HIV prevention and treatment. Medical prevention of HIV: relevance, effectiveness Specific and non-specific prevention of HIV infection

Russian Journal of Skin and Venereal Diseases, 2004. - No. 2. - S. 56-58.

V. A. Molochkov, I. M. Kirichenko, Yu. S. Krivoshein

MMA them. I. M. Sechenov, Moscow

MODERN METHODS OF NON-SPECIFIC PREVENTION Prevention after casual relationships is possible with the use of the antiseptic agent Miramistin"> HIV / Miramistin's instructions for use contain a description of actions for emergency prevention of sexually transmitted infections after casual contact."> STIs

SUMMARY Non-specific (barrier) HIV prevention / STI is currently the main method of preventing these diseases. Domestic Miramistin is an excellent example of a new generation antiseptic. "> Miramistin® antiseptic, used for 10 years as a means of preventing sexually transmitted diseases, has shown high efficiency and safety. Miramistin® suppositories and gel also have a pronounced spermicidal and contraceptive effect.

Fight against HIV infection and STI is one of the most urgent problems facing humanity today.

According to official statistics, about 40 million HIV-infected people are currently registered in the world, and 200,000 in Russia, of which about 2,500 are children. Every day this figure increases in the Russian Federation by 100 people, of which 70 are in Moscow and the Moscow region.

Ten times over last years the incidence of STIs has increased, in the Russian Federation it is 85.5 cases of syphilis and 200 cases Miramistin's instructions contain a sequence of actions for emergency prevention of gonorrhea. > gardnerellosis, urogenital chlamydia, herpes and The use of Miramistin for thrush significantly speeds up the treatment process. "> Candidiasis, mycoureaplasmosis and other STIs. It should be noted that the official statistics do not fully reflect the true picture of the prevalence of HIV / STIs. According to WHO experts, in order to get the real number of infected, you need to multiply the official statistics by 10.

Prevention of HIV / STIs is divided into general (sanitary clearance work, social events, etc.), specific (prevention of influenza and other diseases. "> Vaccination) and non-specific (barrier, mechanical and chemical) (see diagram).

Several types of vaccines are currently being developed. According to WHO estimates, effective and widely available vaccines are likely to be created only in the 2nd decade of the 21st century. No less difficult is the problem of specific prevention of STIs.

Due to the current lack of anti-HIV/STI vaccines, the main way to prevent these infections is an alternative (non-specific) one - with the help of condoms and chemicals. The same funds form the basis of modern contraception, providing both prevention of pregnancy and prevention of HIV / STIs.

The main means of non-specific barrier individual prevention of HIV / STIs are condoms (male and female), which create a mechanical obstacle to the penetration of the pathogen into the human body.

Their effectiveness is limited by the risk of the pathogen passing through the barriers created by polymeric materials, as well as by mechanical damage during use. Certain brands of condoms are estimated to provide only 30% protection against sexual transmission of HIV. It has been proven that when using condoms, in a significant percentage of cases, their ruptures are observed, slipping during intercourse, which leads to infection with bacterial infections (syphilis, gonorrhea, trichomoniasis, chlamydia, etc.) and viral (HIV, herpes in the intimate zone). In most cases, HSV virus carriage is asymptomatic, since simultaneously with infection, the human body begins to produce antibodies that do not allow HSV to actively multiply. during the observed period, 62% of couples did not break the condom even once, 29% broke 1-3 times, and 9% - more than 4 times.In addition, about 30% of men do not use condoms according to physiological data (weak erection), due to the occurrence of allergic reactions to latex or condom lubricant, religious or other beliefs Therefore, condoms are not a universal preventive measure and cannot guarantee complete protection against HIV/STI infection and prevention of pregnancy.

This stimulated the creation of programs to develop and disseminate individual means of HIV/STI prevention and contraception through chemicals- microbicides. For this purpose, preparations have been developed that are intended for treating the genitals of sexual partners before and after sexual contact.

Currently, external microbicides have been created for the prevention of STIs and HIV infection: PRO 2000 (naphthalenesulfonate polymer); buffer gel, negatively charged, non-absorbable high molecular weight polymer gel for maintenance in the vagina in the presence of sperm pH below 5.0; F5 gel. containing 3 spermicides (Nonoxynol9. benzalkonium chloride and sodium cholate); combined preparation C31G, consisting of C14 alkylamine oxide and C16 alkyl betaine, and others. Most common in various countries world received the drug Nonoxynol9 (H9), which has been officially used in the United States as a chemical contraceptive for more than 30 years.

Numerous studies on the use of H9 as a contraceptive, as well as for the prevention of HIV infection, conducted under the auspices of WHO in various countries of the world, have confirmed that intravaginal applications of H9 can prevent pregnancy and protect women from HIV and other STI pathogens. At the same time, it has been proven that H9, like other non-ionic surfactants, are weak microbicides and have an effect only at high concentrations of the drug, which is associated with more pronounced manifestations of their toxic properties. So, when using surfactants, there are signs of allergic reactions (erythema of the vulva, irritation of the vaginal mucosa with the appearance of copious secretions and an unpleasant odor), as well as more serious consequences (development of ulcers, and sometimes - when using sponges, films, caps - the occurrence of toxic shock).

In the study of systemic effects on the fetus as a result of the penetration of H9 through the vaginal mucosa, an almost two-fold increase in the risk of limb shortening, malignant neoplasms, and hypospadias was found for men, Miramistin must be administered. "> urethra, Down's syndrome and other severe chromosomal abnormalities.

There are reports that the use of certain dosage forms of H9 increases the risk of HIV infection. Scientists see the explanation for this phenomenon in the fact that the frequent use of H9 causes irritation of the vaginal wall, which leads to the formation of microcracks that open the way for HIV. However, it should be noted that in most cases we are talking about experiments involving prostitutes who used the drug up to 20 times a day, and there is no evidence that its use 2-3 times a day leads to negative consequences.

Nevertheless, scientists are constantly calling for a more detailed study of the long-term use of H9, since it is a very common drug: in the US alone, it covers up to a third of condoms sold.

In addition, WHO, stating the fact that the use of H9 as a prophylactic agent is promising, constantly points out the need to search for and develop new surfactants, more effective microbicides with minimal irritant and other side effects on the human body, which could be used as a means of contraception by women, as well as for individual prevention of HIV / STIs not only by women, but also by men.

These drugs include the antiseptic Miramistin® produced in Russia, widely used by sexually active groups of the population and persons belonging to risk groups, as an individual means of preventing syphilis, gonorrhea, trichomoniasis, chlamydia, herpes and other STIs.

Miramistin® was developed by prof. Yu. S. Krivoshein and Ph.D. chem. Sciences A. P. Rudko and approved by the USSR Ministry of Health for medical use in 1991 as an antiseptic for individual prevention of sexually transmitted diseases, and in 1993 as a broad-spectrum antiseptic. The exclusive manufacturer of the drug in Russia is CJSC "Infamed".

