NHM 3

1. PHM VN HIU 2. ON NGC PHNG KHANH 3. TRN NGUYN MAI KA 4. TRN TH BCH LIU 5. NGUYN TH THC NNG 6. NGUYN TH NGC THY 7. CHU NGUYN THANH THY 8. TH MINH TRINH 9. PHNG NGN NH TUYN 10.NGUYN TH KIM VNG

A. S LC V VIRUT HIV

HIV BIN PHP PHNG V IU TR

B. CU TRC VIRUT HIV

C. C CH LY NHIM D. HU QU CA VIC LY NHIM HIV (AIDS) E. CC CON NG LY NHIM BIN PHP PHNG V IU TR

I. NGUN GC CA AIDS V HIV

Ca bnhna AIDS (Aquired Immune Deficiency Gn nm sau , Gs Robert Gallo v Syndrome) nhm u tincu tai c th a nh n tai My Institute vo u nhng nm 80 nghin NIH (National of Health) cacng th k trc . pht hin 1 virus nh th v t tn l Dch AIDS thc c Michael Gottlieb virus. v cng s HTLV IIIchnh - Human T-cell lymphotropic cng b trn t Morbidity and Mortality Weekly Report Thng 3/1987, ngy 5 thng 6 nmTng 1981 thng My Ronald Reagan Tng thng Php ng tuyn b Luc Cui v nm 1983, GS Luc Montagnier v c ng s tai vin Montagnier Robert Gallo ng tcv gi pht Pasteur Paris v pht hin ra virusl gy bnh t tn l hin ra HIV . virus. LAV- lymphadenopathy associated

 Nm 1999, pht hin HIV c ngun gc t virus SIV Cc nh khoa hc kt lun rng loai tinh tinh hoang a nhim cung luc 2 chng SIV khc nhau. Hai chng ny giao phi vi nhau sinh ra chng th virus th 3 c th gy bnh cho ngi.

Loi tinh tinh nhim SIV

II. KHI NIM HIV/AIDS

HIV (Human Immunodeficiency Virus) :mt loai vi rt gy suy gim h thng min dch ngi Virut l g?

L mt loai vi sinh vt gy bnh c kch thc nh hn vi khun, vi rut cu truc ca mt t bo khng hon chnh, vi rut khng t pht trin v nhn ln bn ngoi t bo. Vi rut khng c nhn nhng vn c vt cht di truyn c th l ADN hoc ARN.

III. Phn loi virus HIV

Retroviruses

Oncoviruses

Lentiviruses

Spumaviruses

HIV

 HIV thuc nhm Lentivirus, v ging nh mi virus thuc typ ny, n tn cng h min dch. Lentivirus bao gm HIV-1 v HIV-2 u thuc vo mt nhm virus ln hn gi l Retrovirus.

HIV-2

HIV

HIV-1
Phn lp nm 1983 Chia thnh 3 nhm: Nhm M: chia thnh 9 th typ t AK Nhm N Nhm O Nhm M l nhm gy bnh ph bin trn th gii, cn nhm N v O him gp hn

HIV-2

Khc nhau v mc di truyn

Phn lp nm 1986 Chia thnh 6 th typ t AF HIV-2 t ph bin hn HIV-1 v thng gp cc quc gia pha Ty chu Phi

 Tuy nhin, typ Lentivirus m ta quan tm khi nghin cu ngun gc ca HIV l SIV (Simian Immunodeficiency Virus) gy bnh loi kh. - Mt SIV gy nhim cho kh mangabey u - Mt SIV khc gp loi kh ln mi m (spot-nosed ) HIV l 1 virus c tnh thay i cao, t bin d dng Da trn nhng im tng t v di truyn, ta c th phn loai v s cc chng virus khc nhau thnh typ v phn typ.

IV. Sc khng ca HIV

o HIV khng vi nhit lanh, tia cc tm. o Sng c 3 ngy trong mu bnh nhn nu ngoi tri. o D b tiu dit bi Javel, Alcol 700. o Hon ton b bt hoat nhit phng th nghim trong 10 phut vi Abusehol bleach 10%, Ethanol 50%, Isopropanol 35%, Lysol 0,5%, Paraformaldehyde 0,5%, Hydrogen peroxydle 0,3%. o un nng 500C trong 30 phut trong mi trng m t hoc pH1 v pH13 HIV cng b tiu dit.

B. CU TRC HIV

I. Cu trc phn t ca HIV

HIV c cu truc hnh cu, ng knh trung bnh 100 nm gm 3 lp: V ngoi, v trong v li.

