more severe stage - AIDS.
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There are many different ways of contracting this very unpleasant disease:
- Sexually transmitted infection. This type of infection is the most common worldwide. The patient's semen contains a large number of viral cells. Their increase occurs mainly in inflammatory diseases such as urethritis and epididymitis. In these diseases, there is a huge number of inflammatory cells of the immunodeficiency virus. The risk of getting infected may increase in cases of the presence of concomitant diseases.
- Infection when using the same needles and syringes. Often this method of HIV transmission is transmitted among drug addicts, since they use the same syringes and needles for more people, among whom there may be an infected patient.
- Blood transfusion. HIV disease can be present in donated blood and in 80-100% leads to infection of the person who received such blood. Infection can be avoided by administering immunoglobulin. After the procedure for testing donors for HIV was introduced, infections decreased significantly, but the risk still remained. The "blind period" is to blame for everything. This is the moment when the person is already sick, but the antibodies have not yet appeared.
- Infection of the baby during childbirth. This type of transmission is usually due to the presence of a virus in the mother, which is most often transmitted to her baby. This can happen both during childbirth and during pregnancy. The risk of this type of transmission of the disease is no more than 12% in Europe and almost 70% among African people. The percentage of infection directly depends on the correctness of the observations during pregnancy.
- A child from a mother can also become infected when breastfeeding. Doctors have discovered that HIV can be present in colostrum and breast milk of infected mothers. Therefore, if an infection of this kind was found in mommy, then it is contraindicated for her to feed the baby with breast milk.
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HIV treatment
The symptoms of this disease are quite varied. Modern medicine still does not know the answer to the question of how to get rid of HIV infection, but there are many different drugs that help to normalize the life of an infected patient. The manifestation of the virus in the human body is directly immunodeficiency. Therefore, many drugs are based on ingredients that help maintain its normal state and include them in effective treatments.
The principles of treatment for HIV infection are to take antiretroviral drugs to patients. Before you start taking them or your doctor prescribes a new treatment regimen for you, you will need to go through a series of blood tests. Your healthcare provider will refer you for a test that will show compatibility with your antiretroviral drugs. In the course of treatment, the patient is constantly under the supervision of doctors, which makes it possible from time to time to assess the effectiveness of treatment with certain drugs.
When signs of HIV appear, the doctor will prescribe ARVs to fight the disease. Before taking them, the patient needs to undergo a study of the health and functioning of the kidneys and liver. While undergoing treatment for HIV infection, it is very important to try in no case to miss taking medications and to accurately follow all the doctor's prescriptions. If you neglect the treatment and take medication in its process, then no, then the virus can become resistant to these drugs and they become ineffective.
There are cases when human viral immunodeficiency is quite resistant to certain drugs. But there is good news about this. More recently, antiretroviral drugs have been developed by scientists that are potent and will be acceptable to almost all patients. The main thing in taking medications is the schedule. If for some reason you cannot take your medication on time, then contact your doctor and discuss a new intake plan with him. There are many different methods that will facilitate easy drug intake and adherence to the regimen.
One of the first drugs used to treat HIV infection was azidothymidine (AZT). We produced it under the name thymozide, in the West it is known as retrovir, zidovudine (ZDV). The daily dose is determined by the stage of infection and the tolerability of the drug. The drug belongs to reverse transcriptase inhibitors.
The second generation drugs are dideoxyinazine (DDI), dideoxycytidine (DDS). Currently, the range of drugs in this group has expanded significantly (stavudine-DDT, hivid, phosphoside and others).
This group of medicines (MP) has a number of significant disadvantages. These drugs do not completely suppress the replication of the virus, which can be isolated in most patients during therapy.
Studies have shown that resistance to HFA rapidly develops, especially in the late stages of the disease with enhanced HIV replication, when resistance to other nucleoside analogs appears to arise.
A common factor that significantly limits the use of drugs in this group is their toxicity. HFA is mainly characterized by a toxic effect on the bone marrow, while DDI and SDS are neurotoxic. In addition, DDI can cause severe acute hemorrhagic pancreatitis.
A close relationship has been established between the clinical ineffectiveness of ZFA and in vitro resistance to it.
The second group of drugs, discovered relatively recently and already widely used, are protease inhibitors: indinovir (crixivan), invirase (saquinovir), virasept (nelfinovir), and others.
Currently, we are not talking about monotherapy with antiretroviral drugs, but only about di-, tri- and even tetratherapy. Such techniques allow reducing the concentration of the virus to values that cannot be determined using modern test systems (< 200 копий/1 мл).
