By Manuel Antonio Velandia Mora
Spain, 30/08/2010
To handle every situation in life, you have to know beforehand. The more you know, the more we dominate. Therefore, any person living with HIV or AIDS, if you want to achieve proper management of their infection, you should be aware that the more you know about it be more appropriate management. It is important to consult with individuals and institutions that have good management information and are able to do so.
is essential to know at least what the infection, how it spreads, how is not passed, what are the ways of transmission and risk behaviors, etc., and identify the cofactors of risk, what is re-infection and superinfection, which treatments are available and which can be accessed in the country. Needless to know what rights and obligations of those affected by the infection, how and when informing the partner, family and their leaders in the workplace. Learn, especially how to play a positive style of life (do it in the best possible conditions), where and with whom they obtain services.
remember and clarify, then, some concepts already known.
AIDS: Acquired Immunodeficiency Syndrome
Syndrome: a set of symptoms, signs and conditions that are present in a person affected by the virus, but not so specific as to be called disease.
Immune deficiency: the inability of the immune system to function normally; makes people who have it more susceptible to certain diseases, which are not normally affect them.
Acquired a situation that is congenital or inherited.
HIV (human immunodeficiency virus) retrovirus family virus and lentivirus subfamily [1] , which causes AIDS.
Transmission chain
For a person becoming infected with HIV requires the virus was transmitted from the body of a person who is infected previously. The process for infection to occur is called the chain of transmission. The infection can be avoided only by breaking one link. This means that even when condoms are effective, are not the only possibility to prevent.
Steps transmission chain
1. Agent: organism causing the infection in the case of AIDS is HIV (human immunodeficiency virus).
HIV has a simple structure but complex at the same time, by its own possibilities. The sheath covering the core is composed of proteins. The nucleus contains genetic information of the virus and reverse transcriptase. HIV is called 'ret rovirus [2] because the multiplication process will be explained below, makes the molecules of genetic information, RNA (acid ribonucleic) into DNA (acid deoxyribonucleic) by a viral enzyme called reverse transcriptase.
tissue in the immune system, HIV replicates or multiplies continuously at high levels and from the very moment when infection occurs. Initially, it was believed that this were so, it was thought that the virus remained dormant (asleep) for a long time, ie latency and therefore had no manifestations of the disease. Nor was how to measure the concentration of virus in the body.
2. Reservoir host: reservoirs of HIV are macrophages, glial cells and nervous system such as helper lymphocytes in the immune response. The host is the body which houses the microorganism. HIV is only possible to the human host, which means that men and women can be affected by the virus, of all ages, of all sexual orientations, any creed, ethnicity, social or economic position in all around the world.
3. Exit doors: are secretions or body fluids in which the organism is hosted and, leaving our body, have contact with the front doors of the other person, through a transmission path.
enough is required (seed) of the microorganism to be infectious secretion. "The efficiency of transmission is variable and depends on the infectivity of the transmitter, receiver susceptibility, the specific mechanisms of transmission and possibly the type of virus ... Likewise, the exact number of exposures necessary for efficient transmission. "
secretions that transmit HIV are: pre-ejaculatory fluid (lubricant [3] of the penis) and semen in men, in women, vaginal secretions, menstruation, vaginal secretion and lubrication. It is considered that human milk is potentially infectious. Both men and women living with HIV or AIDS, blood is the vehicle of transmission, so are the cerebrospinal fluid and bone marrow. The virus is not transmitted through excretions, sweat, urine, tears, feces [4] , Saliva, ear wax, snot, because in these the presence of virus excretion is minimal or nonexistent.
4. Routes of transmission: are the ways by which the virus coming from an infected person gets into the bloodstream of another is not, and the infected or reinfected [5] (acquire a different strain of virus). The routes of transmission are:
Via sexual in any erotic or genital contact involving fluid mixture in which one contains the virus, there is the possibility that it enters the body of another person. Contacts can be penetrative or oral (penis-vagina-mouth-anus) from man to woman, woman to man, man to man and woman to woman;
blood or parenteral route, by through blood transfusion or any of its derivatives. Also by the transplantation of organs or tissues from a person carries. A health care professional or anyone handling biological material can become infected if it complies with appropriate standards of work (biosecurity) and exposed accidentally (punctures, contact with an open wound) to fluids (secretions) a person living with HIV or AIDS. Even when talking about accidental way, this really is a parenteral transmission;
Vertical transmission when the virus is transmitted from a woman carrying her baby, it can be during pregnancy, childbirth or lactation;
Conduct risk: they are situations that a person is not properly controlled. For example, you can control the risk of infection through blood transfusion, in which case the risk behavior is not to require the national seal of quality blood, which ensures that the blood or its derivatives, have been previously analyzed for the presence of HIV and microorganisms that cause syphilis, Chagas, hepatitis B, C and D. You can prevent sexual transmission risk if you put a barrier between the genitals of the two people in order to avoid the exchange of infectious fluids.
risk behavior would not use condoms and oral barriers. Another risk behavior is not properly implementing biosafety regulations knowing they can reduce the risk of infection through accidental parenteral.
