The fight against HIV/AIDS: new strategies and achievements

The fight against HIV/AIDS: new strategies and achievements

I. Understanding HIV/AIDS: Fundamentals and relevance

1. Human immunodeficiency virus (HIV): mechanism of action and life cycle. HIV belongs to a group of retroviruses characterized by the ability to embed their genetic information in the DNA of the host cell. The virus selectively affects CD4+ T-lymphocytes that play a key role in the immune system. The life cycle of HIV includes several stages: attaching the virus to the host cell (adsorption), penetration into the cell, reverse transcription of viral RNA into DNA using the enzyme reverse transcriptase, integration of viral DNA into the genome of the host of the hoste, transcription of viral DNA, assembly of viral particles and excretion Mature virions from a cage. Each of these stages is a potential target for antiretroviral therapy (art).

2. Acquired immunodeficiency syndrome (AIDS): determination, development stages and clinical manifestations. AIDS is the final stage of HIV infection, characterized by deep inhibition of the immune system and the development of opportunistic infections, malignant neoplasms and other serious diseases. The stages of HIV infection are classified depending on the level of CD4+ T-lymphocytes and the presence/absence of certain clinical manifestations. The clinical manifestations of AIDS are diverse and include pneumocystal pneumonia, candidiasis of the esophagus, tuberculosis, Kaposhi sarcoma, cytomegalovirus infection, brain toxoplasmosis and others. The diagnosis of AIDS is made with a decrease in the level of CD4+ T-lymphocytes below 200 cells/μl or in the presence of one of certain opportunistic diseases.

3. HIV/AIDS epidemiology: global trends and regional features. The global HIV/AIDS epidemic remains a serious problem of public health, although in recent decades significant successes have been achieved in prevention and treatment. According to Unaids, in the world there are about 38 million people living with HIV. The most affected regions are Africa countries south of Sahara, where more than half of all people living with HIV live. In Eastern Europe and Central Asia, there is an increase in new cases of HIV infection, especially among injecting drugs. In Western Europe and North America, the HIV epidemic is better controlled by wide access to art and effective prevention programs.

4. Risk factors for HIV infection: transmission paths and high risk groups. HIV is transmitted sexually, through the blood (when transfusing blood, using common needles for injection, applying tattoos with non -sterile instruments) and from mother to pregnancy, childbirth or breastfeeding. Groups of increased risk of HIV infection include persons practicing unprotected sex, injecting drugs, sex business workers, men with men with men (MSM), as well as persons who have transplanted blood or transplanted the organs before the introduction of HIV screening.

5. Social and economic consequences of HIV/AIDS: Stigma, discrimination and burden of diseases. HIV/AIDS has a significant impact on the social and economic spheres. Stigma and discrimination against people living with HIV (LZHV) lead to isolation, loss of work and restricting access to education and medical services. HIV/AIDS is also a burden for health and economy systems, especially in countries with disabilities. The fight against HIV/AIDS requires an integrated approach that includes prevention, treatment, care and support for lves, as well as the fight against stigma and discrimination.

II. Modern strategies for HIV prevention

1. Propaganda of safe sex: educational programs and condom distribution. Propaganda of safe sex remains the cornerstone of HIV prevention. Educational programs aimed at increasing awareness of HIV transmission routes and protection methods should be available to all segments of the population, especially for young people and high -risk groups. The spread of condoms is an effective way to reduce the risk of HIV infection in sexual contacts. It is important to ensure wide access to condoms, including free distribution in public places and medical institutions.

2. Prevention of HIV transmission from mother to child (PPMR): testing, art during pregnancy and childbirth, alternative feeding methods. The PPMR is one of the most successful directions for the fight against HIV/AIDS. Pregnant women testing on HIV allows you to timely identify infected and start art. Art during pregnancy and childbirth significantly reduces the risk of HIV transfer from mother to child. Alternative feeding methods, such as artificial feeding, eliminate the risk of HIV transmission through breast milk. Thanks to the complex approach of the PPMR, it allows you to minimize the risk of HIV transmission from mother to child.

3. Post -contact prevention (PCP): the use of art after potential infection. The PKP is an emergency measure of HIV prevention, which consists in the use of art after potential HIV infection, for example, with a random needle or insecure sexual contact. The PCP should be started as soon as possible after potential infection, preferably within 72 hours. The duration of the course of the PKP is 28 days. The effectiveness of the PKP depends on the start time, compliance with the regime of taking drugs and individual risk factors.