The preference for combination therapy is justified by the following provisions (V.V. Pokrovsky).
- The use of many etiotropic agents more effectively suppresses the vital activity of the virus, acting on various pain points or synergistically affecting one of them.
- This allows you to reduce the dose of drugs, which reduces the frequency and severity of side effects.
- Different drugs have different ability to penetrate tissues (brain, etc.).
- The combination of drugs makes it difficult for resistance to develop, or it appears later.
All the approaches to the therapy of HIV infection described above assumed a direct effect on viral replication. Another possible method of treating HIV infection is to strengthen the defenses of the host organism. Some variants of this approach are in most cases nonspecific, occasionally specific and can affect the protective properties of the host cell.
Interferons, both natural and recombinant, have a number of disadvantages: antigenicity, the need for repeated administration to maintain a sufficient concentration in the body, a large number of side effects, etc.
Many inducers of endogenous interferon are devoid of these disadvantages, some of them are capable of being involved in the synthesis of IFN in some cell populations, which in some cases has a definite advantage over polyclonal stimulation of immunocytes with interferon.
The most studied effect in HIV infection of a low-molecular-weight synthetic compound from the group of acridones of a 12.5% drug cycloferon, produced by the company "Polisan" in ampoules of 2 ml for intramuscular and intravenous injections.
The specific activity of cycloferon in HIV infection was studied in 1997 at the Institute of Influenza of the Russian Academy of Medical Sciences
.- A pronounced inhibitory activity of cycloferon on HIV reproduction in monocyte cell culture was revealed.
- In terms of inhibitory activity, cycloferon is significantly superior to azidothymidine.
- The presented experimental data substantiate the clinical use of cycloferon for the treatment of patients with HIV infection.
Five-year experience of using cycloferon in HIV-infected patients allows us to evaluate the results of this work.
Between 1992 and 1997, 40 patients with different stages of HIV infection received cycloferon at the St. Petersburg City Center for the Prevention and Control of AIDS. It should be noted that 11 patients underwent two courses of cycloferon therapy, and therefore the total number of persons who received one course of cycloferon treatment was 29 people. They were mainly young people under the age of 40 (20 people), including three children under 14 years old.
The course of cycloferon consisted of five intramuscular injections of 2 ml of a 12.5% solution on the 1st, 2nd, 4th, 6th, 8th days of treatment. The drug was administered as monotherapy in 29 HIV-infected and AIDS patients.
All patients noted the good tolerance of cycloferon, the absence of pyrogenic reactions after its administration.
The patients also noted an improvement in their general condition, sleep and appetite, an increase in vitality, and efficiency. 30% of those who received the drug and had flu or ARVI in the autumn-winter period noted that the disease was unusually easy and recovery came faster than usual.
From clinical practice |
| Patient S., 12 years old. The term of infection is 9 years. Stage 3A of the disease (according to V.V. Pokrovsky). He has been receiving cycloferon for 5 years. Baseline CD4 +< 400 клеток в 1 мл. Первые три года прошел лечение курсами по 2 мл № 10 по схеме 1, 2, 4, 6, 8, 10, 13, 16, 19, 22-й день. Лечение 2 раза в год. Последние три года назначается 1 инъекция в 7 - 10 дней. Показатели CD4+ на уровне 700 - 1200 в 1 мл. В ноябре 1998 года впервые определена вирусная нагрузка, которая составила 8356 копий/мл. Patient T., 10 years old. The term of infection is 9 years. Disease stage niya 3A (according to V.V. Pokrovsky). He has been receiving cycloferon for 3 years. Baseline CD4 +< 300 клеток в 1 мл. Лечение ведется непрерывно в виде инъекций 1 раз в 7 - 10 дней по 2 мл препарата внутримышечно. Вирусная нагрузка составила в ноябре 1998 года 5146 копий/мл. For control, a patient of the same age was taken with the same terms of infection, who received long-term AZT, and in the last 6 months ditherapy (AZT + hivid). His viral load after treatment was 450,000 copies / ml. |
Of no small importance, in our opinion, are studies carried out in 1996 - 1997 to assess the effectiveness of cycloferon. Work was carried out (to a limited extent) to determine the viral load: the expression of HIV-1 RNA copies / ml was assessed using an amplifier from La Roche (quantitative PCR). These studies were carried out in London together with British scientists. The efficacy of cycloferon was studied - both monotherapy and the combined use of the drug with antiretroviral drugs under strictly controlled conditions. For this, patients with HIV infection were selected, whose blood test contained CD4 + cells from 200 to 500 in 1 μl, the number of leukocytes from 3.0 to 10.0x10 g / l.
