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-10 B24.24.
-9 042042
DiseasesDB 5938 5938
MedlinePlus 000594 000594
eMedicine emerg/253  emerg/253 

 (, , . AIDS)  , -[1][2][3] CD4+ , , . , , , , , . - , . , , , ; , .[4][5] -.

, - .[6] 2008 , , 33,4 , 2,7 , 2 , [7].

, - .[8][9] 1981 , , , 1980-.[10]

, - , .[11] -, .[12] , - , e - , .

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.

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  •   , , ( () e, , , , , );
  •   , ,  . .  , (). 67 10000 [22]:21. XX .[   579 ]
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- 15 49 2005

20062007 , - : (6,5 ), (5,5 ), (4,1 ), (3,6 ), (1,8 ), (1,7 ), (1,7 ), (1,3 ), (1 ) (1 )[23].

« /» ( 2009 ), c 60 , 25 , [7]. 2008 , , 33,4 [31,1-35,8] , 2,7 [2,4-3,0] , 2 [1,7-2,4] , . 2008 430 000 [240 000610 000] , 15 , , 2,1 [1,2-2,9] . 40 % -, ( 15 )[7]. M 40 % , 40 % , , . - - , : , , [7].

: 67 % , , 91 % . 14 [7]. - (, 65 35 2006 )[6].

, -,

- -. B 2007 18 % - , 300 000 [7].

- -.[24] 10 % , /.[25] , , /, , , , .[26]

/ , , , .[27] 2010 / 1,1 , 56000 , .[28][29]

2008 , , 1,5 [1,4-1,7] , 66 % 2001 , 900 000 [800 000-1,1 ] . B ( , ) 1 %.[7]O 90 % - ( [7]), [30]. 2007 57 % [7]. , 3,7 , , [7].

, - 100000 .
     no data       10      10-25      25-50      50-100      100-500      500-1000      1000-2500      2500-5000      5000-7500      7500-10000      10000-50000       50000

2005 35500 -, 6 2006  13500 ; , , , 350000. , . , 2005 ,   560 . 1,6 .   : 80 % 15-30 [31].

2007 1,6 % [1,1-2,0 %]  c [7]. 2010 , , 360000 - .[32] , - .

, [7]. 2008 22 % , , (42 %). ,   , ,  [7].

2006 , 3 % 3,5-9 % , 12-14 % , 30 % - 70 % [33]. « /» ( 2009 ), 37 % 38,5-50,3 % [7].

, 2001 , 20022003  , .

, « /» ( 2009 ) , , , , [34]. 2007 42 % - . . 2007 0,4 % . , , , 5,3 % , 6 % 10-23 % [34]. 25 % «barebackers» ( 14 % )  , , [35][36][37]; barebackers «bug chasers»  , - , «gift-givers»[38][39].

UNAIDS[40]
, % , % 100,000 .
45,0 23,18 12977
8,0 5,15 3601
9,0 3,23 905
4,0 4,07 91
, 5,0 13,17 983
2,0 2,06 308
1,10 0,58 1
1,10 0,22 49

[]

            19872007

[] ,

[]

, [41], .

, . , CD4- (CD4+ -, ).[42][43][44]

, CD4+ T- 200 (µl) , . , - CD4+ T- .[45]

- , .[46]

, , .[47][48] , .

, , , .[46][49][50]

-1 ( ) .

, [18]:293-294, 296, :

  • gp41  , TM ( . Transmembrane glycoprotein),
  • gp120  SU ( . Surface glycoprotein).

«» , p17 p24, :

  • RT ( . Reverse transcriptase),
  • IN, ( . Integrase),
  • PR, ( . Protease).

gp120 CD4- -, . - - CXCR-4,   CCR-5.[51][52]

a a , , ,   .[53]

(, ). - . , , . , ( , ), . , , , CD4+ .[54][55]

- . , CD4-, CD8- , : , , , , .[56]

[]

-, , CD4+ , .[57][58] , , 5-10 , , 1-2 , . , .[59]

, e , .[60]

CD8+ - T- I. , e - , , , , , T-. (B- T-), .[61]

CD4+ . - T-. CD4+ - , (-1, -6 α) . .[61]

[]

-, , , , CCR5-Δ32.[62] , .[63][64][65]

, CCR5 - , - -1, - .[66][67] HLA-Bw4 . HLA I , .[68]

, HLA-B14, B27, B51, B57 C8 , HLA-A23, B37 B49 .[69][70] - HLA-B35 , 8 . , HLA I, .[71]

, TRIM5a, . , ,   PtERV1[72].