4. Pre -contact prevention (DCP): the use of art to prevent infection in people with high risk. DCP is a relatively new and promising area of ​​HIV prevention. DCP is the use of art persons with a high risk of HIV infection to prevent infection in case of contact with the virus. DCP showed high efficiency in reducing the risk of HIV infection, especially among MSM practicing unprotected sex, and people with HIV-infected partners. DCP requires regular medical observation and testing for HIV.

5. Harm reduction programs: needles and syringes, replacement therapy for injecting drugs. Damage reduction programs are aimed at reducing the risk of HIV infection and other infections transmitted through blood, among injecting drugs. These programs include the provision of sterile needles and syringes, replacement therapy (for example, a methadone or buprenorphine), consultation and testing for HIV and other infections. Damage reducing programs have proven their effectiveness in reducing the spread of HIV among injectable drug consumers.

6. HIV testing: access expansion and innovative approaches (self -testing). Expanding access to HIV testing is a key element of the fight against the epidemic. It is important that HIV testing is available, confidential and free. Innovative approaches, such as self -testing on HIV, make it possible to expand the coverage of testing, especially among population groups, which are difficult to cover with traditional methods. Self -testing for HIV allows people to independently test at a convenient time for them and in a confidential setting.

III. Achievements in antiretroviral therapy (art)

1. The main classes of antiretroviral drugs: the mechanism of action and side effects. The art includes several classes of drugs, each of which affects a certain stage in the HIV life cycle. The main classes of art include: reverse transcriptase inhibitors (nucleoside and non -acleoside), protease inhibitors, integral inhibitors, CCR5 inhibitors and mergers. Each class of drugs has its advantages and disadvantages, as well as specific side effects. The choice of art should be carried out individually, taking into account the clinical condition of the patient, the viral load, resistance of the virus and related diseases.

2. Modern art schemes: efficiency, tolerance and ease of use. Modern art schemes are of high efficiency, good tolerance and ease of use. Most modern art schemes include a combination of three or more drugs from different classes. Many art schemes are available in the form of single -term modes, which simplifies the observance of the drug administration. Modern art schemes allow you to achieve and maintain an uncertain viral load in most patients, which significantly improves their quality and life expectancy, and also prevents the transfer of HIV to other people (the concept “uncertain = not transmitting” (n = n)).

3. Concept “Uncertain = Non -Transmitting” (H = H): Scientific evidence and influence on Stigma. The concept of H = N is a revolutionary achievement in the fight against HIV/AIDS. Scientific studies have convincingly proved that people living with HIV and having an uncertain viral load due to the art do not transmit HIV -sexually. The concept of H = N is of great importance for reducing stigma and discrimination against lobes, as well as to increase motivation for testing and treatment of HIV.

4. Problems of resistance to art: risk factors, diagnosis and strategies for overcoming. Art resistance is a serious problem that can reduce the effectiveness of treatment and lead to the progression of HIV infection. The risk factors for the development of resistance to the art include non -compliance with the drug administration, dose passes and the presence of resistance mutations in the virus. Diagnosis of resistance to art is carried out by analyzing the genotype of the virus. Strategies for overcoming resistance to art include a change in the art scheme, the use of drugs with another mechanism of action and increasing adherence to treatment.

5. Long-term effects of art: cardiovascular diseases, renal failure, osteoporosis and others. Although the art has significantly improved the quality of life and life expectancy of lies, it can also be associated with long-term side effects, such as cardiovascular diseases, renal failure, osteoporosis and neurocognitive disorders. It is important to carry out regular monitoring of the health status of LZhs located on the art for the timely detection and treatment of these complications.

6. Development of new antiretroviral drugs: innovative approaches and prospects. The development of new antiretroviral drugs is a continuous process aimed at creating more effective, safe and convenient in the use of drugs. Innovative approaches in the development of art include the development of long -acting drugs that can be administered less often (for example, once a month or once every two months), drugs that affect new targets in the HIV life cycle, and immunotherapeutic strategies aimed at stimulating the immune response against HIV.

IV. Clinical aspects of HIV-infected patients

1. Diagnosis of HIV infection: modern testing methods and interpretation of results. Diagnosis of HIV infection includes several stages: a screening test (for example, ELISA) and a confirming test (for example, immunoblot or PCR). Modern HIV testing methods allow you to identify HIV infection in the early stages. It is important to correctly interpret the results of HIV tests, given the possible false positive and false negative results.