After the course of cycloferon, there was a significant decrease in viral load (3.6 times). CD4 + count increased by 62%. Cycloferon monotherapy had a positive stable effect on the studied parameters in patients.
Of particular interest are the results of long-term follow-up of HIV-infected patients who received cycloferon for a long time in a kind of prophylactic regime in order to stabilize the process and prevent the progression of diseases.
In 1998, on the basis of the Russian Scientific and Methodological Center for the Prevention and Control of AIDS (head of the corresponding member of the Academy of Medical Sciences V.V. Pokrovsky), the dynamics of surrogate markers of HIV infections (CD4 + treatment with cycloferon.
The assessment of the reliability of the results obtained was carried out using nonparametric criteria (sign criterion, maximum criterion, Wilcoxon criterion for conjugate populations).
The test group included 10 adult patients with HIV infection at the stage of primary manifestations according to the Russian classification of HIV infection (V.I. Pokrovsky, 1989). The results of the study of the level of CD4 lymphocytes are presented in the table and in the figure, from which it can be seen that after the first four weeks of the study there was a tendency to an increase in the average level of CD4 lymphocytes, which by the 12th week became statistically significant. This increase persisted until the end of the study, despite
the outlined return to the initial level. The viral load progressively decreased throughout the experiment, and in 30% of cases to values below the determined (< 200 копий в 1мл).- conclusions
Thus, the use of cycloferon in the treatment of HIV infections is accompanied by the stabilization of the clinical manifestations of the disease, an improvement in the condition, as well as the hematological and immunological parameters of patients.
Cycloferon as a monopreparation has an immunomodulatory and antiviral effect in the treatment of HIV-infected (stage A1 3B) in cases where there is no significant decrease in the number of CD4 + cells (<200). Хорошо зарекомендовало себя назначение циклоферона по следующей схеме.
- 4 ml of the drug in 1, 2, 4, 6, 8, 10, 13, 16, 19 and 22 days of treatment (in children, 2 ml). The first two injections can be administered intravenously, the rest intramuscularly. Repeated courses of cycloferon are recommended after 6 months under immunological control.
- Cycloferon combines well with all major drugs, it is recommended to use it when there are signs of active HIV replication (high viral load), in patients with exacerbations of various opportunistic diseases.
The disappearance of immunological and virological indications for antiretroviral therapy in some patients may be important for the development of new approaches to the treatment of patients with HIV infection, for reducing the cost of therapy and delaying the development of resistance to it or overcoming the latter.
Cycloferon may turn out to be a promising prophylactic agent in case of questionable contacts and contacts with known HIV-infected partners.
Treatment of HIV infection is currently an important problem in modern medicine. The number of HIV-infected people around the world is growing steadily. Current HIV / AIDS treatment slows the progression of the disease, but does not completely cure patients. Today, the search for drugs is being intensively carried out in many countries of the world. New treatment regimens are being developed. The search for drugs that restore immunity is underway, the issues of combating the development of infectious complications and tumors in AIDS patients are being studied.
Rice. 1. The photo shows the moment of budding of the release of new virions from the target cell.
Main goals of antiretroviral therapy for HIV patients
Timely prescription of antiretroviral therapy, the use of optimal treatment regimens and the creation of a protective psychological regimen can prolong and improve the patient's quality of life, delay the development of life-threatening complications, and achieve longer remissions. The main goal of antiretroviral therapy is to reduce viral load to a level where it cannot be detected by laboratory testing and to increase the number of CD4 lymphocytes.
Rice. 2. For the first time, AIDS has been widely discussed since the mid-1980s.
Basic principles of treating HIV patients
The main principles of treating HIV patients are:
- creation of a protective psychological regime;
- timely initiation of highly active antiretroviral therapy (HAART);
- prevention, early detection and treatment of secondary diseases.
HIV / AIDS treatment should be combined and include antiviral therapy, pathogenetic and symptomatic treatment. Treatment of patients at the stage of AIDS, when the development of opportunistic diseases is noted, is of the same importance as the use of HAART.
Antiretroviral therapy slows down the progression of the disease and its transition to the stage of AIDS for 10 - 20 years. It is necessary to take into account the fact that any treatment regimen after 6 to 12 months may become ineffective due to mutations of viruses and their acquisition of resistance (resistance) to antiviral drugs. In addition, in a number of cases, individual intolerance to HIV drugs is recorded. In 40% of patients with late stages of HIV infection, as a result of taking antiretroviral drugs, neutropenia and anemia develop.