1. Lp v ngoi
Bao ngoi l mt lp mng lipid kp c khng nguyn cho vi mng sinh cht. Gn ln mng l cc nhu, l cc glycoprotein gm c 2 thnh phn: Protein mng ngoi : trng lng phn t 120 kiloanton (KD) k hiu l gp120. (Gp120: dang nh gai, li ra ngoi mng bc, nhim v nhn dang v bm ln b mt t bo ch tai th th CD4+) Glycoprotein: xuyn mng gm gp120 v gp41(Gp41: xuyn qua mng bc v ng vai tr trung gian trong vic iu ha mng gia mng bc HIV v mng t bo ch) gn vi nhau tao thnh cc phn t gp160, c trng lng c th 160KD.

2. Lp v trong
V trong (V capsid): gm 2 lp + Lp ngoi hnh cu, cu tao bi protein c trng lng phn t 17 kilodalton (p17). + Lp trong hnh tr, cu tao bi cc phn t c trng lng phn t l 24 kilodalton k hiu p24 (p24: khng nguyn c hiu nhm, khng c tnh hon i, khng trung ha c virus nhng n l du hiu huyt thanh hc quan trng trong chn on v theo di din tin ca bnh)

3. Li

C dang hnh tr c bao bc bng mt lp protein p24 Gm hai si ARN n, c enzym phin m ngc v 1 s phn t protein phn t lng nh. Mi si ARN ca Virus ny c 3 gen cu trc: gen GAG; gen POL v gen env.

2. Cu trc b gen ca virus HIV

Pol: m ha vi loai protein bao gm: oMen RT: m gipha virus saoprotein chp ngc t RNA thnh DNA Gag: lp bn trong, quan trng nht l Vif(viral Env: m infectivity ha cho gp160 factor), ( tin gen thn vrp(viral ca 2 protein glycoprotein R) v gen Tat(trans activator), Nef(negative regulator factor) v gen oMen Integrase : gip DNA virusp24 gn vo DNA t bo k ch mng vpu(viral protein l gp120 U):m v gp41) hact cho cc protein khc. rev(regulator of virion protein): iu ha s nhn HIV. oMen bc Protease: gip vic phn cc protein khc nhauln caca virus

C th bn cha bit

 Khc vi nhng g chung ta c bit trn sch bo, HIV dng nh c cu tao tinh vi v nguy him hn rt nhiu. Nhng bc nh di y m t 5 lp, t ngoi vo trong ca virus HIV.

1. 3. 2. 5. 4.

C. C CH LY NHIM
Qu trnh xm nhp ca virut trong c th ngi o Giai oan 1: xm nhp vo c th o Giai oan 2: tn cng t ba ch. o Giai oan 3: sao chp bn trong t bo ch (Chu trnh nhn ln ca virut HIV trong t bo lympho T) v gy ra cc hu qu.

1. Giai on 1: xm nhp vo c th
HIV xm nhp vo c th qua 3 con ng: Mu Tnh dc M b nhim HIV truyn sang con thi k chu sinh.

2. Giai on 2: tn cng t bo ch

T bo ch bao gm?

2.1. T bo lympho T CD4+ (LT4) 2.2. ai thc bo v bach cu n nhn. 2.3. T bo rng ca v t bo Langerhans 2.4. C quan bach huyt

T bo lympho T CD4+ (LT4)

o L tb trung tm gi vai tr quan trng trong p ng h min dch ca ngi. o Trn b mt LT4 mang phn t CD4- l th th c hiu vi gp120 giup HIV nhn dang v bm ln b mt LT4. o Cc ng th th CXCR4 Chemokine giup virus d dng i vo t bo. CD4 v CXCR4 l nhm HIV xm nhp. o HIV c phn lp nhiu LT4 vo giai oan nhim trung tin trin. o Thi gian bn hy ca LT4 b nhim l 1,6 ngy.

i thc bo v bch cu n nhn

o ng vai tr chnh trong vic lan truyn v sinh bnh hc ca vic nhim HIV. o Bach cu n nhn tng i kh tiu dit bi HIV, do virut khng nhng tn tai bn trong t bo m c th qua bach cu n nhn a b nhim xm nhp vo cc c quan khc nh nao, phi o nao: y l 2 loai t bo chnh b nhim HIV lin quan n cc triu chng bt thng bnh nhn AIDS. o phi: ai thc bo ph nang lin quan n vim phi k.