2. HIV monitoring: viral load, CD4+ T-lymphocytes and other indicators. HIV monitoring includes a regular measurement of the viral load (the number of cops of HIV RNA in blood plasma) and the level of CD4+ T-lymphocytes. The viral load is an indicator of the activity of the virus, and the level of CD4+ T-lymphocytes reflects the state of the immune system. Other indicators that can be used to monitor HIV infection include a general blood test, a biochemical blood test, a lipid profile and renal and liver function.

3. Treatment of opportunistic infections: prevention and therapy. Opportunistic infections are a serious problem for falsehoods, especially in the later stages of HIV infection. It is important to prevent opportunistic infections, for example, vaccination against pneumococcal infection and influenza, as well as preventive treatment against pneumocystal pneumonia and toxoplasmosis. Treatment of opportunistic infections should be started as soon as possible after diagnosis.

4. Treatment of concomitant diseases: tuberculosis, hepatitis, cardiovascular diseases and others. Lzhzhv often suffers from concomitant diseases, such as tuberculosis, hepatitis, cardiovascular diseases and malignant neoplasms. The treatment of concomitant diseases should be complex and take into account the features of the interaction of drugs. It is important to screening for related diseases and begin treatment in the early stages.

5. Psychological support and counseling: increasing adherence to treatment and improving the quality of life. Psychological support and counseling play an important role in the management of LZHVs. Psychological support helps lhvs cope with the emotional problems associated with HIV infection, increase the commitment to treatment and improve the quality of life. Consulting helps LZHV receive information about HIV infection, ways to protect against infection and treatment and care opportunities.

6. Care and support of lies: social adaptation and rehabilitation. Care and support of lies include social adaptation and rehabilitation. It is important to provide false access to social services, such as housing, food and legal assistance. Rehabilitation helps lhv to return to a full life, find a job and restore social ties.

V. New areas of HIV/AIDS research

1. Development of a vaccine against HIV: immunogens, vectors and clinical trials. The development of an effective HIV vaccine is one of the main tasks in the fight against the epidemic. Studies in the development of HIV vaccine are aimed at creating immunogens, which can cause a wide and prolonged immune response against HIV. Different types of vaccines are developed, including subsidiary vaccines, vector vaccines and DNA vaccines. Clinical tests of HIV vaccines continue all over the world.

2. Development of methods of cure for HIV: strategies of “sterilization” and “functional” cure. The development of HIV cure methods is another important task in the fight against the epidemic. Strategies of “sterilization” of the cure are aimed at completely removing HIV from the body, including latent virus tanks. The strategies of the “functional” cure are aimed at control of HIV without art, by stimulating the immune response or blocking the virus replication. Studies in the field of HIV cure include the use of genetic therapy, immunotherapy and drugs aimed at the latent tanks of the virus.

3. HIV immunotherapy: activation of the immune response and neutralization of the virus. Immunotherapy is a promising direction in the treatment of HIV infection. Immunotherapeutic strategies are aimed at activating an immune response against HIV and neutralization of the virus. Various immunotherapeutic approaches are developed, including therapeutic vaccines, immune control points and a wide range antibodies.

4. General HIV therapy: editing the genome and blocking the virus replication. Gene therapy is another promising direction in the treatment of HIV infection. Genetotherapy strategies are aimed at editing the cells of the cells infected with HIV, and the blocking of the virus replication. Various genetotherapeutic approaches are being developed, including editing CCR5 (HIV coil), the introduction of genes encoding antibodies against HIV, and the use of CRISPR-CAS9 technology to remove HIV from the cell genome.

5. Studies in the field of stigma and discrimination: development of effective interventions. Stigma and discrimination against lies are a serious obstacle in the fight against the epidemic. It is important to conduct research in the field of stigma and discrimination for the development of effective interventions aimed at reducing stigma and discrimination. These interventions should be aimed at increasing the awareness of HIV, a change in the attitude to LZHVs and the creation of a favorable social environment for lies.

VI. Organizational and political aspects of the fight against HIV/AIDS

1. The role of international organizations (UNAIDS, WHO) in the fight against HIV/AIDS. International organizations, such as Unaids and WHO, play a key role in the fight against HIV/AIDS. Unaids coordinates global efforts to combat the epidemic and provides technical assistance to countries. WHO is developing recommendations for the prevention, treatment and care of lies and provides support to the countries in the implementation of these recommendations.