  - CD317/BST-2 (bone marrow stromal antigen 2), «tetherin» [73][74][75]. CD317  2   N- (GPI) -; [76]. , CD317 , «» [77][78][79]. «» , CD317 ; . «» ( GPI) CD317, [77]. CD317 , , : , , [75]. Vpu -1, Env -2 SIV, Nef SIV, 5 [75][80][81]. CD317 Vpu . , CD317 , Vpu ( vpu), , Vpu ( vpu)[79][82]., CD317 2 (Breast cancer-associated gene 2; Rabring7, ZNF364, RNF115)  3 - RING. BCA2 -1, «» CD317 , CD63+ [83].

CCR2 [84],[85],[86]

[]

- .   , , , [87]

- , , , a , . , - , , , , [?], , .[88][89] - .

[] ˸

( Pneumocystis jirovecii) , - . , - -. , , , CD4- 200 .[90]

, -, , - [91]. , : 2007 456000 - , - [92].

, -, . - ( CD4- 300 1 ), . - , . , , , , , - , , .[93]

[] -

  . - , , () ( , ) , .[94]

- (Salmonella, Shigella, Listeria Campylobacter) , , , , , Mycobacterium avium [95] (, , , ; ).

, , , , Clostridium difficile. - .[96]

[]

- , , [97].

Toxoplasma gondii, , .[98] , Cryptococcus neoformans. , , , , , .

  , , . , 70 % . .[99]

- , (. AIDS dementia complex, ADC), . .[100] , , . CD4+ - .

(1020 %)[101] , , (1-2 %).[102][103] , , , . , , -. .

[]

- . -, ,   (. EBV), , ( 8), (. HPV).[104][105]

, - . 1981 . , , . , , - . - , , , - , - . . - . - , , .[106] - - , . , , - .[107]

- , , (), , , , . ( -, , ), , , , .

, , , , - . , -, - , - .[108] , .

[]

, , , . Mycobacterium avium . .

, Penicillium marneffei, ( ), - - .[109]

19. , , .[110]

[]

CD4 .                      CD4+ T (/mm³)
                     .

-, , CD4+ T- .
(. ) CD4 , , , [111].

CD8+ -. - I (.  Human leukocyte antigen-HLA)[112][113][114].

, (), RANTES, MIP-1alpha, MIP-1beta[115], MDC, [116][117][118][119].

CD8+ -[120], [121], :

  • CD8+ - T- CD4.
  • CD8+ , [122].

- CD4+ -, 200 / ( CD4+ T- 1200 /)[123].

CD4+ :

B- - , α, -6[141] DC-SIGN, T-[142].

-2, CD4- 1 - (CD8+, CTL)[143][144] -12  T- 1 NK- (. Natural killer cells)[145].

[]

24 -.                      24                      -24                      -Env

, 99 % 12 (6  12 ) [146]. : 90-95 % 3- , 5-9 %  6 , 0,5-1 %  [147]).

« », [148].

«gag» (. group antigen )   24 17, 55. -24 24 , [149][150].

-24 «Env» (. Envelope)  gp160, gp120, p88, gp41 «pol» (. Polymerase)  p31, p51, p66.

«vpr», «vpu», «vif», «rev», «tat», «nef»[151][152].

«Env»   gp120, gp41. : - -.

-gp120 , - (. ADCC) CD4+ , , gp120,   : Innocent bystanders (Bystander killing)[153][154].

[] , /

- . 1988 4 [155]:

  • I   () -
  • II  
  • III   - (-)
  • IV  

, .

, . .  1989 [156][157].

  • II 
    •  
    •  
    •  
  • III 
    •   10 %, , , , , ,
    •   10 %, 1 , / ( ) : ,
    •   , , , , , , , , , ,
  • IV 

1993 [158] (. U.S. Center for Disease Control and Prevention  CDC) [159] , ( (%) CD4+-- (-) 1 ). , -. CDC- , 3, 3, 1, 2 3 , .

(%) CD4+-- 1

() ( )


-
1. > 500 (> 29 %) 1 1 1
2. 200499 (> 1428 %) 2 2 2
3. < 200 (< 14 %) 3 3 3

[]

1990 . /, 2006 . , , 1 2006 . « /»[160].

15 [161].

  • -
  • 1
    • ()
  • 2
    • ( 6 )
    • ( )
    •   , , , , , ( 6 )
  • 3
    • 1
    • ( 6 )
    • (, , , , , )
    • - ,
  • 4 (*)
    • ˸
    • ( )
    • ( 10 % 6 )
    • - [162]
    • ( 6 )
    • ( )
    • (. HSV) ( 1 )
    • -
    • (, , )
    • , , (. MOTT)

(*) : (- )

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: № 61 « -», 17 2006 . № 166

1.

2. :

  • .
  • .
  • .

3.

4.

  • 4. 10 %, , , , , , .
  • : , ; (, , ).
  • 4. 10 %, , , , , , , .
  • : , ; (, , ).
  • 4. . , , , , , , : , , , ; ; ; .
  • : , ; (, , ).