Taking antiretroviral drugs should only be administered as directed by a physician. The need for daily intake is dictated by the course of the disease itself and is a great test for the patient. Antiviral drugs are in the testing phase, which can be injected twice a month, but for now, antiviral drugs must be taken daily and at the same time. An indication for taking antiviral drugs is a high viral load and a significant decrease in the number of CD4 lymphocytes.
Antiretroviral drugs are taken in combination... The doctor takes into account the general condition of the patient, viral load, concomitant diseases and a number of other factors. Three or more drugs are included in the HIV / AIDS treatment regimen.
Use of immunomodulators could open up new perspectives in the treatment of HIV infection.
Primary prevention suggests the prevention of the development of opportunistic diseases that develop when the level of CD4 lymphocytes is below the critical level - 200 in 1 mm 3.
Secondary prevention suggests the appointment of AIDS patients with chemotherapy to prevent recurrence of the disease.
Supporting the health of people living with HIV is an important factor in the treatment process. Proper nutrition, avoidance of stress, healthy sleep and a healthy lifestyle, regular visits to the doctor are the main components of health support.
Psychosocial assistance to a patient with HIV infection is an integral part of the complex treatment of the disease.
Rice. 3. In HIV infection, herpetic lesions of the mucous membranes acquire a severe course.
Features of the course of HIV / AIDS on the background of HAART
With the use of HAART, the viral load in patients decreases (in 50 - 70% of them it decreases to 50 or less RNA copies / ml) and the number of CD4-lymphocytes increases. Against the background of an improvement in the immune status, the development of opportunistic diseases and oncopathology is prevented, the duration and quality of life of patients increases. You should be aware that in some HIV / AIDS patients on the background of HAART, for a number of reasons, the progression of the disease is possible.
- HIV-1 is the most pathogenic, virulent and most common of all. Minor changes in its genome lead to the emergence of a large number of new strains, which allows the pathogen to escape from the patient's immune system and acquire drug resistance to antiviral drugs.
- Some HIV / AIDS patients develop intolerance to antiretroviral drugs.
Preventing and delaying the development of life-threatening conditions is the main goal of HIV therapy.
Rice. 4. Shingles. A severe recurrent course of the disease is observed with HIV infection.
Indications for the use of antiretroviral drugs
The World Health Organization recommends treating all infected patients. The situation in the Russian Federation is somewhat different. Treatment of patients begins only with a decrease in the immune status, which is determined by the number of CD4 lymphocytes. In HIV-negative persons, their number in the blood is from 500 to 1200 per 1 mm 3.
Any antiretroviral therapy started for the first time must be powerful and aggressive to maximize suppression of HIV replication.
Rice. 5. Esophageal candidiasis (photo on the left) and genital candidiasis in women with AIDS. (photo on the right).
Antiretrovirals - Essential Medicines for HIV / AIDS
Today there is no cure for HIV that can completely cure the patient. Treatment of HIV infection is carried out with antiviral drugs, with the help of which it is possible to slow down the progression of the disease, and significantly (by 10 - 20 years) prolong the patient's life. In the absence of HAART, the patient's death occurs within 9 to 10 years from the moment of infection.
The effect of antiviral treatment of HIV / AIDS patients is achieved by suppressing HIV replication in target cells. It is necessary to take such drugs for a long time, preferably constantly.
1st group represented by nucleoside reverse transcriptase inhibitors (NRTIs). These include: Azidothymidine (Zidovudine, Retrovir, Timazid), Didanosine, Zalcitabine, Lamivudine (Epivir), Stavudine, Abakovir, Adefovir, Zalcitabine. Combined drugs Combivir (Azidothymidine + Lamivudine), Trizivid (Azidothymidine + Lamivudine + Abakovir).
2nd group includes non-nucleoside reverse transcriptase inhibitors (NNRTIs). These include: Nevirapine (Viramune), Delavirdine (Rescriptor), Efavirenz (Stacrin), Emitricitabine, Loviridine.
Group 3 represented by protease inhibitors (PIs). These include: Saquinavir (Fortovase), Indinavir (Crixivan), Nelfinavir (Viracept), Ritonavir (Kaletra), Indinavir, Amprenavir, Lopinavir, and Tipranavir.
4 group represented by receptor inhibitors. This includes the drug Maravirok(Celsentri).
5 group represented by fusion inhibitors. This includes Enfuvirtide (Fuzeon).
Rice. 6. Lamivudine and Zidovudine are medicines for HIV / AIDS.
HIV treatment regimens
Initial therapy with antiviral drugs for HIV / AIDS patients should be combined. The most optimal are the following schemes:
- Scheme 1: 2 drugs from the NRTI group + 1 from the PI group.
