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cn gi l SIDA theo cch vit tt t Syndrome d'ImmunoDficience Acquise ca ting Php) hay bnh lit khng l mt hi chng ca nhiu bnh nhim trng (v d: lao, vim phi, nm), m ngi nhim HIV gp phi do h min dch ca c th b tn thng hoc b ph hy nng n. Cc bnh ny c gi l cc bnh nhim trng c hi. AIDS c coi l giai on cui ca qu trnh nhim HIV. Tuy nhin, mi ngi khi mc AIDS s c nhng triu chng khc nhau, ty theo loi bnh nhim trng c hi m ngi mc phi, v kh nng chng ca h min dch mi ngi.
Triu chng
HIV c ly truyn qua cc dch c th, nh mu, tinh dch, dch tit m o v sa m. N gy bnh bng cch gn vo cc t bo T gip CD4+ (cn gi l limpho bo T4), mt loi bch cu tham gia qu trnh p ng min dch chng li nhim trng v ung th. Khi s lng t bo T CD4+ gim, ngi d mc mt s bnh m c th ngi kho mnh bnh thng sc chng li. Cc bnh nhim trng c hi ny l nguyn nhn t vong chnh ngi mc AIDS. HIV cng nhim vo cc t bo no, gy mt s ri lon thn kinh. Trc y vic mt ngi chuyn sang giai on AIDS hay cha c xc nh da trn cc bnh c hi v cc biu hin ca chng ngi nhim HIV. Ngy nay, chn on da vo vic m s lng t bo CD4+, iu ny cho php a ra chn on sm hn.
Ngun gc ca HIV
HIV, mt retrovirus, c lin h cht ch vi cc virus gy suy gim min dch kh (SIV, simian immunodeficiency virus). SIV l cc lentivirus, cng nh HIV, ang gy ni dch nhiu loi kh ti Chu Phi, tuy nhin phn ln chng khng c triu chng. Hu ht cc nh khoa hc tin rng mt hoc nhiu SIV ly truyn t sinh vt khc sang loi ngi vo khong u th k 20. Kho st tin hnh nm 1999 ti i hc Alabama nhn thy rng HIV-1 rt ging SIV tinh tinh (SIVcpz). Ngun gc ng vt, thi gian v a im chnh xc ca s ly truyn (hoc tht s c bao nhiu ly truyn) hin vn cha r v l ti cho cc cuc kho st v tranh lun. Cng c th c ngi v tinh tinh nhim t mt ngun th ba. Ngy nay, tnh hnh nhim HIV trn lan hn vi nguyn nhn a dng hn, bao gm:
ng tnh luyn i nam Ngi c nhiu bn tnh (quan h tnh dc ba bi) Gi mi dm Dng chung kim chch, nghin ma ty Ngi c sn cc bnh ly lan qua ng tnh dc khc Ngi c quan h tnh dc vi nhng ngi c cc nguy c trn
Khi nhng ngi nhim virus - nhng cha c triu chng - di chuyn, virus ny lan t thnh ph ny sang thnh ph khc; hn th na, cc khch hng khng mang virus ny ti cc lc a khc. Hung th gy nn bnh AIDS l virus Human immunodeficiency virus, gi tt l HIV. c t bnh ny v cng nh, u mi kim c th cha c mi su nghn con. Mc d nh nh th nhng n li c sc st thng rt mnh i vi h thng min dch ca con ngi v cui cng ph tan h thng min dch c t bnh AIDS thng qua hnh vi gii tnh khng an ton ca con ngi hoc kim tim b nhim m i vo tnh mch, thm nhp vo c th. Mc tiu u tin m n cng kch l t bo lympho T c tnh b tr (T - helper cell). T bo lympho T c tnh b tr ng mt vai tr v cng quan trng trong h thng min dch ca c th. N l cht lm hi ha, c th truyn tn hiu ha hc kch thch c th sn sinh ra khng th chuyn dng chng li vi khun xm nhp. N cn c th khng ch s pht trin ca my loi t bo khc trong h thng min dch. Nhng ht c t bnh AIDS sau khi xm nhp vo c th s cng vi nucleoxit v axit nucleic hp thnh RNA. Trn RNA mang y thng tin di truyn ca ht c t bnh. S kt hp ny c tnh chuyn nht rt mnh, ging nh mt cha kha ch c th m c mt kha, phi hp rt nghim ngt vi nhau. Mt khi c t kt hp vi th th th iu ng s s xy ra. c t
bnh cho RNA xm nhp vo trong t bo lympho T c tnh b tr, thng qua men ghi nh chuyn RNA thnh DNA, hp li vo trong DNA ca t bo lympho T. c t bnh DNA sau khi i vo t bo lympho T s nm im , c th nm im trong mt thi gian di. Nhng vo mt dp no , khi h thng min dch ca c th c kch hot chng li loi vi khun no mi xm nhp, t bo lympho T b cm nhim bn sinh si ny n, t m sn sinh ra v s ht c t bnh AIDS. Nhng ht c t ny s c gii phng ra khi cc t bo lympho T. Mt mt, chng git cht mt lng ln t bo T, lm cho phng tuyn th nht ca h thng min dch tan r; mt khc, n tip tc cng kch cc loi t bo khc ca h thng min dch, cui cng ph hy trit h thng ny, khin cho c th mt i kh nng min dch. Trong thc t, bnh AIDS c tn gi chnh thc l "chng thiu min dch tng hp". Chnh v n c th ph hy h thng min dch ca c th cho nn mi c tn gi nh th.
