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"lead": "Область медицины, включающая в себя лечение 354 заболеваний. В 378 клиниках России оказывается помощь по этому направлению медицины.",
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"lead": "Нарушение здоровья, относящееся к группе болезнь, вызванная вирусом иммунодефицита человека [вич]",
"description": "ВИЧ-инфекция представляет собой заболевание, вызываемое вирусом иммунодефицита человека, характеризующееся синдромом приобретенного иммунодефицита, способствующего возникновению вторичных инфекций и злокачественных образований в связи с глубоким угнетением защитных ",
"etiology": "<p>ВИЧ-инфекцию вызывает вирус иммунодефицита человека, относящийся к семейству ретровирусов. </p>\r\n<p>ВИЧ – нестойкий вирус. Быстро погибает вне организма носителя, чувствителен к воздействию температуры (снижает инфекционные свойства при температуре 56 °С, погибает через 10 минут при нагревании до 70-80 °С). Хорошо сохраняется в крови и ее препаратах, подготовленных для переливания. Антигенная структура вируса весьма изменчива. </p>\r\n<p>Резервуаром и источником ВИЧ-инфекции является человек: страдающий СПИД и носитель. Вирус содержится в высоких концентрациях в крови, сперме, секрете вагинальных желез и менструальных выделениях. Может выделяться из женского молока, слюны, слезного секрета и ликвора, но эти биологические жидкости представляют меньшую эпидемиологическую опасность. </p>",
"pathogenesis": "<p>ВИЧ поражает клетки крови человека, имеющие на своей поверхности CD4-рецепторы: Т-лимфоциты, макрофаги и дендритные клетки. Инфицированные вирусом Т-лимфоциты гибнут из-за разрушения вирусом, апоптоза или уничтожения цитотоксическими Т-лимфоцитами. После того, как число CD4+ T-лимфоцитов становится ниже 200 в одном микролитре крови, система клеточного иммунитета перестает защищать организм </p>\r\n<p>Первое время организм компенсирует массовую гибель иммунных клеток, вырабатывая новые, со временем компенсация становится недостаточной, количество лимфоцитов и макрофагов в крови значительно снижается, иммунная система разрушается, организм становится беззащитен как по отношению к экзогенной инфекции, так и к бактериям, населяющим органы и ткани в норме (что ведет к развитию оппортунистических инфекций). Кроме того, нарушается механизм защиты от размножения дефектных бластоцитов - злокачественных клеток. </p>\r\n<p>Заселение вирусом иммунных клеток часто провоцирует различные аутоиммунные состояния, в частности характерны неврологические расстройства в результате аутоиммунного поражения нейроцитов, которые могут развиться даже раньше, чем проявится клиника иммунодефицита. </p>\r\n<p> </p>",
"diagnostics": "<p>В настоящее время существуют следующие методы диагностики ВИЧ: косвенные тесты позволяют обнаружить специфические антитела к ВИЧ, которые имеются почти у 100 % ВИЧ-инфицированных; прямые тесты определяют собственно ВИЧ, антигены ВИЧ или нуклеиновые кислоты ВИЧ (вирусная нагрузка). </p>\r\n<p>Вирусную нагрузку(число молекул геномной РНК ВИЧ в мл крови) напрямую связывают со скоростью снижения количества CD4+ лимфоцитов, эта характеристика является важным прогностическим показателем на ранних стадиях заболевания </p>\r\n<p>Для определения антител к ВИЧ, необходимо использовать, по крайней мере, два разных теста: предварительный тест (скрининг-тест) и подтверждающий тест. Большинства современных скрининг-тестов основываются на иммуноферментом анализе (ИФА) или сходных методах; они обладают высокой чувствительностью (до 99 %) и специфичностью (до 99,5 %). </p>\r\n<p>Методы экспресс-анализа основаны на методах реакция агглютинации, ИФА на полимерных мембранах (тест-полоски), иммунологическом фильтрационном анализе и иммунохроматографии. Экспресс-тесты дают результат в течение 15—30 минут. </p>\r\n<p>Подсчёт CD4+ лимфоцитов является критическим параметром в мониторинге ВИЧ-инфекции и позволяет оценивать состояние иммунной системы и склонность к развитию СПИД. </p>\r\n<p>Для подтверждения предполагаемого диагноза необходимо исследование клеточного субстрата опухоли. С этой целью выполняются диагностические операции: пункционная или эксцизионная биопсия, лапароскопия, торакоскопия, пункция костного мозга с последующими иммуногистохимическими, цитологическими, цитогенетическими и другими исследованиями диагностического материала. </p>\r\n<p>Увеличение медиастинальных и внутрибрюшных лимфоузлов обнаруживается с помощью УЗИ средостения, рентгенографии и КТ грудной клетки, брюшной полости. В алгоритм обследования по показаниям входят УЗИ лимфатических узлов, печени, селезенки, молочных желез, щитовидной железы, органов мошонки и др.; лимфосцинтиграфия, сцинтиграфия костей и внутренних органов, МРТ. </p>",