- Scheme 2: 2 drugs from the NNRTI group + 1 from the NNRTI group.
- Scheme 3: 3 drugs of the NRTI group.
The first scheme is the most optimal. Scheme 2 is an alternative to replace it. The scheme, which includes only 2 NRTI drugs, is inferior in efficiency to the scheme, which includes 3 NRTI drugs. Monotherapy with any of the drugs is ineffective. The exceptions are cases of pregnancy and the impossibility of using alternative treatment regimens.
It is better to use drugs in treatment regimens for HIV / AIDS patients of different groups, in maximum doses and simultaneously, which significantly reduces the likelihood of developing drug resistance of HIV, allows you to reduce the dose of drugs, act immediately on many links of the infectious process, and penetrate into different tissues and organs. This method of using HAART allows you to reduce the concentration of HIV to values that are not determined using modern test systems.
Continuing antiretroviral therapy is necessary for a long time (possibly lifelong). Discontinuation of treatment leads to resumption of HIV replication.
Combination therapy according to the rules of HAART increases the effectiveness of treatment up to 80 - 90%, monotherapy - up to 20 - 30%.
Rice. 7. AIDS patients at the stage of development of opportunistic diseases: lymphoma (left photo) and Kaposi's sarcoma (right photo).
Interruption of antiretroviral therapy and change of treatment regimen
There is an opinion of experts that if it is necessary to interrupt therapy for a long time, it is better to cancel all drugs than to switch to monotherapy or therapy with 2 drugs. This will reduce the level of development of HIV resistance.
The reason for the appointment of a new treatment regimen is insufficient virological and immunological effect, intercurrent infection or vaccination, side effects and intolerance to antiretroviral drugs.
An increase in viral load indicates the ineffectiveness of treatment for HIV / AIDS patients, and the number of CD4-lymphocytes is not taken into account in this case.
- With a pronounced side effect of the drug, it must be replaced with another of the same group with a different profile of intolerance and toxicity.
- When inappropriate therapy is prescribed (eg, only 2 NRTI drugs), but an adequate response is obtained (suppression of HIV replication), other drugs must be added. Inadequate therapy will still lead to an inadequate response.
- It is recommended to completely replace the inadequate initial treatment regimen.
- The high likelihood of developing cross-resistance dictates the condition for the appointment of 2 drugs of the same group. This is especially true for protease inhibitors.
There are side effects from antiretroviral drugs, but there are more benefits from antiretroviral therapy.
In the treatment of a patient with HIV infection, great importance is attached to the prevention and treatment of opportunistic infections and malignant tumors. Facilitates the course of the disease and prolongs the patient's life immunocorrective and immunosubstitution therapy. For many years, a number of countries around the world have been searching for new antiretroviral drugs and vaccines. Of the 10 drugs recommended by WHO for HIV infection in the Russian Federation, 8 generics will begin to be produced in 2017, and 2 more in 2018.
Rice. 8. Antiretroviral therapy slows down the progression of HIV infection and the transition to the stage of AIDS up to 10 - 20 years.
The difficulty in obtaining effective drugs for HIV infection is complicated by the great variability of immunodeficiency viruses, which, under the influence of external factors, quickly develop resistance and previously effective drugs and become ineffective.
Disappointing statistics presented by WHO show that 36 million people worldwide are infected with the human immunodeficiency virus. However, HIV has ceased to be a sentence today. In many large clinics in Israel, his successful treatment is carried out.
Why timely treatment is important
When it enters the body, the immunodeficiency virus begins to behave very aggressively. Its cells attach to the CD4 proteins present on the surface of T-lymphocytes (cells responsible for immunity) and insert their own DNA into them. As a result, the behavior of T-lymphocytes becomes similar to the behavior of the viruses themselves: they begin to infect healthy cells. Therefore, the most important condition for successful treatment is early detection of the virus and initiation of therapy. This is quite difficult, because, despite the active damage to lymphocytes, the external symptoms of the disease can appear several years after infection, when it is no longer about HIV, but about AIDS. These concepts must be distinguished. Suppressing HIV is a challenging task, but a very real one; as for AIDS, it develops as a result of a neglected virus, and today this disease is incurable.
Diagnostic methods
The diagnostic methods used in Israeli medical institutions make it possible to detect HIV even at a latent stage, when the virus has not yet had time to weaken the immune defense, which is fraught with the addition of concomitant pathologies.
Diagnostics is quite lengthy, it can take 2 weeks or more. It includes two stages:
- Consultation with a specialist.
- Analyzes.