Cu to virus HIV
HIV c c im chung ca h retroviridae. Ht virus hon chnh (virion) c cu trc gm 3lp. - Lp v ngoi (v peplon): lp ny l 1 mng lipid kp c khng nguyn cho vi mng nguyn sinh cht t bo. Gn ln mng ny l cc nh. l cc phn t Glycoprotein c trng lng phn t 160 kilodalton (gp160). N gm c 2 phn: + Glycoprotein mng ngoi c trng lng phn t l 120 kilodalton (gp120). GP120 l khng
nguyn bin i nht, gy kh khn cho phn ng bo v c th v ch vacxin phng bnh. + Glycoprotein: xuyn mng c trng lng phn t 41 kilodalton. - V trong (v capsid): v ny gm 2 lp protein: + Lp ngoi hnh cu, cu to bi protein c trng lng phn t 18 kilodalton (p18). + Lp trong hnh tr, cu to bi cc phn t c trng lng phn t l 24 kilodalton (p24). y l khng nguyn rt quan trng chn on nhim HIV/AIDS. - Li: L nhng thnh phn bn trong ca v capsid, bao gm: + Hai phn t ARN n, l b gen di truyn HIV(genom). Genom ca HIV cha 3 gen cu trc: Gag (group specific antigen) l cac gen m ho cho cc khng nguyn c hiu ca capsid ca virus; Pol (polymerase) m ho cho cc Enzym: reverve transcriptase (RT:Enzym sao m ngc), protease v endonuclease (cn gi khng nguyn integrase); v EnV (envelop) m ho cho glycoprotein lp v peplon ca HIV
X t nghim HIV
Xt nghim HIV l xt nghim xem c khng th chng li vi rt HIV hay khng. Cc xt nghim khng th chnh c s dng pht hin s c mt ca vi rt HIV trong c th l xt nghim ELISA v xt nghim Western Blot. Mt ngi sau khi b nhim HIV thng s mt t 3 n 6 thng c th sn xut ra khng th chng li vi rt. y chnh l thi k ca s; tc thi k vi rt mi xm nhp vo c th. giai on ny, ngi nhim HIV s khng c bt k triu chng g. mt s trng hp khc, sau khong t 2 n 8 tun hay thm ch lu hn, ngi nhim HIV c th c mt vi triu chng nh st, ra m hi, au u, au c, ho khan, mch mu c v nch sng ph, v da try xc.
Nu xt nghim vo thi im ny tm s c mt ca khng th HIV th kt qu c th s l m tnh (HIV-), tuy nhin ngi nhim HIV ny vn c th lm ly truyn sang ngi khc. Thi k ca s c th ko di t 3 n 6 thng. Do vy mt xt nghim c tin hnh trong thi k ca s c th c kt qu m tnh gi. Ch nhng xt nghim c tin hnh su thng k t ngy c quan h tnh dc khng c bo v (khng s dng bao cao su ng cch) hoc dng chung kim tim th mi c th chc chn khng th c xut hin hay khng. Giai on nhim bnh khng c triu chng: Nu xt nghim tm khng th HIV, kt qu xt nghim c th s l dng tnh. Ngi nhim HIV giai on ny, giai on c th ko di t nm n 10 nm, khng c biu hin bnh no c. Trong giai on ny, mt s chng bnh c th rt ngn giai on chuyn ho huyt thanh v y nhanh sang giai on AIDS. Giai on AIDS: xut hin cc triu chng lm sng ch yu chun on c chnh xc AIDS. Nhng triu chng ny bao gm cc nhim trng c hi v ung th, m kt cc dn n t vong.