T bo rng ca v t bo Langerhans
C quan bch huyt
ng vai tr trung tm trong vic nhim HIV. Trong qu trnh nhim HIV, ngay c trong giai oan nhim trung tim tng, HIV vn ch ng sao chp trong m bach huyt.

3. Giai on 3: sao chp bn trong t bo v gy ra cc hu qu

S nhn ln ca virut trong t bo lympho T

Hu qu

S nhn ln ca virut HIV trong t bo lympho T

Gn kt Sao chp ngc Ho nhp Sao chp Bin i T hp virus v trng thnh

GN KT:
HIV c cc protein trn v bc, bao ph thng tin gen (RNA+ enzyme c bit) cun hut manh m c quan nhn cm b mt CD4+ bn ngoi t bo T4. Khi HIV kt hp vi 1 c quan nhn cm b mt CD4+ kch hot cc protein khc trn b mt TB, cho php v bc HIV lm ngng hoat ng bn ngoi TB

SAO CHP NGC: Virus HIV

(RNA)

Enzyme (RNA) sao chp ngc Enzyme ribonulease

si cDNA

chui DNA kp

HO NHP:
Virus (DNA) nhn t bo (DNA) Enzyme virus (men tng hp-intergrase), a DNA tim virus vo DNA (t bo) provirus

SAO CHP:
Provirus Nhn t bo
phin m

mRNA

BIN I:
Cc mRNA i khi nhn TB, s dng b my tng hp protein ca TB b nhim tng hp protein ca n.

Qu trnh ny tip tc cho n khi si mRNA b bin i hoc chuyn n cc protein b nhim mi tao ra nhng virus mi

T HP VIRUS V TRNG THNH

Cc chui di protein Enzyme protease

Protein nh hn

Cc protein ny thc hin hng loat chc nng. Cc mnh nh virus mi c t hp lai, chui ra khi TB ch v tao ra 1 virus mi giai oan trng thnh kh nng ly nhim cho mt TB mi sn sinh ra nhiu virus mi

Hu qu
S cht t bo Khi b nhim virut, u tin virut s c ch s tng hp protein ca t bo, trong khi s tng hp protein ca virut vn din ra. K n, virus c ch s tng hp DNA v RNA ca t bo ch gy ra s cht t bo.

Hin tng hp bo
o LT4 (nhim HIV) xut hin cc gp120 trn b mt ca virus. o Gp120 gn vi phn t CD4 ca LT4 khc cha b nhim HIV tao hp bo. o Cc hp bo ny khng cn chc nng na v gp120 s lm thay i b mt cng nh tnh thm ca mng hp bo cht.

Hin tng ADDC (Antibody Dependent)

Trn b mt LT4 b nhim HIV c mang khng nguyn gp120 v c th tao ra khng th khng gp120. Phn vi hat ca HIV s gn ln b mt LT4 tai gp120, phn cn lai ca khng th s gn ln b mt t bo dit dn n lympho bo T c gp120 b tiu dit.

Hin tng hot ha h b th

Gp120 t do trong mu phng thch t LT nhim HIV s gn vo phn t CD4 ca cc LT4 cha b nhim HIV. Sau cc khng th khng gp120 s n gn vo gp120 ny tao thnh h phc hp min dch. Phc hp min dch s hoat ha h b th, cui cng LT4 b ly gii.

Hin tng siu khng nguyn

HIV hoat ng nh mt siu khng nguyn. Siu khng nguyn ny hoat ha khng chuyn bit nhiu lympho bo T giup v dn n s cht chung.

S cht theo chng trnh

Cc tb CD4+T c th b git khi chc nng ca t bo ri lan khng cn iu khin c do s hin din ca cc protein HIV Cui cung s dn ti mt tin trnh t bo cht theo chng trnh

HU QU CA VIC LY NHIM HIV

HIV
AIDS
BNH NHIM TRNG C HI

DIE

AIDS l g?

AIDS = Acquired Immuno Deficiency Syndrom: l hi chng gy suy gim min dch ngi. Hi chng AIDS bao gm c 3 giai oan: nhim HIV cp, khng triu chng v biu hin lm sn ca AIDS.

1. Hi chng nhim HIV cp

Thi gian: 3 n 6 tun sau khi nhim HIV. Triu chng: 50-60% ngi c cc triu chng nh st, vim hng, ni hach, pht ban, lot da v nim mac, vim dy thn kinh ngoai bin, vim no, vim mng no. Lng virut tng cao nhng khng th cha xut hin trong huyt thanh bnh nhn.

