AIDS (Hi chng suy gim min dch mc phi, vit tt t Acquired Immune Deficiency Syndrome ca ting Anh,

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.

Hi chng suy gim min dch mc phi

Hi chng: nhm cc biu hin (triu chng) nh : st, tiu chy, st cn, ni hch... do mt cn bnh no gy ra. Suy gim min dch: H min dch l h thng phng ng bo v c th chng li cc mm bnh t ngoi xm nhp vo c th, suy gim min dch l tnh trng h min dch tr nn yu, gim hoc khng c kh nng chng li s tn cng ca cc tc nhn gy bnh. Mc phi: Khng do di truyn m do b ly nhim trong cuc sng AIDS c lu ln u tin nhng ngi n ng ng tnh luyn i v nhng ngi tim ma tu vo tnh mch vo thp nin 1980. Sang thp nin 1990 hi chng ny tr thnh mt dch ton cu v vo nm 2004 58 phn trm ngi b AIDS l ph n. Mc d nhng ngi ng tnh luyn i nam v nhng ngi gc Phi tip tc hng chu t l AIDS theo u ngi cao nht, phn ln nn nhn hin nay l nhng ngi d tnh luyn i nam v n, v tr em, cc nc ang pht trin. Bng thng k tui nhim HIV nm 2004

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.

Tuyn truyn phng chng HIV

Vacxin" hu hiu chn ng HIV/AIDS: Tc ng nhn thc ton x hi Gii php gim tc hi y khng c ngha l thu gom, m phi bao hm ng b cc yu t: Tng cng tuyn truyn gio dc cho nhm c nguy c ly nhim cao h li tuyn truyn cho ln nhau; cung cp bm kim tim sch, bao cao su (bin php can thip gim thiu); v iu tr thay th. Bin php can thip gim thiu bng cung cp bm kim tim sch v bao cao su min ph c th im ti 21 tnh, thnh trong c nc. Tuy nhin, vic tin hnh khng ng b, khng n ni n chn, hoc ch th im trn din hp. V vy, cha t c sc mnh tng hp, cha to nn qu m thp y li vn nn ny khuyn khch cc quc gia, cc t chc v c nhn thc hin cc mc tiu cam kt c i din cp cao ca hn 180 nc thng qua ti Phin hp c bit ca i hi ng Lin hip quc v HIV/AIDS (thng 6 nm 2001) cc c quan Lin hip quc phi hp vi cc t chc x hi dn s c lin quan chn Gi vng cam kt, quyt tm ngn chn AIDS lm ch xuyn sut ca cc Chin dch Phng, chng AIDS ton cu nhn Ngy Th gii phng, chng AIDS hng nm trong giai on 2006-2010.