All procedures for the diagnosis and treatment of HIV infection in Israel are completely confidential. The analyzes include:
- General blood analysis.
- Biochemical analysis.
- Other analyzes depending on the detected changes.
- ELISA - enzyme-linked immunosorbent assay (ELISA). This result is speculative and may also be false positive. It is also possible to obtain a negative result in an infected person when 3 months have not passed since the moment of infection. Sometimes a negative result occurs even 8 months after the virus enters the body.
- Western Blot, or Western blotting, is a more accurate method of confirming infection. However, it is also associated with antibodies, which are often absent for short periods.
- Polymerase chain reaction (PCR) is a highly accurate method that allows detecting a virus from an early stage. With the help of the reaction, the RNA of the pathogen (a specific strain of the virus) is detected.
The block of instrumental studies carried out to identify side pathologies includes X-ray, ultrasound, CT, MRI, and a number of other methods.
Based on the data obtained, the patient is assigned individual treatment: the most effective medicines and procedures are selected. The attending physician informs the patient about the prospects and possible risks of the therapy, gives recommendations on the necessary adjustments to the lifestyle, diet, and physical activity.
The main directions of therapy
The main danger of AIDS is the suppression of the function of lymphocytes, which are responsible for the immune defense. The result is a sharp decrease in immunity. As a result, the penetration of even a minor infection can be fatal, regardless of whether it leads to the development of, for example, lymphoma or the common cold.
Given this moment, the main goal of treatment in Israel is to ensure a sufficiently high level of immune protection.
The second direction of the therapy is suppression of the development of HIV-infected cells.
Particular attention is paid to constant monitoring of the patient's condition for the timely detection and elimination of developing diseases (pneumonia, Kaposi's sarcoma, etc.). So, the efforts of specialists are aimed both at suppressing the underlying pathology and at preventing other diseases.
Another important goal of the therapy is psychological support for patients and their loved ones. According to experts, it is very important that a person understands that HIV is not a sentence. Currently, thousands of people who have undergone treatment in Israel live a normal life, work, get married, give birth to children.
The main methods of HIV treatment in Israeli clinics
Therapeutic appointments are made on the basis of data obtained as a result of a thorough examination of the patient. Concomitant diseases provoked by the weakening of the body's defenses are also taken into account.
Antiretroviral drug therapy is being carried out to reduce the viral load on the body and suppress the further development of HIV cells. Three groups of drugs are considered the most effective today:
- The first includes nucleoside reverse transcriptase inhibitors (NRTIs for short), which are defective versions of the constituent fragments required for viral cell reproduction. These include Zidovudine, Emtricitabine, Tenofovir, Azidothymidine, Hivid, Stavudine, Lamivudine, Zeffix, Videx, etc.
- The second is non-nucleoside reverse transcriptase inhibitors (NNRTIs). Their action is to block the protein that the virus needs to reproduce. The main drugs in this category are: Nevirapine, Stokrin, Viramune.
- The third group is protease inhibitors, the effectiveness of which is based on the deactivation of the protease protein, which is an essential component of the process of viral cell division. The most commonly used drugs are Ritonavir, Atazanavir, Darunavir, Fosamprenavir
- The fourth group is fusion inhibitors. These are the fusion blocks of the virus and CD4 lymphocytes. The main drugs of the group: Enfuvirtide, Maravirok.
- The fifth group is integrase inhibitors. Their action is aimed at blocking the integrase protein, which is necessary for the virus when DNA is introduced into the CD4 leukocyte. The medicines used include Raltegravir.
Taking tenofovir is contraindicated in the presence of kidney problems. An enhanced protease inhibitor is prescribed if the virus is resistant to nucleoside and non-nucleoside reverse transcriptase inhibitors. This category includes:
- Darunavir;
- Saquinavir;
- Atazanavir;
- Fosamprenavir
Treatment tactics
At the initial stage, the patient is prescribed a combination of drugs of three main groups - the first line of therapy. This takes into account the characteristics of the course of the disease, the tolerance of drugs and the body's response to treatment. The patient takes the medication once or twice a day. Tests are regularly prescribed, which allow an objective assessment of the effectiveness of treatment. Factors such as the stage of the disease and the presence of concomitant pathologies (pneumonia, Kaposi's sarcoma, etc.) are also taken into account. If necessary, a course of preventive drug therapy is prescribed to prevent diseases provoked by a weakened immune defense.