Miramistin® is a cationic surfactant that has pronounced antimicrobial properties and does not have local irritating, mutagenic and carcinogenic effects. The effectiveness of the prevention of STIs by treating the genitals of sexual partners with a 0.01% solution of Miramistin® after sexual contact has been demonstrated. In addition, instillations of Miramistin® solution are included in the complex treatment of chronic urethritis in gonorrhea, trichomoniasis, mixed trichomonadal nococcal and chlamydial infections. This addition to traditional therapy led to a significant increase in the effectiveness of treatment.

Multifaceted studies of the anti-HIV activity of Miramistin®, conducted in leading laboratories in Russia, Ukraine, Sweden, Germany, made it possible to prove that Miramistin® at working concentrations is effective for the destruction of extracellular and intracellular HIV. It turned out to be a more active agent for the destruction of HIV compared to other disinfectants (see table). Based on these data, the Pharmacological State Committee of the Ministry of Health of the Russian Federation decided to include in the instructions for the use of Miramistin® information that the drug has anti-HIV activity.

Minimum concentrations at which various disinfectants inactivate HIV

Dosage forms of Miramistin® and special packaging have been developed that allow its use for the prevention of HIV / STIs both in men (aqueous solution in a special vial) and in women (candles, gel, aqueous solution). The proposed preparations of Miramistin® are protected by patents of the Russian Federation.

Clinical trials, as well as ten years of experience in the use of Miramistin® preparations for the prevention of STIs, prove the reliability of their protective action, provided that the instructions for use are followed. As a rule, when using Miramistin preparations, no adverse reactions are observed, only in some cases, when instilled into the urethra, a slight burning sensation may occur, which disappears on its own after 15-20 seconds and does not require analgesia or discontinuation of the drug. There have been isolated cases of individual intolerance to Miramistin®, associated with a general hypersensitivity of the body to surfactants.

Experimental and clinical data on the high contraceptive efficacy of Miramistin® have been accumulated. A vaginal contraceptive (VC) has been developed, consisting of Mir Mistin® and a gel or suppository (suppository) base. An in vitro experiment showed that, in the recommended ratios of the ingredients, VC has a pronounced spermicidal effect, and in in vivo experiments - no harmful effects on the animal organism. In the experiment, VK prevents pregnancy in rats in 95.6% of cases (with intravaginal administration of the drug before mating). In the course of clinical trials conducted on a limited contingent of volunteers (10 couples who regularly used VC for contraception for 12 months), a 100% contraceptive effect of this drug was established. At the same time, in no case were any local or general adverse reactions of the body noted.

Therefore, the Miramistin® antiseptic is a highly active non-toxic microbicide and spermicide, which makes it possible to recommend it for randomized clinical trials as a means of individual prevention of the sexual transmission of HIV and STI pathogens, as well as contraception.

For statistically reliable confirmation of the observed protective effect, a protocol of randomized clinical trials of Miramistin® has been developed as a means of individual prevention of the sexual transmission of HIV and STI pathogens (phase III). It is based on the program "A Phase III Nonoxynol9 and HIVinfection. HIVNET Protocol 016" (UN AIDS, 1998), taking into account its shortcomings (designed only for women, side effect H9, etc.). The protocol reflects the stages of a placebo-controlled study of the prophylactic efficacy of Miramistin solution, gel and suppositories in sexually active individuals belonging to a high-risk group (sex workers, "unorganized" youth, high school students, technical schools and vocational schools, university students, etc.). The project is designed for 3 years, it will cover 4.5 thousand people who, according to various reasons do not use barrier and other means of protection. Various state and public organizations will take part in its implementation. The protocol will be finally adopted after agreement with Russian and international institutions involved in HIV/STI prevention.

Literature

1. Barrier contraceptives and spermicides. Geneva, 1990
2. Borisenko KK Diagnosis, treatment and prevention of sexually transmitted diseases. Methodical materials. - M.: Association SANAM, 1998.
3. Vintserskaya G. A. // Proceedings of the Crimea. honey. unta. Simferopol, 2001. - T. 137. - Part 2. - S. 13-16.
4. Global strategy to fight AIDS. - M., 1994. - Issue. eleven.
5. Krivorutchenko Yu. L., Krivoshein Yu. S., Marennikova S. S. et al. / / Vopr. virusol. - 1994. - No. 6. - S. 267
6. Krivorutchenko Yu. L. // Zhurn. dermatol. and venerol. - 1998. - No. 15. - S. 22-24.
7. Krivoshein Yu. S., Nesterova I. E., Rudko A. P. // Morphology and regeneration. - Simferopol, 1977. - S. 98-100.
8. Krivoshein Yu. S., Skuratovich A. A., Rudko A. P. // Vestn. derma tol. - 1983. - No. 11. - S. 29-32.
9. Krivoshein Yu. S., Skuratovich A. A., Tyshkevich L. V. et al. // Miramistin is not an antibiotic "> Antibiotics and chemotherapists. - 1984. - No. 7. - C 519.
10. Krivoshein Yu.S. Antimicrobial properties of new surfactants and the rationale for their medical use: Abstract of the thesis. ...dra honey. Sciences. - Kyiv, 1985.
11. Krivoshein Yu.S., Rudko A.P. Medicinal preparation. Pat. RF No. 2161961.
12. Krivoshein Yu.S., Rudko A.P. Vaginal contraceptive. Pat. RF No. 2173142.
13. Logadyr T. A., Milyavsky A. I. // Abstracts of the International Conf. 150th anniversary of I. I. Mechnikov - Kharkov, 1995. - S. 183.
14. Milyavsky A.I., Krivoshein Yu.S., et al. // Vestn. dermatol. - 1996. - No. 2. - S. 67-69.
15. Molochkov V.A., Ilyin I.I. Chronic urethrogenic prostatitis. - M., 1998.
16. Molochkov V. A., Zur N. V. Urogenital chlamydia. Features of the clinic, diagnosis, treatment. - M.. 2003.
17. Bad 3. H. et al. // Tez. report VII Ross. nat. congr. "Man and medicine". - M., 2000. - S. 303.
18. Pokrovsky VV Epidemiology and prevention of HIV infection and AIDS. - M., 1996.
19. Order of the Ministry of Health of the USSR No. 146 dated May 31, 1991 "On approval for medical use of Miramistin, an antiseptic agent for the individual prevention of sexually transmitted diseases." - M., 1991.
20. Decision of the Pharmacological Committee of the Ministry of Health of the Russian Federation dated April 23, 1992, protocol No. 8. "On the permission of the medical use of 0.01% aqueous solution of miramistin for additional indications as a means for the prevention of suppuration and the treatment of purulent wounds." - M., 1992.
21. Rudko A.P., Krivoshein Yu.S., Vintserskaya G.A. et al. // Abstracts. 1st Intern. conf. "Clinical drug research". - M., 2001. - S. 230-231.
22. Chvapil M. et al. // J. Environ. Pathol. Toxicol. - 1983.
23. Colin P. et al. // 12th World AIDS Conference. - Geneva, 1998. - P. 1067, Abstr. No. 60370.
24. FDA. Vaginal Contraceptive Drug Products for OvertheCounter Human Use. Federal Register., 1980. - P. 82014-82049.
25. Kreiss J. el al. // J. A. M. A. - 1992. - V. 268. - N 4. - P. 477-482.
26. Malamud D. et al. // 12th World AIDS Conference. - Geneva, 1998. - P. 621, Abstr. N 33149.
27. Marin J. et al. // Zbl. Hyg. Umveltmed. - 1991. - V 191. - N 5-6. - S. 516-522.
28. Mayer J. et al. // 12th World AIDS Conference. - Geneva, 1998. - P. 623, Abstr. N 33158.
29. North V. V. // J. Reprod. Med. - 1988. - V. 33. - N 3.
30. Polsky B. et al. // Lancet. - 1988. - V. 1. - P. 1456.
31. Profiy A. T. et al. // 12th World AIDS Conference. - Geneva, 1998. - P. 620-621, Abstr. N 33146.
32. Roddy R. E. et al. // N. Engl. J. Med. - 1998. - V. 339. - N 8. - P. 504-510.
33. Rosenberg M. J. et al. // Am. J. Publ. Hlth. - 1992. - V 82. - P. 669-674.
34. Voeller B., Nelson J., Day C. // AIDS Res. Hum. Retrovir - 1994. - V. 10. - P. 95.-100.
35. White N. et al. // Nature. - 1988. - V. 335. - P. 19
36. Wittkowski K. M. // AIDS. - 1995. - V. 9. - N 3. - P. 310-311.
37. Wortman J. // Popul. Rep. H. - 1976. - V. 4. - P. 65.