2. National HIV/AIDS fighting programs: structure, financing and effectiveness. National HIV/AIDS programs are the basis for the fight against the epidemic in every country. It is important that national HIV/AIDS programs are well structured, adequately funded and are effective. National HIV/AIDS programs should include prevention, testing, treatment, care and support for lves, as well as the fight against stigma and discrimination.

3. The role of the civil society and communities of LZhs in the fight against HIV/AIDS. Civil society and the communities of LZHVs play an important role in the fight against HIV/AIDS. They provide services for the prevention, testing, care and support of LZHVs, and also defend the rights of LZHV. It is important to maintain and expand the participation of civil society and LZhov communities in the fight against HIV/AIDS.

4. Financing the fight against HIV/AIDS: sources of financing and resource distribution problems. Financing the fight against HIV/AIDS is critical for achieving the goals of the fight against the epidemic. Sources of financing the fight against HIV/AIDS include state budgets, international donor organizations and private donations. It is important to effectively distribute resources to ensure access to prevention, testing, treatment and care for everyone who needs it.

5. Political and legal aspects of the fight against HIV/AIDS: Protection of LZHV rights and the fight against discrimination. Political and legal aspects play an important role in the fight against HIV/AIDS. It is important to protect lies and fight discrimination. Laws and politics should be aimed at ensuring the access of lves to medical services, education, employment and other rights.

6. Integration of HIV/AIDS programs into the healthcare system: advantages and problems. The integration of HIV/AIDS programs into the healthcare system has many advantages, such as increasing efficiency, reducing stigma and improving services coordination. However, the integration of HIV/AIDS programs can also face problems, such as lack of resources, a lack of qualified personnel and the lack of coordination between various services.

VII. Calls and prospects in the fight against HIV/AIDS

1. The uneven access to art: geographical differences and socio-economic factors. Despite significant successes in expanding access to art, the uneven access to art remains a serious problem. Geographical differences and socio-economic factors affect access to art. It is important to overcome these barriers to ensure equal access to art for everyone who needs it.

2. Stigma and discrimination: their influence on testing, treatment and prevention. Stigma and discrimination continue to have a negative impact on testing, treatment and prevention of HIV infection. It is important to deal with stigma and discrimination by conducting educational campaigns, changing the attitude to lobes and creating a favorable social environment for lies.

3. Prevention of new cases of HIV infection: achievement of the goals of Unaids 95-95-95. Unaids set a goal 95-95-95: 95% of people living with HIV should know their HIV status; 95% of people who know their HIV status should receive art; And 95% of people receiving art should have an uncertain viral load. Achieving these goals will require significant efforts to expand access to testing, treating and prevention of HIV infection.

4. Resistance to drugs: the need to develop new drugs and treatment strategies. Resistance to drugs is a serious threat to the effectiveness of art. It is important to develop new drugs and treatment strategies to overcome resistance to drugs. This will require significant investments in research and development.

5. The aging of the population living with HIV: new problems and strategies of management. The population living with HIV is aging that it creates new problems and requires new management strategies. It is important to take into account the characteristics of the health of older people living with HIV and develop adapted care and support programs.

6. The future of the fight against HIV/AIDS: achieving the goals of sustainable development and the cessation of the epidemic. The future of the fight against HIV/AIDS is associated with the achievement of sustainable development goals and the cessation of the epidemic. This will require an integrated approach, which includes prevention, testing, treatment, care and support of lobes, as well as the fight against stigma and discrimination. It is important to continue to invest in research and development to create new and effective methods of prevention and treatment of HIV infection.

VIII. Technology and innovation in the fight against HIV/AIDS

1. Telemedicine and mobile technologies: expanding access to medical services. Telemedicine and mobile technologies can significantly expand access to medical services for LZhv, especially in remote and rural areas. Telemedicine allows doctors consultations, monitoring of health status and the provision of drugs remotely. Mobile applications can be used to increase adherence to treatment, provide information about HIV infection and support lobe.

2. Artificial intelligence and machine learning: improving diagnostics and forecasting the results of treatment. Artificial intelligence and machine learning can be used to improve the diagnosis of HIV infection and predict treatment results. For example, artificial intelligence can analyze patient data to identify risk factors for the development of complications and determine the optimal scheme of art.