2. Nhim HIV khng triu chng

Thi gian: trung bnh khong 10 nm. Ngi nhim HIV hon ton khng c triu chng nhng thc s virut vn tn tai v tng sinh bn trong t bo v m bach huyt.

3. Biu hin lm sn ca AIDS

L giai oan cui cung ca ngi nhim HIV. T khi c biu hin lm sn thng khng sng qu 24 thng. Biu hin lm sn quan trng l cc bnh nhim trung c hi hoc cc bnh ung th.

S hon chnh cc giai on HIV/AIDS

BNH NHIM TRNG C HI NGI NHIM HIV

Th no l bnh c hi?

L bnh xy ra khi h min dch suy yu trm trng.

BNH C HI THNG GP NGI NHIM HIV

H h hp

H tiu ha

H thn kinh trung ng

H da

Cc b phn khc ngi

H h hp

Vim phi PCP

Vim phi do lao

o Tc nhn gy bnh vi khun lao hin (Mycotabacterium Tc nhn gy bnh :thng - :Pneumocystis jiroveci (Pneumocystis Giai oan AIDS: c biu bnh ngoi phi, tuberculosis) carinii carinii)m thng m tnh KH KHN xt nghim o ng ly: ly qua ng hp (git nhm) ) ng ly: ly qua ng hh hp (hat sng TRONG VIC CHN ON LAO o Du hiu v chng : ho > tng 3 tun , st ko di, chm ni hach c im : st , triu ho khan, kh th dn , tin trin , X-, ra m trm , st cn, thm nhim nt vng quang chi hnh nh phi k,X-quang nt. nh phi.

Nm ming

H tiu ha

Nm thc qun

Lao rut

1. Nm ming
o Tc nhn gy bnh: nm canida, c bit cadida albicans. o L sinh vt hi sinh ng tiu ha (1/3 ngi khng suy giam min dch tm thy canida trong ming) o Suy gim min dch canida pht trin manh o Du hiu: au rt, thay i v gic, c mng trng xp trong ming.

2. Nm thc qun
Nm ming khng iu tr nm thc qun. Du hiu: kh nut, au khi nut.

3. Lao rut
Tc nhn: vi khun L lao phi, thng gp khi CD4 < 200. Du hiu: tiu chy man tnh, st st cn.

Vim no do Toxoplasma H thn kinh trung ng Vim no do Cryptococus

Lao mng no

1. Vim no do Toxoplasma
Tc nhn: ng vt nguyn sinh Toxoplasma gondii. Du hiu: St, au u, nn, i. Gim th lc, co git. Lit mt, lit na ngi. Chp CT nao: hnh nh ging vng nhn trong no.

2. Vim no do Cryptococus
Tc nhn: vi khun Du hiu: St au u, nn vt C cng C th lit na ngi

Zona

Tc nhn: Virus varicella zoster Du hiu: au rt, ni mn nc (AIDS: tn thng ln, ti pht nhiu ln)

H da

Herpes

Tc nhn: Virus herpes simplex typ I nim mac ming v typ II nim mac sinh dc Pht bnh: yu mt, suy gim min dch.

Vim da do nm penicillinum

Tc nhn: nm Penicillinum Marneffei Triu chng: ni sn trn da, lm gia, mt v u

Herpesviridae

penicilium marneffei

C. CC CON NG LY NHIM BIN PHP PHNG V IU TR

CC CON NG LY NHIM

1.ng tnh dc
Xc sut l 1/1 000 n 1/100 (c tnh trn qun th). Nhng vi tng c nhn c hnh vi tnh dc khng bo v th xc sut ly nhim HIV lun l 1 hoc 0. Kh nng ly nhim ny s tng gp nhiu ln, nu mt trong hai ngi b mc cc bnh ly truyn qua ng tnh dc nh: Lu, giang mai, sui mo g, nm, Herpes

 Hng ly nhim trong quan h tnh dc ng ming t tinh dch, dch tit m ao n mi ming ngi dung ming nu c tn thng. Hng ngc lai cng c th xy ra nhng t hn.
HIV c th ly truyn qua tt c cc cch giao hp, nht l cc cch giao hp gy xy xc hoc c thng tn t trc (qua ng hu mn, giao hp dng vt ming c tn thng dng vt v chy mu chn rng).

2.ng mu
HIV c th ly truyn qua truyn mu hoc cc ch phm t mu b nhim HIV.