Preventing infection with immunodeficiency is much easier than maintaining life after the disease is detected. An effective vaccine that completely cures the patient has not been invented. HIV prevention is becoming the main line of all health care institutions, education and social sphere. Health education, especially schoolchildren and students, is an integral part of the work of all subjects of the prevention system. Epidemiology HIV infection every year becomes more informative. Medical scientists are striving to pass on this knowledge so that the prevention of the spread of infection is more effective.

Prevention of HIV, first of all, is aimed at informing people about the ways of transmission of infection and precautions. Everyone should have an idea of ​​how to protect themselves from AIDS.

The right way to prevent HIV infection is to refuse.

Trying light psychotropic drugs, a person exposes himself to the delusion that at any moment he can stop and stop taking drugs. This is not true. In the later stages, the likelihood of the virus entering the body is especially high. The use of one syringe per group of people exposes a weakened body to mortal danger. The best defense option is not to try any substances that can affect consciousness.

Precautions are not superfluous in the life of every person. Sufficiently observed simple rules making it more difficult to get an infection. Contraceptives will help protect against the immunodeficiency virus.

Secondary measures to prevent HIV infection

The purpose of secondary prevention measures is to prevent diseases that provoke the development of immunodeficiency. Work is carried out with people who are at risk for HIV disease. These include injection drug addicts, gay couples, children from antisocial families, and prostitutes.

Secondary prevention of HIV is also carried out with persons who have confirmed the presence of the virus in the body. The person is already aware of his status. The main task is to minimize the risk of transmission of the virus to healthy people. This does not mean that the infected person is isolated. He needs to be given all the information on how to prevent the infection of other people.

Diabetes mellitus, chronic obstructive pulmonary disease, types of hepatitis, diseases of the lymphatic system put an infected person at great risk. Knowledge of how these diseases occur and how not to get infected - milestone in the system of secondary prevention measures.

The postoperative period carries the risk of complications. Especially if the immune system subject to destruction from within. Effective preventive care will be the use of antibiotics and antiviral drugs.

Post-exposure prophylaxis for HIV is aimed at a person who has been confirmed to have the virus in their body. Reception of antiretroviral agents begins no later than two hours from the estimated moment of risk. Later than 72 hours, the drug will not bring effectiveness. The duration of the prophylactic course is 4 weeks. Such preventive measures are shown mainly to persons who are in contact with patients or are at risk. The drugs are complex in the regimen. Many drugs have a wide range of side effects that require their use only under the supervision of a physician.

Pregnancy is a stress factor for the body. The body is rebuilt in such a way as to preserve the fetus. Pregnant women are required to donate blood for analysis several times. Perhaps the partner was infected and did not know about it. Then the virus will reveal itself in a woman during re-analysis. If HIV is detected, then a caesarean section will be used at the time of delivery. This will reduce the risk of transmission from mother to child. In the future, highly active therapy of the newborn will block the virus in his body.

The tertiary level of protection of the population.

Tertiary prevention aims to motivate the already infected population for medical support and antiretroviral therapy. Confirmation of the diagnosis is not a reason to panic. Measures to prevent HIV infection at this stage are limited to supporting patients who are undergoing therapy. Medical intervention reduces the risk of secondary diseases and reduces the viral load on the body. The psychological support of those people who have recently been given a disappointing diagnosis is also important. Non-specific prevention will allow you to convey the necessary and important information for the patient and people from the immediate environment. The life of patients is not limited to limiting their vital activity. Her character is changing. It is important to convey to the patient that the lack of medical care leads to the development of acquired immunodeficiency syndrome. Visiting AIDS centers will allow timely and accurate assessment of the viral load. This will allow adjusting antiretroviral therapy.

The role of the state in the fight against HIV infection.

The main role in the prevention of HIV infection belongs to the state. In our country, there is a state program for the prevention of HIV infection. It is supported by all media. Special ones travel regularly to the cities of Russia. Booklets and leaflets are distributed in health care institutions, telling about the ways of HIV infection.

In addition to the above, the tasks of the state include the fight against drug trafficking. This is directly related to the spread of HIV infection.

The fight against prostitution is aimed not only at supporting the moral side of the development of a citizen. Numerous partners of women of easy virtue do not always spread about the presence of sexual and viral diseases, so the risk of infection is high. The lack of contact with representatives of the ancient profession will greatly facilitate the life of a man.

As with any other infection, HIV prevention can be carried out at three levels: social, contact-household, individual. Prevention at the social level includes relevant government programs to identify and monitor the health status of AIDS patients and those infected with HIV, promotion of restrained sexual behavior and sexual relations with one partner, and encouragement of a late onset of sexual life.

In order to effectively carry out prevention at the household and individual level, one should know the features of infection transmission. HIV is transmitted through the blood and body fluids, with the highest concentration of the virus in the blood.

There is no specific prevention of HIV today, but research is being actively conducted to create a vaccine. At the same time, it is possible to carry out chemoprophylaxis in cases of suspected HIV infection through contact with the blood of an infected person. Such measures are usually provided for health workers, who are often at risk of HIV infection due to injuries in the workplace.