5.

[] -1

.

-1 , [163], , , «» , . Cooper[164] , - , , , , , , , [165]. , , [166][167]. Hecht .[168] - (80 %) (68 %),   (86 %) (85 %) (. , -).

-1-[169]

(95%- ) *
80 % 5,2 (2,3-11,7)
51 % 4,8 (2,4-9,8)
37 % 3,1 (1,5-6,6)
54 % 2,6 (1,3-5,1)
44 % 2,6 (1,3-5,1)
(95%- )
54 % 2,5 (1,2-4,8)
> 2,5 32 % 2,8 (1,3-6,0)
68 % 2,2 (1,1-4,5)
49 % 2,1 (1,1-4,2)
46 % 8,3 (3,6-19,3)

(*)   ,   [170].

-1 ( ) 100  1, CD4 , , [171] (. . CD4 ). , ( 1200 /). CD8+ , CD4/CD8 1[172]. , . -[173][174].

- 7-10 , 14 . - - ( ).

-1 ( >10 000 /[175]) 100 %[176]. p24 79 %,   99,5-99,96 %. - .

- ( )[177]

96 %
74 %
70 %
(*) 70 %
54 %
32 %
32 %
27 %
14 %
13 %
12 %
(**) 12 %

(*)  , , . , .
(**)  , , , , -, , .

, (8-10 ), ( 1 ). CD4 . , , , ( 2 ). CD4 200 /. [178].

[]

CD4+ -, , [179].

  -, , , , ( ) CD4+ . CDC CD4+ 200 /.  3, 3 .

, [180] 2006 . CDC[181] :

[]

[]

[]

  • (. Herpes simplex virus, HSV): 1 , , ,
  • , , . .
  • 8 (. Kaposhi Sarkoma Herpes Virus, KSHV)
  • (. Human papillomavirus, HPV), .

[]

  • ,
  • ,

[]

CD4[182][183]

CD4
< 200 1

,


-



< 100 1 ,


,

< 50 1
- ( Mycobacterium avium)

[] -

( )

[184][185]

  •   . 100 % -.
  •   (   3 ), ( p24 .), - .

CD4 [186].

, , , :

  • (-)
  • .

- ( ) , (99 %) (99,5 %). , (-1, -2, -1-N, -1-O, -1-M).

  -. , , -.

-

: , (-), . 15-30 . , ( )

CD4+ - [187]:

  • ()

( )

[] -

, - 15 25 % , 25 % 35 % [188]. 3-8 %[189], 2 %[190], 1,2 %[191]. - 19,4 % 2001 10,9 % 20022005 .[192].

, - 12-15 , , . , 18 , (). - , , : 1 4 ,   4 [193][194].

[] -

[]

[]

(), 2006[200].

CD4
< 200/mm³
200350/³
< 200/³
200350/³
200-350/³
200-350/³

  CD4 350 , .

  > 100000 /, CD4 350/³.

CD4 14-28 , .

[]

9 11 ,[201] , , 6 19 .[202] , , - 85,1-99,3 % , , - 20 .[203][204][205][206][207] 385 619 .[208]

- : , , , . .[46] , -, , . . - , : CD4 , , , .

, .[209] , : , ,[47][48][62] , ,[46][209] , .[64][210][211]

, , : ( -), , , , , - . , -, .[212][213][214][104][105][215][216][217]

. - 1990 .[218]

.[219]


, 6
400 /
> 95% 78%
90-95% 45%
80-90% 33%
70-80% 29%
< 70% 18%

- 19992004 , ( 33 %) , , , . , , 25 %.[220] 75 % , -, - , , .[221]

[]

- .

:

  1. 10-11 ;
  2. « »;
  3. , (, « » , , ).


« » (Harm Reduction), (), :

  1. ( - );
  2. ( « », «», « ») () , ;
  3. - ;
  4. , ( ), , ( );
  5. , ;
  6. ;
  7. - , ( () - ) ( );
  8. (, , , , )

.

« » «» , , . « » « ».

:

  1. , .
  2. .
  3. .
  4. ( ).

-, (. . « »).

. . . , . , , . , , ( ) , .

, , .

- , , .

- .

, , (0,2%- , ).

.

[]

, (-). .[222]

[]

, « » ( , )[223], [224][225], - [223][226]. , , , , , .

1990- , 1950- .[227][228] [229][230][231].

, [232][233][234][235][236][237][238][239], « » , [240], , [232][233][241].

[]

70 000 - , [242]. , 2010 20 [243].

[]

  • , - , 2000- .
  • , , Sainte-Catherine  Gay Village (-) [244].
  •   , . , , , XX .

[] .

[]

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