5. gateways : are the physical spaces a person who can enter secretions containing the virus. The entrance doors, in descending order of risk are: the bloodstream, the anal mucosa, placenta, vaginal mucosa, oral mucosa and skin with continuity.
mucosal features: mucosal tissues are characterized by soft and moist. All mucous membranes are susceptible to infection. They are the eyes, nose, mouth, penis, the vagina and rectum.
rectal mucosa, rectal tissue is epithelium [6] so cylindrical, single layer. It has a high blood supply, is very fragile and rich in CD4 cells or T4 cells, receiving the virus [7] . It has no natural lubrication. As the completion of the large intestine is absorbing. All these conditions make the right of where the body that by its own terms is more susceptible to viral entry.
vaginal mucosa, the tissue of the vagina is a flat epithelium with several layers, elastic and somewhat fragile. At menopause, has a lower blood supply. It has natural lubrication, which facilitates the movement of the penis during genital. There is compelling. These conditions make the vagina is less susceptible than the straight entry of the virus, but the fact that women do not consider them vulnerable increases the risk.
Reporting requirements:
1. that a person is infected, can infect, secretions, tissues and organs must contain the virus;
2. must enter the body with a minimal amount of virus;
3. the virus must penetrate the body so that it reaches the bloodstream.
The penis abrasions or sores on the penis, especially in the glans, which occur during masturbation, oral practice or insight into the movements of intercourse and contact with the hair genital facilitate exit and entry of the virus.
When HIV enters the bloodstream, it attaches to the CD4 cell surface and penetrates inside. Once there, the virus particle or virion [8] decomposes and releases its genetic material, which consists of two molecules of RNA (ribonucleic acid).
It contains all the viral genes necessary for replication (viral replication or multiplication), ie, to form new decks and virions.
Cofactors associated with risk of infection
situations are presented in the body and facilitate entry of the virus. Some of these cofactors are
· The presence of mucosal lesions, or skin, caused mainly by the manifestations of sexually transmitted diseases that cause ulcerative lesions character ( syphilis, herpes, genital ulcers) and the trauma that causes inadequate penetration (without sufficient lubrication, the use of blunt objects)
· High levels stress caused by emotional conflicts, emotional, occupational, economic or otherwise;
· Improperly balanced diets;
· repeated penetrative relations genitals without adequate protection;
· ; time exposure;
· inadequate genital hygiene;
· In women, pregnancy (because the defense system, adapting to the pregnancy, lowers their defense as a means of not rejecting the fetus in training);
· The use of psychoactive drugs or substances that affect the defense system;
· ; In general, all conditions that damage the immune system response of the organism;
· use of immunosuppressive drugs.
6. Susceptibility: ability of a body to support a modification or receive some effect or action. With regard to HIV infection, it was felt that all men and all women, regardless of their sexual orientation, age, creed, color, race, religious or political, were susceptible to acquiring the virus (universal susceptible).
Recently, however, has been known that there is a characteristic genetic alteration in a gene called CKR-5 (coreceptor greater for virus entry into the cell), which prevents, in some people, that your body recognizes the virus because they have no receptors for this and therefore avoids being infected, ie who has the disorder has a kind natural immunity.
chain of virus replication can be broken by a series of medications called angiotensin [9] . The transcriptase [10] act within the infected cells, preventing the virus to use a portion of its structure, reverse transcriptase, and generates virions which then circulate in the bloodstream to infect new cells.
protease inhibitors [11] act on one of the proteins of the virions, with defective structure. So avoid that can infect new cells.
If people are not using antiretroviral medications your infection can progress to AIDS, although some who use them do because when you begin treatment with these drugs had already progressed some infections or Simply put, the stage of disease is so advanced that do not achieve the desired effect.
Stages of HIV replication
1. HIV enters the CD4 cell.
2. HIV is a retrovirus. This means that their genetic information is stored in a single-stranded RNA (ribonucleic acid) rather than double-stranded DNA (deoxyribonucleic acid), as in most organisms. To replicate, HIV uses an enzyme called reverse transcriptase, by which converts its RNA into DNA.
3. HIV DNA enters the CD4 cell nucleus and inserted into the DNA chain of the cell, then tells the cell to produce many copies of the original virus and copies of the foil.
4. Protease through new viral particles are assembled that allow cells to infect other CD4 cells.
antiretroviral agents for HIV
non-nucleoside reverse transcriptase inhibitors (NNRTIs)
are the latest generation of antiretroviral drugs. Acting on the same stage as nucleoside analogues, but they do a completely different way: stop HIV replication, reverse transcriptase directly isolating, which prevents the conversion of RNA into DNA.
nucleoside analogues
effective are the first class of antiretroviral drugs. Work incorporated into the DNA of the virus and thus stop the construction process. The resulting DNA is incomplete and can not create new virus.