In practice, transmission paths can be as follows:

• during sexual contact (the bulk),
• through surgical equipment, injection needles,
• transfusion of blood and its preparations,
• from mother to child during pregnancy, childbirth, breastfeeding,
• through general hygiene items in case of damage to the skin and mucous membranes (razor, toothbrush, manicure accessories),
• directly from blood to blood with open soft tissue injuries of an AIDS patient or HIV-infected and infected with it.

Very rarely, HIV is transmitted through household contacts, as it is very unstable in the external environment. Subject to all the rules of personal hygiene, infection does not occur. An HIV-infected person should monitor the health of the oral cavity and skin, use only his own razor and toothbrush, not allowing other people to take them in turn. Children should be especially closely monitored: they often show interest in the personal belongings of their parents. For complete safety, an HIV-infected person should be given a separate locker in the bathroom, where only his bath accessories and hygiene products will be stored. Through ordinary household and friendly contacts, HIV is not transmitted.

Individual HIV prevention in the medical environment

Difficulties for medical workers are that the patient has the right not to disclose information about his HIV status. Therefore, each manipulation, in which there is direct contact with the patient's blood, is dangerous for the physician. The main risk group includes dentists, surgeons, nurses. It is recommended to serve all patients with the maximum amount of protective equipment, the use of disposable instruments, careful processing of instruments and reusable equipment.

In the event that a physician has experienced an injury to the skin during parenteral intervention (surgery, injection, wound treatment), and it has been established that the patient has HIV status (or its probability is high), chemoprophylaxis with antiretroviral drugs is performed. In some cases, prophylactic medication is not prescribed: for example, if there is severe bleeding during injury, or the injury is shallow and local preventive measures were taken immediately. If the biological fluids of an HIV-infected person get on the mucous membranes of a physician, the mucous membranes are treated with sodium sulfacyl (eyes), protargol (nose), 70% alcohol (mouth and throat). If gloves are damaged, they should be treated with a solution of chloramine or medical alcohol, removed and discarded, then washed with soap and water and treat the wound on the hand. It is advisable to cause bleeding from the wound so that the virus comes out with the bloodstream, and then treat the damage with an iodine solution. These measures are also suitable for preventing HIV infection at home, when providing medical care to an infected family member.

Prevention of blood transfusion and its preparations

The donation procedure provides for a mandatory HIV test. The first time the analysis is taken before the first blood sampling. In case of a negative result, a portion of blood received from a donor is stored for six months, blood is taken for re-analysis, and only after a repeated negative result for HIV, the first and subsequent portions are used. The meaning of the two-stage procedure is to take into account the possible absence of a serological reaction in the early period of HIV infection (the first six months). In the future, donors are also subject to regular examinations for the immunodeficiency virus.

Individual HIV prevention measures during sexual intercourse

It is not recommended to have sexual intercourse with people whose health you do not know anything about (in particular, the presence or absence of HIV infection), or if their positive HIV status is known reliably. If it turns out that one of the spouses is infected, the issue of sexual intimacy is decided by the healthy spouse.

For individual prevention, it is recommended to use a condom. Today it is the most effective method of preventing sexually transmitted infections, including HIV, but it is far from ideal. According to the latest WHO data, the effectiveness of condoms as protection against infections is slightly more than 80%. The effectiveness of condom protection is reduced as a result of careless opening of the package, the use of poor-quality condoms or those that were stored in inappropriate conditions, in violation of the technique of putting on a condom, oral sex before or after intercourse, etc. The effectiveness of the barrier method can be increased by using simultaneously with a condom (applied outside the condom or in the vagina) surfactants. Such drugs can have both antibacterial and spermicidal effects, and are often applied to the condom during the manufacturing process. The most effective today is Miramistin, which has a high activity against HIV inside epithelial cells and significantly reduces the risk of infection.

Truvada- new drug, developed in the USA, and intended for individual chemoprophylaxis of HIV infection in risk groups. Available in tablets. The effectiveness of protection against HIV infection with this drug under experimental conditions was 73%. Now the question of the mass use of the drug is not worth it, since it is quite expensive. In addition, some doctors believe that taking the medicine will reduce vigilance, and the person will not be careful during sexual intercourse, while the risk of infection remains considerable.

MODERN METHODS OF NON-SPECIFIC HIV/STI PREVENTION

Nonspecific (barrier) prevention of HIV/STIs is currently the main method of preventing these diseases. The domestic antiseptic miramistin, used for 10 years as a means of preventing sexually transmitted diseases, has shown high efficiency and safety. Candles and Miramistin gel also have a pronounced spermicidal and contraceptive effect. The fight against HIV infection and STIs is one of the most urgent problems currently facing humanity. According to official statistics, about 40 million HIV-infected people are currently registered in the world, 200 thousand in Russia, of which about 2.5 thousand are children. Every day this figure increases in the Russian Federation by 100 people, of which 70 are in Moscow and the Moscow region. In recent years, the incidence of STIs has increased dozens of times, in the Russian Federation it is 85.5 cases of syphilis and 200 cases of gonorrhea per 100,000 population. The number of patients with trichomoniasis, gardnerellosis, urogenital chlamydia, herpes and candidiasis, mycoureaplasmosis and other STIs has sharply increased. It should be noted that official statistics do not fully reflect the true picture of HIV/STI prevalence. According to WHO experts, in order to get the real number of infected people, it is necessary to multiply the official statistics by 10. HIV / STI prevention is divided into general (sanitary education, work, social events, etc.), specific (vaccination) and non-specific chemical). Several types of vaccines are currently being developed. According to WHO estimates, effective and widely available vaccines are likely to be created only in the 2nd decade of the 21st century. No less difficult is the problem of specific prevention of STIs.

20. Epidemiology, specific and non-specific prevention of rabies. Rabies vaccine and gamma globulin. Pasteur's work.

Epidemiology. The reservoir of the virus in nature are various warm-blooded animals. Bats can develop chronic asymptomatic infections. Dogs, foxes, wolves, jackals, as well as cats and lynxes are most sensitive to the causative agent of rabies. Most often, a person becomes infected with rabies in foxes and cats, less often - from dogs and other animals in which the virus is contained in salivary glands and is released into the environment with saliva. The virus is transmitted by bites and saliva on damaged skin and mucous membranes.

A person is a dead end in the circulation of the virus, the transmission of the pathogen from person to person is extremely rare.

The rabies virus is sensitive to heat. At 56°C, inactivation occurs in 60 minutes, at 80-100°C - in 1 minute. It is quickly inactivated in solutions of alkalis, iodine, detergents and UV radiation. Slow drying leads to inactivation of the pathogen in the material in a few days, and under lyophilization conditions, the virus persists for years.

Prevention. Currently live and inactivated vaccines are used.

