| - , | ||
| -10 | B24. | |
| -9 | 042 | |
| DiseasesDB | 5938 | |
| MedlinePlus | 000594 | |
| eMedicine | 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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- 1981 5 , (. Centers for Disease Control and Prevention, CDC) 5 [13] 28 . , . - (. Gay-related immune deficiency).[14] " " - , , , .[15] , , , ,[16] GRID AIDS () 1982.[17] 1982 CDC .[16]
- 1983 , HTLV-1, -, . , (. Lymphadenopathy-associated virus, LAV). 2008 .[18]
- 1984 . «- , 3» (. Human T lymphotropic virus type 3, HTLV-3).[18]
- 1985 , .[18]
- 1985 / .
- 1986 , LAV HTLV-III , « », (. Human immunodeficiency virus, HIV).[18]
-2, , -1 -2. - 1987 .[18] [19]. - .
- 1988 1 .[18]
- 1988 .
- 1990 ().[18]
- 1995 30.03.95 . № 38- « , (-)».[18] , / .
- 1996 .[18] XI .
- 1998 XII , - - .[18]
- 2001 8 26/2 « ».
- 2003 58- /.
- 2006 « /» (UNAIDS) AIDS Epidemic Update 2006[20].
- 2007 , 1969 .[21]
- 2008 , .[9]
[]
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.
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- , , . . , (). 67 10000 [22]. XX .
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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].
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].
, « /» ( 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].
| , % | , % | 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 |
[]
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, [41], .
, . , CD4- (CD4+ -, ).[42][43][44]
, CD4+ T- 200 (µl) , . , - CD4+ T- .[45]
- , .[46]
, [18], :
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]
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].
[]
- . , , , [87]
- , , , a , . , - , , , , [?], , .[88][89] - .
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( 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]
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-, , 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+ - T- CD4.
- CD8+ , [122].
- CD4+ -, 200 / ( CD4+ T- 1200 /)[123].
CD4+ :
- CD4+ T- [124]
- CD4, , -, [125].
- CD4+ T-, , LFA-1[126][127][128] (. Lymphocyte function-associated antigen 1)
- CD4 , - (. ADCC-antibody-dependent cellular cytotoxicity)[129][130].
- -[131][132].
- [133][134]
- gp120 CD4- ( CD4-) , CD4 HLA II[135][136].
- [137][138].
- (. Ανεργία , , . Anergy)[139][140].
B- - , α, -6[141] DC-SIGN, T-[142].
-2, CD4- 1 - (CD8+, CTL)[143][144] -12 T- 1 NK- (. Natural killer cells)[145].
[]
, 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
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- IV
, .
- I
- II
- III
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- 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 |
:
- ()
: -
:
1.
2.
3.
4.
5.
6.
7. -
8.
9.
10.
11.
12.
13.
14.
15.
16.
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1990 . /, 2006 . , , 1 2006 . « /»[160].
15 [161].
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: № 61 « -», 17 2006 . № 166
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.
-1 , [163], , , «» , . Cooper[164] , - , , , , , , , [165]. , , [166][167]. Hecht .[168] - (80 %) (68 %), (86 %) (85 %) (. , -).
-1-[169]
|
|
(*) , [170].
-1 ( ) 100 1, CD4 , , [171] (. . CD4 ). , ( 1200 /). CD8+ , CD4/CD8 1[172]. , . -[173][174].
-1 ( >10 000 /[175]) 100 %[176]. p24 79 %, 99,5-99,96 %. - .
- ( )[177]
|
|
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, (8-10 ), ( 1 ). CD4 . , , , ( 2 ). CD4 200 /. [178].
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-, , , , ( ) CD4+ . CDC CD4+ 200 /. 3, 3 .
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- ˸
- ( 6 )
- , (Mycobacterium avium),
[]
- , ,
- , ,
- Pneumocystis jirovecii ( Pneumocystis carinii Pneumocystis jiroveci.)
- ,
[]
- (. Herpes simplex virus, HSV): 1 , , ,
- , , . .
- 8 (. Kaposhi Sarkoma Herpes Virus, KSHV)
- (. Human papillomavirus, HPV), .
[]
[]
- ,
- -, -
| CD4 | ||
|---|---|---|
| < 200 1 | , |
- |
| < 100 1 | , , |
|
| < 50 1 | - ( Mycobacterium avium) |
[] -
CD4 [186].
, , , :
- (-)
- .
- ( ) , (99 %) (99,5 %). , (-1, -2, -1-N, -1-O, -1-M).
- -
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].
[] -
[]
- (Retrovir, ZDV, AZT) . 1964 . 1985 -. 1987 .[195]
- 19911994 , . /, , , , .
- 1995 1996 , , , 38 % 22 %[196].
- 1996 .
- 1994 1997 , , 2 % 64 %[197], 1994 1998 30,7 % 2,5 %[198].
- 1998 , , 1999 , .
- 2000 Harrington Carpenter CD4 [199].
[]
| 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]
| |
, 6 400 / |
|---|---|
| > 95% | 78% |
| 90-95% | 45% |
| 80-90% | 33% |
| 70-80% | 29% |
| < 70% | 18% |
- 19992004 , ( 33 %) , , , . , , 25 %.[220] 75 % , -, - , , .[221]
[]
| . |
- .
:
- 10-11 ;
- « »;
- , (, « » , , ).
« » (Harm Reduction), (), :
- ( - );
- ( « », «», « ») () , ;
- - ;
- , ( ), , ( );
- , ;
- ;
- - , ( () - ) ( );
- (, , , , )
.
« » «» , , . « » « ».
:
-, (. . « »).
, , .
.
[]
, (-). .[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].
[]
[] .
[]
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