If HIV begins to show activity towards the combination of drugs used, or there are unwanted reactions from the body, a change in therapy is necessary. The patient is prescribed a new combination of three new drugs, which significantly increases the chances of a successful treatment. Highly active antiretroviral therapy, based on the use of a “cocktail” of several antiviral agents, has an aggressive effect on HIV and prevents the virus from becoming addicted to a particular drug. The constant change of the ingredients of the medicinal cocktail quickly suppresses the resistance of the virus. In the course of therapy, innovative antiretroviral drugs are used, which allows you to take control of the development of the virus and significantly slow down the progression of the disease.
The purpose of complex drug treatment is also to eliminate symptoms and prevent complications of concomitant diseases (lymphoma, pneumonia, etc.)
Throughout the treatment, the patient undergoes a series of tests, on the basis of which the doctor monitors the condition of the infected person. A decrease in the number of CD4 lymphocytes is evidence of the progression of the disease, and an increase indicates the effectiveness of treatment.
The use of antiretroviral drugs for HIV treatment must be lifelong, which is problematic for many patients due to their relatively high cost. Therefore, in many clinics and research centers in Israel, research is being carried out, new options for therapy, vaccines are being developed, the use of which will not be aimed at reducing the viral load, but at the complete destruction of the virus.
Additional programs
Since a person can contract HIV at almost any age, Israeli doctors are doing everything possible to comprehensively improve the quality of life of patients. After undergoing a special therapy program, a person with HIV may even become a parent. The use of modern technologies makes it possible to exclude the transition of a viral infection from the mother or father to the fetus.
New medical technology developed by specialists allows a male carrier to have a healthy child. The essence of the method is to remove the virus from the semen by washing the semen. After that, artificial insemination is carried out. In Israeli medical institutions, special measures are also being taken to prevent the transmission of the virus from a woman to a child. New methods of treating young patients diagnosed with HIV are constantly being developed.
The latest methods and developments in the field of HIV treatment
AIDS vaccine
Scientists have noticed that taking an antiretroviral cocktail can neutralize a deadly virus. However, the decrease in the number of leukocytes continues. The weakening of the immune defense provoked by the virus progresses. Autoimmune processes are triggered, that is, the human body is practically fighting with itself. Israeli specialists have developed a special vaccine to support the immune system. The basis for its creation was the diseased leukocytes isolated from the blood of an HIV-infected person, "eating" healthy cells. They are destroyed and administered to the patient in the form of a vaccine. This triggers a sharp reaction in the body from the immune system, which continues to destroy similar cells in the blood. The tests carried out gave good results. The use of the new vaccine will turn HIV into a common chronic disease that requires supportive care.
Other innovations
Recently, Israeli experts have developed a unique substance capable of destroying cells infected with a deadly virus. The revolutionary discovery, giving hope for a final victory over the virus, was the result of a collaboration between biologists and chemists at the Hebrew University (located in Jerusalem).
The protein was isolated during the work of a group of scientists led by Dr. Assaf Friedler. The introduction of the protein into HIV-infected cells led to the death of the latter within two weeks. However, no side effects were noticed. The drugs used before helped to slow down the infectious process or the death of the virus, but could not cope with the infected cells that constantly reproduce the dormant virus.
The use of traditional methods of treatment often results in the development of immunity to drugs from HIV, as a result, it continues to infect new cells. The value of the new technique lies in the fact that the excreted protein leads to their immediate death.
In the near future, full-scale studies of the innovative tool are planned. So far, the drug is not available for widespread use. Despite this, scientists around the world recognize that its creation is a real breakthrough in medicine.
Another sensational invention of Israeli scientists is a special device that makes it possible to determine the presence of HIV in a person in just a few minutes. As already mentioned, the diagnostic tests used today last for at least two weeks, which significantly increases the cost of treatment in Israel and creates a host of other problems, especially for foreign patients.
The new diagnostic method does not even require a blood test. Outwardly, the device looks like a blood pressure monitor. The cuff with electrodes reads the data, which is then studied using a special computer program. The results obtained contain information about the presence or absence of HIV infection in the patient.
A large number of different viruses are constantly present in human blood, each of which has its own unique "handwriting". The work of the unique device is based on this: it reads an electrical signal emanating from HIV, which is then analyzed by a computer system.
The device has already successfully passed the testing stage and has proven its effectiveness. Its application will shorten the time of diagnosis from 14 days to several minutes.
Clinics offering HIV therapy
You can take the course of treatment for the human immunodeficiency virus in the following medical institutions in the country:
- Hadassah - specialists of the center have been conducting research in the field of diagnostics and therapy of the human immunodeficiency virus for more than 20 years. There is a reproductive department for the infected, helping patients to conceive and give birth to a healthy baby.