Long before the isolation of the virus, L. Pasteur developed a method of attenuation by multiple passages of the "street" virus through the brain of rabbits. As the passage progressed, the incubation period of the infection decreased to 5 days and then remained stable. Therefore, Pasteur called the virus he received fixed (virus fix). It multiplied only in the brain of rabbits and was not detected in the saliva of infected animals, and also lost its pathogenicity for humans and dogs. After drying the brain suspension, Pasteur used it as a vaccine to prevent rabies in humans.

Currently, a live anti-rabies vaccine is prepared from a virus grown on diploid human cells. The rabies vaccine can be considered as a therapeutic and prophylactic drug, since specific defensive reactions develop during the incubation period.

With multiple bites of dangerous localization (head and neck area), when the incubation period may be short, a specific immunoglobulin is administered in parallel with the vaccine. It is obtained from the blood serum of hyperimmunized horses.

21, 22. Retroviruses. Human immunodeficiency virus (HIV), characteristics. Epidemiology, pathogenesis, methods laboratory diagnostics, prevention of HIV infection. AIDS, definition, stages of development. The role of CD4+ and CD8+ T cells. AIDS-associated diseases.

[lecture on HIV + training manual on viruses]

1981 - first discovered.

4 risk groups: homosexuals, drug addicts, hemophiliacs, persons who have visited Haiti.

The study showed the development of ID → the name AIDS.

Cultivation of E-lymphocytes, stimulation of IL-2, studying human leukemia → HTLV - I, II.

Moncagnier '83 - Poster Institute - LAV

86. Given the name of HIV (HIV - I)

85-86 - HIV-II is isolated.

Family Retroviridae, genera: p. Onkovirinae, p. Pumovirinae (only in animals), p. Lentovirinae (relative to HIV). These viral infections are called slow → long-term incubation and the course of the disease, leading, as a rule, to a fatal outcome (nj, that is, DEATH). The name of the family was obtained due to the presence of enzymatic reversetase (RNA-dependent DNA polymerase or reverse transferase).

RNA genomic viruses (2nd RNA)

Genes are arranged linearly

Integrability - the ability to integrate into the genome as a provirus

Activation of the genome - the synthesis of proteins and NK, the formation of a mature virion during penetration through the cytoplasmic membrane of the informing cell.

The supercapsid is a two-layer membrane; it acquires, during budding, a three-membrane protein with M = 17-18 kDa.

The bilipid layer pierces the receptors GP-41 (glycoprotein) and GP-120 (virion spine) - surface proteins and AT are produced for them, GP-120 is a T-lymphocyte receptor carrying CD-4.

Features of the HIV genome - 9749 nucleotides (100,000 times shorter than the human genome). There are 3 reading frames LTR (long terminal repeat), There are genes:

1. gag gene (internal proteins),

2
.pol (reverse transcriptase),

3. env (outer shell protein),

6 additional genes:

1. rev (selectivity of action, thanks to it, the synthesis of virion proteins is regulated)

2. vif (infectivity factor)

3. nef (the ability of the virus to stop reproducing, to go into a dormant stage)

4. tat (for replication)

5-6. vpr and vpu - the function is different, not decoded

No onc virus - does not form malignant formations. Tumors arise due to the most powerful repayment of immunity.

Features of the genome. High variability (100 times higher than influenza). The reason for the variability is reverse transcriptase, which makes many errors when reading. The virus at the beginning and at the end of the disease is different.

Life cycle of HIV.

adsorption from the target cell (macrophages, monocytes, neurons, E-helpers, intestinal cells) - GP-120, where there is CD-4 R.

Stages of interaction of the virus.

RR CD-4 interact with GP-120

Penetration into the cell by fusion with the cell membrane

The inclusion of reverse transcriptase in the work and synthesis of DNA copies.

DNA polymerase activity that catalyzes the synthesis of 1 strand DNA complementary to viral DNA.

Ribonuclease activity, cleaves original DNA

Reverse transcriptase synthesizes the 2nd strand of DNA using the 1st as a template.

Integral activity, DNA insertion into the host chromosome, provirus formation.

The infection is permanent, long-term - the cell carries information until the end of the host's life.

The production of new virions, with the activity of the tat genes, the synthesis of new proteins and NA, the assembly of virions and exit from the cell by budding → a lattice is formed in the cell membrane → cell fusion → the formation of symplasts.

Damage to the immune system

The development of apostasy. infections

Affects T-helpers → malfunction of T-killers → lymphopenia → T-suppressors actively proliferate → suppression of activity (T-helpers / T-suppressors = 0.5 (normal 2 or more)) HLD is negative, non-serum IgA, IgM. Kidney damage, ID.

The incubation period (from infection to the appearance of AT) - 6 months - 2 years.

Acute HIV infection caused by a retrovirus (t 0 , pneumonia, increase in blood pressure, sweating, cardiomediastinal syndrome, stool disorder, thrombocytopenia, bleeding, neurological syndrome.

Asymptomatic latent carriage (2-4 - 10-20 years)

L.s. systemic increases, tongue plaque

Laboratory diagnostics: immune system analysis, immune blot, GWH? Specific changes in the immune system.

In the world: RB > 5,000, RF - 250,000, 20 million died.

Antiviral therapy: azidotherapy, thymosin, thymus, bone marrow transplantation, etc., intensive search for the virus.

What methods are used to prevent HIV infection

Acquired Immunodeficiency Syndrome AIDS is an infectious disease that can lead to the death of the patient. AIDS develops rapidly and within a few years the patient may die from concomitant diseases. Since there are no specific treatments, HIV prevention remains relevant to prevent the spread of the disease.

What is the danger of the virus

The human immunodeficiency virus belongs to retroviruses and its effect on the body is to suppress human cellular immunity. By affecting CD4 receptors, which are located on the surface of T-lymphocytes, macrophages and dendritic cells, the virus reduces the body's immune defenses. This depresses the immune system and increases the risk of developing infectious diseases, oncological neoplasms, which ultimately lead to the death of the patient.

The virus is constantly undergoing changes, this causes differences in the course of the disease, and is the reason that there are no methods of specific prevention (vaccination) against it. Nonspecific prevention of HIV infections is aimed at preventing infection. An important role in this is played by the awareness of the population about the ways of transmission of HIV infection. Measures taken by the media and medical institutions have helped reduce the spread of HIV.

How can you get infected

Infection occurs when the virus enters the internal environment of the human body. The source of infection is a patient or carrier of the virus. Moreover, there are a lot of seropositive carriers of HIV. Not everyone who is infected develops AIDS, as some have resistance to the virus at the gene level.

The infectious agent can be found in body fluids such as:

Other biological fluids may also contain it (urine, saliva, sweat), but its concentration in them is so low that it cannot cause infection in a healthy person. Based on this, measures have been developed to prevent infection, the observance of which allows avoiding such a serious disease as AIDS.