Protease
protease inhibitors work in the last stage of virus replication cycle. Prevent the possibility that the virus's genetic information is assembled and prevent the virus is successfully removed the infected CD4 cell.
Fusion Inhibitors
These are drugs that inhibit or prevent the binding of HIV to lymphocytes have receptors on their surface, that is, proteins for which HIV has a high affinity .
The process of fusion of HIV to infect the cell is very complex, involving not only those proteins or receptors that the cells have on their surface, but also proteins of the virus itself and the lymphocyte cell membrane. So when the virus is anchored to the cell membrane it undergoes a series of changes that make it permeable to the virus and it manages to get inside.
FIs they do is prevent or hinder the anchoring of the virus into the cell and thereby prevent the lymphocyte membrane becomes permeable to the virus. If the virus does not accomplish its goal of entering the cell, can not reproduce and their life cycle stops.
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Bibliography:
Main source: Velandia Mora, Manuel Antonio (2002). Vital alternative. Manual pre-and post-test counseling on HIV and AIDS. Ministry of Health, AIDS Program / Foundation-let's support Colombian Foundation Support in AIDS, Hepatitis and STDs. Bogota, Colombia.
Jaime Sepúlveda et al (1989). AIDS, science and society in Mexico, Mexico: Fondo de Cultura Economica.
drug classes. infosidas.es
[1] Lentivirus : retroviruses are a family of viruses, there is a named subtype of lentiviruses, ie, viruses that act continuously, but slowly.
[2] For the virus to infect lymphocytes, to insert its genetic code in the genetic code of cells, thus making the two codes are consistent and that the virus can multiply at the expense of information of lymphocytes . Once this happens, the lymphocyte is destroyed and, thus, the defense system is progressively compromised. HIV's genetic code is composed of RNA and DNA is transformed by the action of reverse transcriptase.
[3] Lubricant: a physiological mechanism that facilitates genital relationships mechanical act of penetration and is produced by the same agency to safeguard the integrity of the mucosa.
[4] fecal matter containing the virus, however, certain particles may contain blood, which can reach the bloodstream during a relationship anal sex with an infected person and cause infection.
[5] Reinfect: a person already infected can become infected again with a variant strain of the virus, the same or different from what you have in your body and thus further complicate the disease process, especially when reinfection occurs with resistant virus antiretroviral drugs, as in this case the person is also resistant to those drugs.
[6] epithelium: layer of cells lining the external cavity, the ducts of the body and skin.
[7] lymphocytes or T cells, are a type of blood cell (WBC), in whose development the thymus is involved. They are responsible, in part, to carry out specific cellular response of the body's defense system or immune system to antigens. Antigen is known as the body any foreign substance. Mobilized antigen specific cellular immune response every time you enter the body.
[8] virions: virus in the process development. It is now known that after a day and a half of the initial infection, large amounts of new virions are released from a CD4 cell, which eventually dies. The infected CD4 have an average life of 1.6 days. These virions are removed from the plasma after a life of six hours. After this time, begins a new cycle of infection of CD4 cells. It is estimated that 99% of HIV found in blood plasma comes from the cycle. It is estimated that every day there are 10 billion or more new HIV (virions) in the infected person and, in turn, more than 2 billion CD4 cells die and are replaced by the immune system.
[9] inhibitors: drugs that adversely affect the replication of the virus.
[10] Reverse Transcriptase: allows the virus enters the cell to transcribe its RNA genetic code (which is inscribed the HIV genetic code) deoxyribonucleic acid (DNA). This enzyme converts the single-stranded RNA molecule (the virus's genetic material) in a double strand of DNA that is introduced in the genetic material of infected CD4 cell. The DNA copy serves as a template for the replication of HIV DNA, which is assembled as a new viral particle. To infect a lymphocyte, the virus must insert its code, consisting of RNA, the genetic code of lymphocytes. This provides that the two codes are consistent and that the virus can multiply at the expense of the replication machinery of the cell. Once this happens, the lymphocyte is destroyed and, thus, the defense system is progressively compromised.
[11] Protease is a part of the structure of the virus, which is necessary for it to play. Breeding occurs in several stages and all must be completed when new virus. Once the new viral particles mature, bulge (cross) the wall of the cell surface and continue to infect other CD4 cells, repeating the replication process. During one of these stages, some of the proteins needed to create the new virus as part of a long chain. The chain must be cut before they move to the next stage of virus replication. An enzyme called a protease, acts as a 'scissors' cutting charge chain protein. If the scissors are damaged (is inhibited), the virus can not assemble.
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