 Dung chung cc dng c xuyn chch qua da khng c v trung hoc khng m bo nguyn tc khi kh trung hoc v trung nh: Bm kim tim, kim chm cu, kim xm mnh, bm l tai, Nhng ngi s dng cht gy nghin ng tim chung bm kim tim th nguy c ly nhim s rt cao.

3.T m sang con

Ngi m b nhim HIV c kh nng truyn cho con trong thi k mang thai, sinh con v cho con b.

 Trong thi k mang thai, HIV c kh nng di chuyn t mu ngi m qua nhau thai ri vo bo thai. Trong khi sinh l do xy xt nim mac v da, tao ng xm nhp ca virus t ngi m sang con. V trong thi gian cho con bu, HIV c th ly nhim cho con qua sa m hoc do xy xt.

HIV khng ly truyn khi Mui t Hn Tip xc thng thng

Mui t
Khi t ban, mui tit vo c th ban mt t nc bt. Nhng v HIV khng sinh sng trong c th mui nn nc bt ny khng cha HIV, v vy ban khng th ly nhim HIV qua ng mui t. Vi mui rt tinh t, cho php mui ly mu rt gn gng, khng bao gi mu ca ngi b t trc dnh vo ngi b t sau. Mui hon ton v can trong s lan nhim HIV.

Hn
Ban ng qu hoang mang. Hn nhn chung khng lm ly nhim HIV, bi HIV trong nc bt v cung t, khng truyn c. Ch khi hai ngi b lot, xc trong ming hoc chy mu rng m hn su th mi c kh nng ly do tip xuc mu.

Tip xc thng thng

Tt c cc kiu tip xuc thng thng nh cung n ung, mc chung qun o, m p, bi chung b bi, cung nh, ng chung ging (tt nhin l khng quan h tnh dc!), lm vic cung c quan, dung chung nh v sinh, ct tc khng lm cho ai b nhim HIV.

PHNG TRNH LY NHIM HIV

1. VC XIN
o Hin nay cha c mt loai vc-xin no c kh nng phng Mtbnh s kh khn : i vi HIV. c hiu o HIV bin i nhanh, c bit l khng nguyn Mt c s tnh hng nghin cu ch tao vc -xin: bc tao nnc cclc chng o mng Vc-xin sng gim hay btbin hoat . khng vi khng trung ha.ti t hp o th Protein virut o Cha bit r s phi hp min dch nhm bo v c th v Liu php gen. chng lai s nhim v nhn ln ca Hiv. Thiu m hnh ng vt th nghim.

2. Phng bnh tng qut

Quan h tnh dc an ton: Ch nn quan h sinh dc vi mt i tng duy nht Chung thy, mt v mt chng, Trnh tip xuc vi HIV: s dng bao cao su, khng dung chung kim chch, dao cao ru. Ch c truyn mu v cc ph phm ca mu a c th nghim Ph n nn lm xt nghim trc khi c thai. Nu ngi m b nhim HIV th khng nn cho con b.

KR, 10.5% Tnh dc, 38.7% ng mu, 47.5%

M truyn sang con, 3.2%

Phn b trng hp nhim HIV theo ng ly

B. IU TR HIV
C 3 nhm thuc iu tr chng Hiv: 1. Thuc c ch men sao chp ngc nucleoside (NRTIs) - NRTIs c ch tng hp DNA ca HIV-1 bi men sao chp ngc. - Tc dng ph: ri loan tiu ha, bin chng thn kinh, vim ty. - Cc thuc tiu biu: AZT, d4T, ddI, 3TC, - i vi AZT: hin nay a xut hin dng HIV khng vi thuc ny.

2. Thuc c ch men sao chp ngc khng nucleoside (NNRTIs) - Tc dng: chng men sao chp ngc ca HIV-1. - Tc dng ph: pht ban, vim gan. - Cc thuc tiu biu: Enfavirenz (EFV), Nevirapin (NVP), 3. Thuc c ch protease (PIs) - Tc dng: chng men protease ca HIV-1. - Tc dng ph: ri loan tiu ha, ri loan lipid - Cc thuc tiu biu: Indinarvir (IDV), Sapuinavir (SQV),

NHNG CON S BIT NI

200000 150000
100000

164197

50000 0 HIV

37189

45227

AIDS

TV

S trng hp nhim HIV, bnh nhn AIDS hin cn sng v ngi t vong do AIDS tnh n 31/3/2010.

Phn b trng hp nhim HIV theo gii