Transmission routes can be divided into several groups:

• contact infection or sexual;
• vertical path or from mother to child;
• artificial infection (medical, cosmetic manipulations).

Methods of prevention in adults

The most common route of infection in adults is the penetration of the virus into the body during sexual intercourse, and the semen and vaginal mucus of the patient or the virus carrier contain HIV in high concentrations.

But there is a high risk of infection in drug addicts and with various manipulations associated with damage to the skin. There is no data on the possibility of penetration of the virus through the contact-household route with a kiss, handshake, food, water, and bites of blood-sucking insects.

Prevention during sexual intercourse

Infection during sex can occur even with interrupted intercourse, since the infectious agent is also found in the pre-ejaculatory fluid. The risk of contracting HIV increases many times with an increase in the number of sexual partners and the use of unprotected sex.

The risk of infection is especially high in the youth environment, in adolescents, since during this period there is a sexual surge in the body, which reduces the sense of danger. And even awareness of the risk of unprotected sex does not always stop.

Using condoms during intercourse reduces the risk of infection by almost 95-98%, but they must be used correctly.

1. Choose condoms from large manufacturers, preferably in opaque packaging.
2. Use condoms without various aromatic lubricants, as they can cause irritation, allergies, which means that the likelihood of microdamage to the mucosa increases.
3. Do not use creams, Vaseline for lubrication, they can damage the latex.
4. Check condom expiration date.
5. Storage conditions play an important role, so it is better to purchase them in pharmacies.
6. Do not store condoms for a long time in the light or at elevated temperatures, for example, in pockets, this leads to a violation of their integrity.
7. You can not put one condom on another, the likelihood of damage increases due to friction.
8. One should not be shy about offering protected sex to a partner, this does not indicate distrust, but indicates awareness, care for one's own and his health.

Sanitary and educational work on awareness of the population begins at school. Adolescents are introduced to the ways in which HIV is transmitted and how to prevent diseases such as AIDS. In some countries, free condoms are distributed to schoolchildren and warned that the best prevention measure is to abstain from promiscuity, to test partners for HIV before marriage.

Prevention for drug addicts

Another problem inherent in the youth environment is drug addiction. The introduction of narcotic substances with one syringe can lead to infection. Educational work on the dangers of drug addiction with different age groups, compulsory treatment and the fight against the production and distribution of drugs are measures to prevent acquired immunodeficiency syndrome.

Prevention in medical and cosmetic procedures

There is a risk of infection during medical, cosmetic procedures. You can get infected by shaving, nail polishing, tattooing. Compliance with the rules of personal hygiene and careful sterilization of instruments in beauty salons can reduce it.

With regard to medical interventions, procedures, the use of sterile or disposable instruments prevents infection. Compliance with the norms of their processing is carried out at several levels in each medical institution.

There were times when HIV infection occurred as a result of transfusion of infected blood products. This has led to the development of rules for manufacturing, processing and proper use, which have significantly reduced the risk of infection.

Medical workers are also at risk, since during the care of patients there is a possibility of infection through contaminated blood with cuts and injuries. In such cases, they undergo emergency medical post-exposure prophylaxis, which consists in providing first aid (treatment of the wound) and prescribing antiretroviral drugs.

Methods of prevention in newborns

AIDS infection of a child can occur on early dates pregnancy, during childbirth and while breastfeeding. HIV-infected pregnant women are given antiviral drugs. Childbirth is usually carried out by caesarean section to shorten their duration. To exclude infection when feeding a child, they are transferred to artificial nutrition.

HIV prevention is necessary to prevent the development of AIDS and virus transmission. Everyone should understand that AIDS is a serious disease with high level mortality, and its prevention is the only way to preserve the health of oneself and loved ones.

receptdolgolet.ru

Presentation on the topic: Non-specific prevention of HIV infection. HIV vaccination

Prevention of the spread of HIV infection is a consistent activity of organizations, structures and individuals aimed at informing the population about the danger of HIV infection and the formation of safer forms of behavior to reduce the risk of HIV infection. Prevention of the spread of HIV infection is a consistent activity of organizations, structures and individuals aimed at informing the population about the danger of HIV infection and the formation of safer forms of behavior to reduce the risk of HIV infection.

Non-specific prevention is a field of activity that does not directly affect the problem, but affects it indirectly. Non-specific prevention is a field of activity that does not directly affect the problem, but affects it indirectly. Specific prevention is an activity aimed directly at certain manifestations of a problem.

Implementation of programs to prevent sexual transmission of HIV Implementation of programs to prevent sexual transmission of HIV Implementation of programs to prevent transmission of HIV through injecting drug use Implementation of programs to prevent mother-to-child transmission of HIV.

a) Providing accurate and complete information on less hazardous sexual behavior, from information on abstinence to less hazardous sexual practices; a) Providing accurate and complete information on less hazardous sexual behavior, from information on abstinence to less hazardous sexual practices; b) information on abstinence, delayed onset of sexual activity, mutual fidelity, reduction in the number of sexual partners, comprehensive and correct sexual education; c) information on early and effective treatment sexually transmitted infections.

a) prevention of drug use (reducing the demand for drugs, reducing the number of drug users); a) prevention of drug use (reducing the demand for drugs, reducing the number of drug users); (b) A necessary set of effective treatment and rehabilitation options for drug dependence; c) harm reduction measures;

a) Primary prevention of HIV infection a) Primary prevention of HIV infection among women; b) prevention of unwanted pregnancies among HIV-positive women; c) prevention of HIV transmission from infected pregnant women to infants, including ensuring access to ARV therapy and quality substitutes breast milk; d) providing care, treatment and support to HIV positive women and their families.

Measures for susceptible populations; Measures for susceptible populations; Prevention of nosocomial infection; Prevention of occupational infection; Prevention of infection during transfusion of donor blood and its components, organ transplantation and IVF.

At present, the first phase of clinical trials of the anti-HIV/AIDS vaccine "VICHREPOL", created at the Institute of Immunology, has been successfully completed. This vaccine is a new generation drug that has no analogues in world practice. The test results confirm that the VICHREPOL vaccine is safe and does not cause side effects. At present, the first phase of clinical trials of the anti-HIV/AIDS vaccine "VICHREPOL", created at the Institute of Immunology, has been successfully completed. This vaccine is a new generation drug that has no analogues in world practice. The test results confirm that the VICHREPOL vaccine is safe and does not cause side effects.

a synthetic protein that copies conserved (permanent) HIV antigens; a synthetic protein that copies conserved (permanent) HIV antigens; polyoxidonium, a synthetic immunostimulant that greatly enhances the immune response to the vaccine antigen.

