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AIDS ´ëÀå°æ Á¤¸®

1. ADISÀÇ Á¤ÀÇ: AIDS-indicator conditions or CD4+ cell < 200/uL

2. category B: oropharyngeal candidiasis, vulvovaginal candidiasis, cervical CIS,

herpes zoster, ITP, listeriosis, PID, peripheral neuropathy

»ó±â category B´Â AIDSÀÇ Á¤ÀÇ¿¡ µéÁö ¾ÊÀ½, Áï AIDS-indicator conditionÀÌ ¾Æ´Ô!!

3. AIDS ÀüÆÄ°æ·Î 4°¡Áö

sexual, vertical, transfusion, IV drug abuser

4. AIDS¿¡¼­ MAI¿¡ ÀÇÇÑ °¨¿°ÀÇ ºóµµ°¡ ³ôÀ¸¸ç ÀÌ´Â standard tuberculosisÄ¡·á¿¡ resistant

ÇÏ´Ù.

AIDS¿¡¼­ M. tuberculosis¿¡ ÀÇÇÑ °¨¿°ÀÇ ºóµµ°¡ ³ôÀ¸¸ç ÀÌ´Â standard TbÄ¡·á¿¡ Àß µè´Â´Ù.

5. ziduvudineÀº survivalÀ» Áõ°¡½ÃŰ°í ±âȸ°¨¿°ÀÇ ºóµµ¸¦ °¨¼Ò½ÃŲ´Ù.

ƯÈ÷ CD4 < 200 /ul¿¡¼­.

6. HIV ±¸Á¶

gp120 : outer membrane

gp41 : transmembrane component

gp18(17) : inner membrane

gp24 : core protein

reverse transcriptase

genomic RNA

HIV infection¿¡¼­ life cycleÀÇ hallmark: RNA -> DNA·ÎÀÇ reverse transcription

À̶§ reverse transcriptase°¡ ÇʼöÀû

gp120ÀÌ CD4 cellÇ¥¸é¿¡ ³ôÀº ģȭ·ÂÀ¸·Î ºÎÂøÇϸé gp41 fusionÀÌ ÀϾ HIV genomic

RNA°¡ uncoated & internalize.

7. HIV gene

gag gene: core protein(gp24 AgÆ÷ÇÔ)

pol gene: reverse transcriptase

env gene: envelope glycoprotein

rev gene: regulator of expression of virion product

tat gene: trans-activator of transcription

8. AIDS¶§ CD4+ T cellÀº ¾çÀûÀÎ °¨¼Ò »Ó¸¸ ¾Æ´Ï¶ó ÁúÀû º¯È­µµ °¡Áø´Ù.

ÁúÀûº¯È­= AgÀÎ½Ä Àå¾Ö, lymphokine & IL-2»ý»ê ÀúÇÏ

soluble antigen and mitogen¿¡ ´ëÇÑ responseÀå¾Ö

9. AIDS¶§

B lymphocyte´Â polyclonal activationµÇ¾î hypergammaglobulinemia°¡ »ý±â°í TNF-¥á,

IL-6µîÀÌ Áõ°¡µÈ´Ù.

monocyte/macrophage´Â HIV infection reservoir·Î ÀÛ¿ëÇÏ¿© HIV¸¦ ¸öÀüü¿¡

dissemination½ÃŰ´Â ¿ªÇÒÀ» ÇÑ´Ù.

10. HIV expressionÀ» °¡Àå °­·ÂÈ÷ À¯µµÇÏ´Â cytokines: IL-1¥â, IL-6, TNF-¥á

11. HIV infection¶§ CD4 cell depletionÀÌ ÀϾ´Â ÀÌÀ¯

1) cell membrane¿¡¼­ virionÀÇ budding¶§ »ý±â´Â cell membrane disruption

2) syncytium formation: °¨¿°µÈ CD4 cell°ú °¨¿°µÇÁö ¾ÊÀº CD4 cell»çÀÌ¿¡ gp120 ¹× CD4¿¡

ÀÇÇÑ °áÇÕ ¹× À¶ÇÕÀÌ ÀϾ ÆÄ±«µÈ´Ù.(=cytopathic effect)

3) innocent bystander destruction: À¯¸®µÈ gp120ÀÌ °¨¿°µÇÁö ¾ÊÀº T4 cellÇ¥¸é¿¡ °áÇÕÇϰí

À̸¦ Ç׿øÀ¸·Î ÀÎÁöÇÏ¿© NK cell°ú killer T cellÀÌ °ø°ÝÇÔ

4) peripheral T cellÀÇ »ý¼ºÀå¾Ö: lymphoid precursor cellÆÄ±« ¹× lymphoid tissueÀÇ Á¡Â÷Àû

ÆÄ±«

5) autoimmune destruction, superantigens, apoptosis

12. HIV virusÀÇ targetÀÌ µÇ´Â CD4 Ç׿øÀ» °¡ÁüÀ¸·Î½á HIVÀÇ Ç¥ÀûÀÌ µÇ´Â °¡Àå Áß¿äÇÑ ¼¼Æ÷

: T4 lymphocyte, monocyte/macrophage, colorectal epithelial cells

brain & spinal cordÀÇ cell population

13. Toxoplasma gondii´Â AIDSȯÀÚ¿¡¼­ °¡Àå ÈçÇÑ CNS infection¿¡ ¼ÓÇÑ´Ù.

Pneumocystis carinii pneumoniaȯÀÚ¿¡¼­ Ga scanÇϸé 95%À̻󿡼­ diffuse increased

uptake¸¦ º¸ÀδÙ.