- Meir is one of the leaders in HIV treatment. A modern diagnostic base, laboratories equipped with the latest technology, experienced specialists - all this guarantees an effective medical care.
- - patients are offered a full range of diagnostic and therapeutic procedures.
- - in the treatment of HIV, the latest antiretroviral drugs are used, which allow to achieve a significant reduction in the amount of the virus in the body.
- Asaf Ha-Rofe Medical Center.
- Herzliya Medical Center.
- LevIsrael is a network of clinics.
- Clinic Tel Aviv.
Approximate prices for treatment
It is rather difficult to calculate the cost of HIV treatment in Israel in advance. The costs include the price of specialist consultations, diagnostic examinations, drug treatment, physiotherapy procedures, accommodation, nursing care. Medicines account for a significant part of the financial costs. It is difficult to predict which medications will be prescribed: it all depends on the patient's condition and test results. It is also necessary to take into account the possibility of the development of concomitant diseases, which entails new costs. With regard to the cost of diagnostic procedures for the detection of HIV, they cost about 1500-2700 USD. A doctor's consultation costs at least 400 USD, one day of hospitalization - from 500 USD.
November 17-18, 2016 specialists of the AIDS Center took part in the work of the First Scientific and Practical Conference "Modern Aspects of Prevention, Diagnostics and Treatment of HIV Infection" (St. Petersburg)
Scientists, experts, health organizers, medical professionals and public figures attended the conference and exchanged experiences on the best strategies and practices for HIV response. Only by consolidating the efforts of all specialists affected by this problem, further opposition to the epidemic is possible.
The conference was organized by: the Government of St. Petersburg, the Health Committee of St. Petersburg, the St. Petersburg State Budgetary Institution of Health "Center for the Prevention and Control of AIDS and Infectious Diseases"
At the grand opening, a welcoming speech was read from the Vice-Governor of St. Petersburg O.A. Kazan, in which the significance of the conference was noted, since HIV infection poses a serious threat to the life, health and well-being of the population, state and public security not only in our country, but throughout the world. The current epidemiological situation of HIV infection requires an integrated, interdisciplinary approach with the involvement of the widest circle of specialists, analysis of all accumulated knowledge and best practices. The Vice Governor expressed confidence that the conference events will become an effective platform for close interaction of various specialists: doctors, healthcare organizers and social workers.
At the opening of the conference, the Chairman of the Healthcare Committee of the Government of St. Petersburg V.M. Kolabutin, who noted the relevance of a broad discussion of the HIV / AIDS problem in Russia and the need for new organizational solutions to stabilize the epidemiological situation in St. Petersburg.
Chief freelance specialist of the Health Committee of the Government of St. Petersburg, Professor Yu.V. In his welcoming speech, Lobzin noted that despite the achievements of modern medicine, it is still difficult to reverse the negative trends in the spread of HIV infection, therefore, the fight against the HIV epidemic is recognized by the Government of the Russian Federation as one of the priority areas of its activity.
Head of the Federal AIDS Center V.V. Pokrovsky expressed the opinion that the spread of HIV in Russia is largely due to the fact that less and less attention is paid to primary prevention of HIV, despite the fact that last year the number of newly diagnosed HIV cases exceeded the number of officially registered cases of influenza.
In his welcoming speech, Vinay Patrick Saldana, Regional Director of the Joint United Nations Program on HIV / AIDS in Eastern Europe and Central Asia, noted that a special situation has developed in Russia today, since Russia has the largest HIV / AIDS epidemic of all countries in Eastern Europe and Central Asia. ... Therefore, it is in Russia that the UNAIDS “90-90-90” strategy should become the key for the Government, which is to achieve three goals by 2020: 90% of the level of diagnostics of HIV-infected persons, 90% of access to antiretroviral therapy among all identified persons and the achievement of undetectable viral load in 90% of individuals.
Director of the charitable foundation "Humanitarian Action" S.G. Dugin emphasized the uniqueness of the conference, which was that the discussion of the issues of counteracting the HIV epidemic was held within the framework of the tripartite communication of the professional community, the patient movement and non-profit public organizations.
The first plenary session was followed by the opening ceremony of HIV testing week in St. Petersburg.
In just two days, 2 plenary and 18 sectional sessions were held.
The Conference was attended by 589 people, including well-known scientists, international experts, practitioners, activists, representatives of the patient community. Exhibitions of pharmaceutical campaigns and the possibility of quick testing in the mobile laboratory of the humanitarian action charitable foundation were organized. A number of working meetings have taken place, new contacts have been acquired and cooperation is planned. All reports will be published in the collection of conference materials.
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