3. Big data and data analysis: identification of trends and development of effective strategies. Big data and data analysis can be used to identify trends in the HIV/AIDS epidemic and develop effective prevention and treatment strategies. For example, data analysis can help determine the groups of the population that are most at risk of HIV infection and develop targeted prevention programs.

4. Nanotechnologies: Development of new drugs and drug delivery methods. Nanotechnologies can be used to develop new drugs against HIV and drug delivery methods that will increase the effectiveness of treatment and reduce side effects. For example, nanoparticles can be used to deliver drugs directly to cells infected with HIV.

5. Biomarkers and diagnostics: Early detection of HIV infection and forecasting the progression of the disease. Biomarkers and diagnostics play an important role in the early detection of HIV infection and predicting the progression of the disease. It is important to develop new and more sensitive biomarkers and diagnostic tests to improve early diagnosis of HIV infection and determine the risk of complications.

IX. Ethics and human rights in the fight against HIV/AIDS

1. Confidentiality and protection of personal data: ensuring the rights of lies. Privacy and protection of personal data are the fundamental principles of ethics in the fight against HIV/AIDS. It is important to ensure the rights of falsehoods to confidentiality and protection of personal data in order to prevent discrimination and stigmatization.

2. Voluntary testing and counseling: the right to informed choice. Voluntary testing and counseling are key elements of the fight against HIV/AIDS. It is important to ensure the right of each person to voluntary testing and counseling so that people can make informed decisions about their health.

3. Nediscrimination and equal access to medical services: Ensuring the rights of LZHV. Nediscrimination and equal access to medical services are the fundamental rights of lies. It is important to ensure that LZHV has equal access to medical services, education, employment and other rights.

4. Participation of LZHV in decision -making: taking into account the opinion of the community. The participation of LZHVs in making decisions regarding the fight against HIV/AIDS is an important principle of ethics. It is important to take into account the opinion of the LZH community in the development and implementation of programs to combat HIV/AIDS.

5. Reproductive rights LZHV: the right to create a family and safe motherhood. LZHV have the right to create a family and safe motherhood. It is important to provide false access to information and services that will help them make informed decisions about their reproductive health.

6. The right to access information about HIV/AIDS: increased awareness and decrease in stigma. Everyone has the right to access information about HIV/AIDS. It is important to increase the awareness of HIV/AIDS and reduce the stigma by conducting educational campaigns and the dissemination of information.

X. Case Stadi and the best practices in the fight against HIV/AIDS

1. Successful HIV/AIDS prevention programs in different countries of the world. The study of successful HIV/AIDS prevention programs in different countries of the world allows you to identify the best practices and adapt them to other contexts. For example, the program for the prevention of HIV transmission from mother to child in Brazil is one of the most successful in the world.

2. Innovative models for the provision of medical care for lyges. The study of innovative models for the provision of medical assistance allows you to identify effective ways to improve the quality of medical care and expand access to medical services. For example, a model for the provision of medical assistance, based on the principle of a “patient in the center”, has proven its effectiveness in increasing the adherence to treatment and improving the results of treatment.

3. Successful strategies for the fight against stigma and discrimination. The study of successful strategies for the fight against stigma and discrimination allows you to identify effective ways to reduce stigma and discrimination against lobes. For example, educational campaigns aimed at increasing the awareness of HIV and a change in attitudes towards lobes have proven their effectiveness in reducing stigma and discrimination.

4. Examples of effective partnership between state, private and public sectors. Studying examples of effective partnership between the state, private and public sectors allows us to identify ways to improve the coordination of efforts and achieve common goals in the fight against HIV/AIDS. For example, a partnership between the Government of South Africa and private healthcare companies made it possible to significantly expand access to art.

5. Lessons extracted from the fight against HIV/AIDS: what works and what is not. An analysis of the lessons extracted from the fight against HIV/AIDS avoids repetition of errors and focus on those strategies that have proven their effectiveness. For example, experience in combating HIV/AIDS showed that prevention investments are more effective than investment in treatment.

6. Global initiatives and goals: achievement of progress and overcoming obstacles. The study of global initiatives and goals in the fight against HIV/AIDS allows you to evaluate the progress achieved in the fight against the epidemic, and to identify obstacles that must be overcome to achieve the goals of sustainable development. For example, Unaids set a goal to stop the AIDS epidemic by 2030. Achieving this goal will require significant efforts to expand access to the prevention, testing, treatment and care for everyone who needs it.