"treatment": "<p>Варианты лечения онкологических заболеваний при ВИЧ-инфекции включают оперативный метод, лучевую терапию и химиотерапию; их выбор определяется морфологическим типом, распространенностью, локализацией опухоли, сохранностью и возрастом больного. </p>\r\n<p>Лечение онкологических заболеваний включает лечение основного заболевания. До настоящего времени не разработано лечения ВИЧ-инфекции, которое могло бы устранить вирус иммунодефицита человека из организма. Современная высокоактивная антиретровирусная терапия замедляет прогрессирование ВИЧ-инфекции и её переход в стадию СПИД, позволяя ВИЧ-инфицированному человеку жить полноценной жизнью. </p>\r\n<p>На сегодняшний день преимущественным этиотропным лечением является назначение препаратов, снижающих репродуктивные способности вируса. Антиретровирусную терапию следует начинать у пациентов с ВИЧ-инфекцией независимо от клинической стадии заболевания, при любом количестве клеток СД4, в том числе всем ВИЧ-инфицированным беременным женщинам. </p>\r\n<p>Лечение ВИЧ-инфицированных включает общеукрепляющие и поддерживающие организм средства (витамины и биологически активные вещества) и методики физиотерапевтической профилактики вторичных заболеваний. </p>",
"prevention": "<p>В настоящее время Всемирная организация здравоохранения проводит общие профилактические мероприятия по снижению заболеваемости ВИЧ-инфекцией по четырем основным направлениям: </p>\r\n<ul>\r\n<li>просвещение в вопросах безопасности половых отношений, распространение презервативов, лечение заболеваний, передающихся половым путем, пропагандирование культуры половых взаимоотношений; </li>\r\n<li>контроль над изготовлением препаратов из донорской крови; </li>\r\n<li>ведение беременности ВИЧ-инфицированных женщин, обеспечение их медицинской помощи и предоставление им средств химиопрофилактики (в последнем триместре беременности и в родах женщины получают антиретровирусные препараты, которые также на первые три месяца жизни назначаются новорожденным детям); </li>\r\n<li>организация психологической и социальной помощи и поддержки ВИЧ-инфицированных граждан, консультирование. </li>\r\n</ul>\r\n<p>В настоящее время в мировой практике особое внимание уделяют таким эпидемиологически важным в отношении заболеваемости ВИЧ-инфекцией факторам, как наркомания, беспорядочная половая жизнь. В качестве профилактической меры во многих странах производится бесплатная раздача одноразовых шприцов, метадоновая заместительная терапия. В качестве меры, способствующей снижению половой неграмотности, в учебные программы вводятся обучающие половой гигиене курсы. </p>\r\n<p> </p>",
"clinical_picture": "<p>К онкологическим заболеваниям, возникающим при СПИДе, относятся: саркома Капоши, инвазивный рак шейки матки, неходжкинская лимфома и лимфома центральной нервной системы. При синдроме приобретенного иммунодефиците высока вероятность развития рака прямой кишки, болезни Ходжкина, рака ротовой полости, опухолевых заболеваний кожи, рака легких и яичек. </p>\r\n<p>Саркома Капоши характеризуется образованием темно-фиолетовых и коричневых пятен (лезии), возникающих на разных участках тела, преимущественно на стопе, боковых поверхностях голени и поверхностях кистей. В редких случаях злокачественные новообразования возникают на слизистых оболочках и веках. </p>\r\n<p>Примерно у 5-10% больных СПИДом встречаются лимфомы. Неходжкинская лимфома – заболевание лимфоидной ткани, которое при прогрессировании может распространиться и на другие органы. Все проявления лимфосарком укладываются в три синдрома: увеличение лимфоузлов, лихорадки и интоксикации. </p>\r\n<p>У ВИЧ-инфицированных также встречаются и первичные лимфомы центральной нервной системы. Частыми симптомами первичной лимфомы ЦНС являются судороги, потеря памяти, паралич лицевого нерва, сонливость. </p>\r\n<p>У ВИЧ-позитивных женщин высока вероятность развития предракового состояния в шейке матки, которое со временем может перейти в инвазивный рак шейки матки, когда раковые клетки поражают глубокие слои шейки матки. Наиболее характерным проявлением рака шейки матки служат кровянистые выделения и кровотечения: межменструальные, постменопаузальные, контактные (после полового акта, осмотра гинекологом, спринцевания и т. д.), меноррагии. Больные отмечают появление белей - жидких, водянистых, желтоватого или прозрачного цвета влагалищных выделений, обусловленных лимфореей. При распаде раковой опухоли выделения принимают гноевидных характер, иногда имеют цвет «мясных помоев» и зловонный запах. </p>",
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