دراسة الوضع الحالى لفيروس نقص المناعة المكتسبة (الإيدز) فى مصر

                                                "الملخص العربى

مقدمة:

يعد فيروس الإيدز الذى يتسبب فى مرض نقص المناعة المكتسبة  واحداً من أشهر أسباب الوفيات فى العالم , ويصاب الإنسان بنوعين من الفيروس فيروس الإيدز (1) الذى يتسبب فى مرض نقص المناعة المكتسبة فى جميع أنحاء العالم وفيروس الإيدز (2) الذى يقتصر وجوده على دول غرب إفريقيا.

ينتقل فيروس الإيدز عن طريق السوائل الملوثة بالفيروس كالدم ومشتقاته والسائل المنوى ؛ ولذلك فوسائل الانتقال متعددة منها:

-              الاتصال الجنسى غير الآمن.

-              الأشخاص الذين يتعرضون لنقل الدم أو أحد مشتقاته.

-              استخدام العقاقير المخدرة عن طريق الحقن الوريدى.

-              من الأم المصابة إلى الطفل سواء أثناء الحمل والولادة أو من خلال  الرضاعة الطبيعية.

ويتم اكتشاف وجود الفيروس عند المصاب بالكشف عن وجود الأجسام المضادة للفيروس فى الدم ويوجد اختبارات أخرى عديدة للتأكد من وجوده.

ويجب على المصاب بفيروس الإيدز تلقى العلاج المضاد للفيروس   حتى تقل نسبة الإصابة بمرض نقص المناعة المكتسبة.

فيروس الإيدز فى مصر:

تعد مصر واحدة من أقل البلدان فى العالم تأثراً بالإيدز حيث يقدر  عدد الحالات بإثنى عشر ألف حالة حسب تقدير برنامج الإيدز بالأمم المتحدة بينما يصل عدد الحالات المسجلة فعلياً بوزارة الصحة إلى ألفى  حالة وذلك منذ بدء اكتشاف المرض فى مصر عام  1986إلى الآن.

وتبذل مصر  قصارى  جهدها  للحفاظ على  هذه  النسبة  منخفضة عن طريق التوعية الصحية  للنساء  والشباب  بوسائل  انتقال  الفيروس  وكيفية الوقاية منه , حيث يوجد وسائل عديدة تساعد على  انتشار المرض فى مصر منها تزايد نسبة متعاطى المخدرات عن طريق الحقن الوريدى , وكثرة عدد الوافدين إلى البلد سواء من السائحين أو من العمالة المؤقتة. 

SUMMARY

AIDS was first recognized in the United States in the summer of 1981, when the U.S. Centers for Disease Control and Prevention (CDC) reported the unexplained occurrence of Pneumocystis carinii pneumonia and Kaposi's sarcoma (KS). A second type of HIV, called (HIV-2) was identified in 1986 in West African patients.

HIV belongs to the lentivirus group of the retroviruses family. Retroviruses have a unique replication cycle whereby their genetic information is encoded by RNA rather than DNA. They contain an RNA-dependent DNA polymerase (a reverse transcriptase) that directs the synthesis of a DNA form of the viral genome after infection of a host cell and thence incorporated into the host cell genome.

The hallmark of HIV disease is a profound immunodeficiency resulting primarily from a progressive quantitative and qualitative deficiency of the subset of T lymphocytes referred to as helper T cells, or inducer T cells. The combination of viral pathogenic and immunopathogenic events that occurs during the course of HIV disease from the moment of initial (primary) infection through the development of advanced-stage disease is complex and varied.

Acute HIV-1 infection presents in 40 - 90 % of cases as a transient symptomatic illness. With 14,000 new cases per day worldwide, it is an important differential diagnosis in cases of fever of unknown origin, maculopapular rash and lymphadenopathy. After the period of acute HIV infection, individuals may have little or no clinical manifestations of HIV infection. This time between initial infection and the development of AIDS may be long, averaging 10 years, even in the absence of treatment.

HIV transmission requires contact with body fluids containing infected cells or plasma. HIV may be present in any fluid or exudate that contains plasma or lymphocytes, specifically blood, semen, vaginal secretions, breast milk, saliva, or wound exudates.

The diagnosis of an HIV infection is normally made indirectly, i.e., through the demonstration of virus-specific antibodies. Besides indirect diagnosis based on detection of antibodies, a direct diagnosis of HIV infection is also possible: either through the demonstration of viral antigens (p24 antigen ELISA) or of viral nucleic acid (i.e., viral genome); the latter is also termed nucleic acid testing (NAT). Quantitative viral genome assays have gained great importance in guiding antiretroviral therapy.

The aims of management in HIV infection are to maintain physical and mental health, to avoid transmission of the virus, and to maximize quality of life. There is still no cure for HIV and AIDS, and patients must live with a chronic, progressive infectious and unpredictable condition.

Currently, all FDA-approved antiretroviral medications work by inhibiting 1 of 3 steps in the life cycle of HIV:

I.             Blocking the reverse transcriptase (RT) enzyme.

II.            Blocking the protease enzyme.

III.           Inhibiting fusion of the viral and host membranes.

In addition to conventional ART, immuno-modulatory treatment strategies have been investigated as a means to enhance HIV-specific immune responses.

HIV has many complications and most systems of the body are affected by the disease.

Strategies that have been shown to be effective in prevention of HIV transmission include treatment of sexually transmitted infections, use of condoms, use of clean needles and syringes for drug users, use of ART to reduce MCT, screening blood products and post exposure prophylaxis to reduce occupational transmission.

Acquired Immunodeficiency Syndrome (AIDS) has killed more than 25 million people since it was first recognized in 1981, making it one of the most destructive epidemics in recorded history. Despite recent, improved access to antiretroviral treatment and care in many regions of the world, the AIDS epidemic claimed 3.1 million [2.8-3.6 million] lives in 2005; more than half a million (570000) were children. The total number of people living with the human immunodeficiency virus (HIV) reached its highest level: an estimated 40.3 million [36.7-45.3 million] people are now living with HIV. Close to 5 million people were newly infected with the virus in 2005.

AIDS cases have been reported to the World Health Organization since 1986, and increasing numbers of patients are detected each year. Results of the National AIDS Control Programme surveillance (NACP) reveal that the prevalence is 0.03 among the general population and ranges from 0.05-0.5 among people with high risk behavior. Egypt faces several challenges in maintaining a low prevalence of HIV/AIDS."