Recombinant subunit vaccines. The classic representative is AIDSVAX (Vaxgen Inc., USA) containing the surface protein of the virus (gp120). Current state of development of subunit recombinant vaccines: Recombinant subunit vaccines. The classic representative is AIDSVAX (Vaxgen Inc., USA), which contains the surface protein of the virus (gp120). Aventis Pasteur, France and Chiron, USA) p24 (major core coat protein of the virus) - phase I

Inactivated subunit vaccines. When creating inactivated vaccines for the prevention of HIV infection, an inactivated Tat toxin of the virus is currently used. Inactivated subunit vaccines. When creating inactivated vaccines for the prevention of HIV infection, an inactivated Tat toxin of the virus is currently used. DNA vaccines. The preparations are purified nucleotide sequences of the DNA of the virus. Current status of DNA vaccine development: Phase I. Live recombinant vaccines based on viral vectors. Avian pox virus vaccine (ALVAC (Aventis Pasteur, France and Chiron, USA) - phase II. Variola vaccine product - phase I

Live recombinant vaccines based on bacterial vectors. Current status of vaccine development based on bacterial vectors: Salmonella - Phase I. Live recombinant vaccines based on bacterial vectors. Current status of vaccine development based on bacterial vectors: Salmonella - Phase I. Synthetic peptide vaccines. Current developments of synthetic peptide vaccines in clinical trials: p17 (one of the core proteins of the virus): Phase I Lipopeptides: Phase I V3-based (one of the gp120 protein fractions): Phase I Combination vaccines. Current development of combination vaccine candidates in clinical trials: avian pox virus + gp120 vector vaccine.

Modern methods of non-specific HIV / STI prevention

Russian Journal of Skin and Venereal Diseases, 2004. - No. 2. - P. 56-58.

V. A. Molochkov, I. M. Kirichenko, Yu. S. Krivoshein

MMA them. I. M. Sechenov, Moscow

MODERN METHODS OF NON-SPECIFIC HIV/STI PREVENTION

SUMMARY Non-specific (barrier) HIV prevention / STI is currently the main method of preventing these diseases. The domestic antiseptic Miramistin®, used for 10 years as a means of preventing sexually transmitted diseases, has shown high efficiency and safety. Candles and Miramistin® gel also have a pronounced spermicidal and contraceptive effect.

Fight against HIV infection and STI is one of the most urgent problems facing humanity today.

According to official statistics, about 40 million HIV-infected people are currently registered in the world, and 200,000 in Russia, of which about 2,500 are children. Every day this figure increases in the Russian Federation by 100 people, of which 70 are in Moscow and the Moscow region.

In recent years, the incidence of STIs has increased dozens of times, in the Russian Federation it is 85.5 cases of syphilis and 200 cases of gonorrhea per 100,000 population. The number of patients with trichomoniasis, gardnerellosis, urogenital chlamydia, herpes and candidiasis, mycoureaplasmosis and other STIs has sharply increased. It should be noted that official statistics do not fully reflect the true picture of HIV/STI prevalence. According to WHO experts, in order to get the real number of infected, it is necessary to multiply the official statistics by 10.

Prevention of HIV / STIs is divided into general (sanitary clearance, social activities, etc.), specific (vaccination) and non-specific (barrier, mechanical and chemical) (see diagram).

Several types of vaccines are currently being developed. According to WHO estimates, effective and widely available vaccines are likely to be created only in the 2nd decade of the 21st century. No less difficult is the problem of specific prevention of STIs.

Due to the current lack of anti-HIV/STI vaccines, the main way to prevent these infections is an alternative (non-specific) one - with the help of condoms and chemicals. The same funds form the basis of modern contraception, providing both prevention of pregnancy and prevention of HIV / STIs.

The main means of non-specific barrier individual prevention of HIV / STIs are condoms (male and female), which create a mechanical obstacle to the penetration of the pathogen into the human body.

Their effectiveness is limited by the risk of the pathogen passing through the barriers created by polymeric materials, as well as by mechanical damage during use. Certain brands of condoms are estimated to provide only 30% protection against sexual transmission of HIV. It has been proven that when using condoms, in a significant percentage of cases, they break, slip during intercourse, which leads to infection with bacterial infections (syphilis, gonorrhea, trichomoniasis, chlamydia, etc.) and viral (HIV, herpes) nature, as well as pregnancy . Data from surveys of sexual partners who regularly use condoms showed that during the observed period, 62% of couples did not break a condom even once, 29% broke 1-3 times, and 9% more than 4 times. In addition, about 30% of men do not use condoms for physiological reasons (weak erection), because of the occurrence of allergic reactions to latex or condom lubricant, for religious or other beliefs. Therefore, condoms are not a universal prophylactic and cannot guarantee complete protection against HIV/STI infection and prevention of pregnancy.

This stimulated the creation of programs for the development and distribution of individual means of preventing HIV / STIs and contraception using chemical agents - microbicides. For this purpose, preparations have been developed that are intended for treating the genitals of sexual partners before and after sexual contact.

Currently, external microbicides have been created for the prevention of STIs and HIV infection: PRO 2000 (naphthalenesulfonate polymer); buffer gel, negatively charged, non-absorbable high molecular weight polymer gel for maintenance in the vagina in the presence of sperm pH below 5.0; F5 gel. containing 3 spermicides (Nonoxynol9. benzalkonium chloride and sodium cholate); combined preparation C31G, consisting of C14 alkylamine oxide and C16 alkyl betaine, and others. The drug Nonoxynol9 (H9), which has been officially used in the United States as a chemical contraceptive for more than 30 years, has received the greatest distribution in various countries of the world.

Numerous studies on the use of H9 as a contraceptive, as well as for the prevention of HIV infection, conducted under the auspices of WHO in various countries of the world, have confirmed that intravaginal applications of H9 can prevent pregnancy and protect women from HIV and other STI pathogens. At the same time, it has been proven that H9, like other non-ionic surfactants, are weak microbicides and have an effect only at high concentrations of the drug, which is associated with more pronounced manifestations of their toxic properties. So, when using surfactants, there are signs of allergic reactions (erythema of the vulva, irritation of the vaginal mucosa with the appearance of copious secretions and an unpleasant odor), as well as more serious consequences (development of ulcers, and sometimes - when using sponges, films, caps - the occurrence of toxic shock).

In the study of systemic effects on the fetus as a result of the penetration of H9 through the vaginal mucosa, an almost twofold increase in the risk of limb shortening, malignant neoplasms, urethral hypospadias, Down syndrome and other severe chromosomal abnormalities was established.

There are reports that the use of certain dosage forms of H9 increases the risk of HIV infection. Scientists see the explanation for this phenomenon in the fact that the frequent use of H9 causes irritation of the vaginal wall, which leads to the formation of microcracks that open the way for HIV. However, it should be noted that in most cases we are talking about experiments involving prostitutes who used the drug up to 20 times a day, and there is no evidence that its use 2-3 times a day leads to negative consequences.

Nevertheless, scientists are constantly calling for a more detailed study of the long-term use of H9, since it is a very common drug: in the US alone, it covers up to a third of condoms sold.