iu tr v vaccine
Hin ti khng c vaccine no phng nga ly nhim HIV, v cng khng c mt liu php no c th loi b hon ton vi-rt HIV ra khi c th. Tuy nhin, nhng ngi sng chung vi AIDS hin nay c th ko di v ci thin cht lng cuc sng bng liu php iu tr khng virt, hay cn gi l ART (vit tt ca Anti- Retroviral Therapy). ART l liu php iu tr s dng cc thuc khng vi-rt, hay cn gi l thuc ARV (Anti-retrovirus). Cc thuc ARV ny c tc dng lm chm s nhn ln ca HIV trong c th, do tng kh nng min dch v t mc cc nhim trng c hi. La chn iu tr l tng hin ti bao gm cc kt hp ("cocktail") hai hay nhiu loi thuc khng retrovirus nh hai cht c ch reverse transcriptase ging nucleoside (nucleoside analogue reverse transcriptase inhibitor, NRTI), v mt cht c ch protease hoc mt cht thuc c ch reverse transcriptase non-nucleoside (non-nucleoside reverse transcriptase inhibitor, NNRTI). Vi iu tr nh vy, kt qu cho thy HIV khng pht hin c (m tnh) lp i lp li nhiu ln, nhng nu ngng iu tr lng virus trong c th s tng nhanh chng. Cng c lo ngi cui cng s xut hin khng thuc vi phc . Nhng nm gn y thut ng "iu tr khng retrovirus tch cc cao" (highly-active anti-retroviral therapy, HAART) thng c dng ch cch thc iu tr ny. Tuy nhin, iu khng may l phn ln s ngi bnh trn th gii khng tip cn c cc iu tr HIV v AIDS. Hin ang c cc nghin cu tm vc-xin nga HIV v pht trin thuc mi khng retrovirus. Cng ang c mt s th nghim ngi. Liu php gene c ngh l bin php kh thi ngn nga hoc iu tr nhim HIV. VRX496, mt thnh phn di truyn c vai tr c ch HIV (c bit kiu tr liu i m (antisense therapy)) c lentivirus b bin i, ang c th nghim lm sng pha I nm 2003ln u tin dng vector lentivirus trn ngi. Nghin cu nhm ci thin cc iu tr ang c bao gm gim tc dng ph ca thuc, n gin ho phc tng mc tun th v xc nh trnh t iu tr tt nht trnh khng thuc. K t khi AIDS c cng ng thc, nhiu phng thc y hc thay th c dng iu tr triu chng. Trong thp k u tin khi cha c bin php iu tr hu hiu, nhiu bnh nhn AIDS dng nhiu loi iu tr thay th nh mt-xa, tho dc v chm cu. Khng bin php no trong s cho thy hiu qu thc s hoc lu di trn virus cc th nghim c kim sot, nhng chng c l nng cao cht lng sng cho bnh nhn. Hin chng c dng phi hp vi iu tr quy c ci thin triu chng, nh au, n mt ngon... Chng vn c s dng n thun bi nhng ngi tin rng AIDS khng phi do HIV gy ra.
Thc Trng
Ton tnh hin nay c hn 7200 ngi nhim HIV/AIDS, chim trn 0.3% dn s. Tuy nhin, s ca nhim ang gim dn qua cc nm. Nm 2008, ton tnh pht hin 485 ca nhim mi, gim so vi thi im cao nht l nm 2005 vi 1179 ca. Trong nm 2008, thc hin 6/9 mc tiu phng, chng HIV/AIDS ra. Trong tiu biu nh: chng trnh gio dc truyn thng thay i hnh vi thng qua cc chng trnh chiu phim, ca nhc, ni chuyn chuyn , ti liu pht
trc tip tuyn truyn v kin thc HIV/AIDS cho cng nhn, ngi dn; chng trnh can thip gim thiu tc hi: pht bao cao su, pht v thu hi bm kim tim cho cc i tng nguy c; qun l v iu tr cc bnh ly qua ng tnh dc Theo , mc tiu ca d n trong nm 2009 s l tip tc thc hin truyn thng thay i hnh vi cho hn 10.000 cng nhn; phn u 85% gi mi dm, ngi s dng ma ty c tip cn truyn thng trc tip, s dng bm kim tim sch v bao cao su; m bo 100% x, phng trin khai d n c gim st h tr theo di v nh gi; gim t l ly nhim cc bnh qua ng tnh dc trong gi mi dm t 50% xung cn 40%; chm sc v iu tr bnh nhn nhim trng c hi; tng cng trang thit b, kinh ph cho 6 phng VCT ca 4 huyn v thnh ph; tng cng nng lc cn b v hp tc quc t.