In addition, WHO, stating the prospect of using H9 as a prophylactic agent, constantly points out the need to search for and develop new surfactants, more effective microbicides with minimal irritant and other side effects on the human body, which could be used as contraceptives by women, as well as for individual HIV / STI prevention not only by women, but also by men.

These drugs include the antiseptic Miramistin® produced in Russia, widely used by sexually active groups of the population and persons belonging to risk groups, as an individual means of preventing syphilis, gonorrhea, trichomoniasis, chlamydia, herpes and other STIs.

Miramistin® was developed by prof. Yu. S. Krivoshein and Ph.D. chem. Sciences A. P. Rudko and approved by the USSR Ministry of Health for medical use in 1991 as an antiseptic for individual prevention of sexually transmitted diseases, and in 1993 as a broad-spectrum antiseptic. The exclusive manufacturer of the drug in Russia is Infamed CJSC.

Miramistin® is a cationic surfactant that has pronounced antimicrobial properties and does not have a local irritant, mutagenic and carcinogenic effect. The effectiveness of the prevention of STIs by treating the genitals of sexual partners with a 0.01% solution of Miramistin® after sexual contact has been demonstrated. In addition, instillations of Miramistin® solution are included in the complex treatment of chronic urethritis in gonorrhea, trichomoniasis, mixed trichomonadal nococcal and chlamydial infections. Such an addition to traditional therapy led to a significant increase in the effectiveness of treatment.

Multifaceted studies of the anti-HIV activity of Miramistin®, conducted in leading laboratories in Russia, Ukraine, Sweden, Germany, made it possible to prove that Miramistin® at working concentrations is effective for the destruction of extracellular and intracellular HIV. It turned out to be a more active agent for the destruction of HIV compared to other disinfectants (see table). Based on these data, the Pharmacological State Committee of the Ministry of Health of the Russian Federation decided to include in the instructions for the use of Miramistin® information that the drug has anti-HIV activity.

Minimum concentrations at which various disinfectants inactivate HIV

Primary prevention carried out to prevent the occurrence of the first episode of infection. Secondary prophylaxis is carried out in order to prevent the occurrence of a second episode of infection after an infection.

Distinguish non-specific prophylaxis, immunoprophylaxis, as well as drug prophylaxis and treatment of opportunistic infections.

Nonspecific infection prevention.

Children and/or their caregivers should receive advice from their doctor on non-specific prevention of opportunistic infections, i.e. advice on developing hygiene habits and avoiding risky behavior based on data on the epidemiology of opportunistic infections and on the possibility of an individual child to contract them.

Recommendations for non-specific prevention of zoonotic infections:

Immunoprophylaxis of infections in HIV-exposed and HIV-infected children.

HIV-infected children are at high risk of infectious diseases, which increases as immunodeficiency worsens. Therefore, vaccination of HIV-infected children, including children in the AIDS stage, should be carried out with particular care.

A. Vaccination of HIV-exposed children and HIV-infected children without pronounced signs of immunodeficiency (clinical categories 1-3 according to the WHO classification of 2006 and CD4 > 15%) is carried out according to the national calendar of preventive vaccinations in accordance with the order of the Ministry of Health of the Republic of Belarus No. 913 dated December 5, 2006 d. “On improving the organization of preventive vaccinations”, taking into account the following:

• in the presence of clinical manifestations of acute infections, vaccination is carried out during a period of remission lasting at least 0.5-1 month;
• the use of live vaccines is limited: children are vaccinated against tuberculosis with the BCG-M vaccine; vaccination of children, as well as other persons living with them (family contact) against polio is carried out with inactivated polio vaccine (IPV), but not live oral vaccine (OPV).

B. Vaccination of HIV-infected children with severe immunodeficiency (clinical category 4 according to the 2006 WHO classification or CD4<15%) должна проводится всеми анатоксинами, убитыми и рекомбинантными вакцинами. Из живых вакцин показано введение только коревой вакцины. Для пассивной иммунопрофилактики у ВИЧ-инфицированных детей с выраженным иммунодефицитом по клиническим показаниям применяется внутривенный нормальный человеческий иммуноглобулин.

Approaches to drug prevention

Primary drug prophylaxis is given to patients who are at risk of opportunistic infection (begins with a decrease in the number of CD4 lymphocytes or the appearance of other infections).

Treatment is carried out with clinical and laboratory confirmation of the presence of an active opportunistic infection.

Secondary prophylaxis is given to patients who are at risk of developing recurrent opportunistic infections. Secondary prevention begins immediately after the completion of the course of treatment for the infection.

Indications for prescribing the prevention of opportunistic infections are formulated in national protocols for the treatment of HIV/AIDS.

A quick look at the main drugs for prevention:

There are no uniform recommendations for stopping primary and secondary prevention of opportunistic infections in children. It should be remembered that the prophylaxis regimen can only be canceled in a child receiving effective ART, provided that a stable (recorded for at least 6 months) increase in the level of CD4 lymphocytes > 15% of the age norm is achieved, and also if the child has no clinical laboratory manifestations of this opportunistic infection.

In an era when ART was not yet available, only the introduction of high-quality drug prevention of opportunistic infections made it possible to reduce mortality from AIDS by several times.

Biseptoprophylaxis in HIV-exposed and HIV-infected children.

Pneumocystis pneumonia in HIV-infected children can develop quite early (sometimes even before the diagnosis of HIV infection is confirmed) and is usually characterized by a rapid course with a rapid increase in respiratory failure. Pneumocystis pneumonia is the leading cause of death of HIV-infected children in the first year of life. Therefore, the prevention of pneumocystis pneumonia in all children born to HIV-infected mothers is mandatory.

Prevention is carried out with a combined chemotherapy drug trimethoprim / sulfamethoxazole (biseptol).

Biseptol prophylaxis in HIV-exposed children should be started from the moment of discontinuation of drug ARV prophylaxis (4-6 weeks of life) or, if drug ARV prophylaxis is not started for any reason, from the 5th day of life.

Schedule: trimethoprim/sulfamethoxazole (biseptol) 150/750 mg/m2 (or 5/25 mg/kg) per day orally in 2 divided doses daily.

Biseptol prophylaxis in HIV-exposed children is terminated at the age of 6 months, provided there are no clinical signs of initial immunodeficiency (normal physical and psychomotor development, absence of lymphadenopathy, splenomegaly, hematological manifestations and clinical symptoms of barrier organ damage - frequent recurrent infections of the respiratory, urinary tract and skin). Biseptol is recommended for HIV-exposed children aged 6-12 months at each episode of a respiratory infection for the duration of its acute manifestations.

Biseptoprophylaxis is terminated immediately after the exclusion of the diagnosis of HIV infection in a child, at whatever age this happens.

Biseptoprophylaxis in HIV-infected children is carried out in accordance with current regulations.