Cryptosporidum°¨¿°Àº ÀϹÝÀûÀ¸·Î ½ÉÇÑ diarrhea¸¦ ÃÊ·¡Çϸç, °á±¹ malabsorptionÀ»

ÃÊ·¡ÇÒ¼ö ÀÖ´Ù.

14. ADISȯÀÚ¿¡¼­ malabsorption & weight loss¸¦ º¸ÀÏ ¶§ °¡Àå ÈçÇÑ ¿øÀÎ?

enteric infection or small intestinal Kaposi's sarcoma

Èí¼öÀå¾Ö°¡ º¸ÀÏ ¶§ ÈçÈ÷ D-xylose test´Â ÀÌ»ó¼Ò°ßÀ» º¸À̰í, serum Zinc levelÀº °¨¼ÒµÈ´Ù.

small-bowel biopsy¸¦ Çϸé mononuclear cell & histiocyte infiltrationÀ» º¼¼ö ÀÖ´Ù.

15. AIDS¿Í °°Àº T-cell immunity°¡ ÀúÇÏµÈ È¯ÀÚ¿¡¼­ diarrhea¸¦ ÃÊ·¡ÇÏ´Â ±âȸ°¨¿°?

CMV, cryptosporidium, MAC

cf. MAC(atypical mycobacterium)¿¡ ÀÇÇÑ infection¶§ ÀϹÝÀûÀÎ Ç×°áÇÙÄ¡·á¿¡ Àß ¹ÝÀÀÇÏÁö

¾Ê´Â´Ù.

´Ù¾çÇÑ Á¶ÇÕÀÇ Ç×°áÇÙ¾àÁ¦ Ä¡·á·Î ¾à°£ÀÇ »ýÁ¸±â°£À» ´Ã¸±¼ö ÀÖÀ»»ÓÀ̾ú´Ù.

±×·¯³ª new macrolide(clarithromycin)ÀÌ ³ª¿À¸é¼­ ÁÁÀº Ä¡·á¹ÝÀÀÀ» º¸¿´´Âµ¥

ÇöÀç HIV infectionȯÀÚ¿¡¼­ MAC infectionÄ¡·áÀÇ choice´Â clarithromycin + ethambutol

ÀÌ´Ù.

16. AIDSȯÀÚ¿¡¼­ blurred vision ¹× diarrhea¸¦ º¸¿´´Ù¸é °¡´É¼ºÀÖ´Â Áø´Ü?

CMV retinitis, CMV colitis

cf. CMV infectionÄ¡·á·Î ganciclovir, foscarnet¸¦ ½ÃµµÇÒ ¼ö ÀÖÀ¸³ª CMV retinitis´Â

necrotic inflammatory processÀ̹ǷΠirreversibleÇÏ´Ù.

17. AIDS¶§ ±âȸ°¨¿°À¸·Î ¹ß»ýÇÏ´Â neurologic disease

toxoplasmosis, cryptococcosis, M. tuberculosis, CMV

progressive multifocal leukoencephalopathy, HTLV-1

18. HIV ȯÀÚ¿¡¼­ Pneumocystis carini¿¹¹æÀÇ indications

°¨¿°ÀÇ °ú°Å·Â(+), CD4 cell< 200/uL, 2ÁÖÀÌ»óÀÇ ºÒ¸í¿­(37.8¡É),

oropharyngeal candidiasis Hx(+)

19. P. carini¿Í °ü·ÃÇÑ ¿¹ÈÄÀÎÀÚ

PaO2, (A-a)DO2, organism burden, BAL¿¡¼­ neutrophil %,

CXR abnormality, LDH¡è, albumin¡é

20. P. carini pneumonia·Î ÀÎÇØ hypoxemia°¡ ³ªÅ¸³¯ ¶§ º¸Á¶Àû Ä¡·á ¹× ÀûÀÀÁõ

glucocorticoids, PaO2 < 70 mmHg or (A-a)DO2 > 35 mmHg

21. CD4 < 200/uL : Pneumocystis carini

CD4 < 50/uL : aspergillosis, MAC, CMV

22. HIVȯÀÚÀÇ ¿¹ÈÄ¿Í Áúº´ÀÇ ÀÌȯÁ¤µµ¸¦ Æò°¡Çϱâ À§ÇØ °¡Àå À¯¿ëÇÑ Ç¥ÁöÀÚ?

CD4+ cell count, HIV RNA level

23. CD4 cell count¿¡ µû¸¥ ±âȸ°¨¿°

<500 /uL : antiretroviral therapy°¡ ÇÊ¿äÇÔ

<200/uL : PCP ¿¹¹æ¿ä¹ýÀÌ ÇÊ¿äÇÔ

<100 /uL : CMV, MAC°¨¿°ÀÇ À§ÇèÀÌ ³ô´Ù.

24. HIV infectionÀÇ window period: Æò±Õ 4-8ÁÖ

25. HIV infectionÀÇ screening°ú È®ÁøÀ» À§ÇÑ °Ë»ç¹ý

screening: ELISA, È®Áø: western blot

26. western blotÀ¸·Î °ËÃâÇÒ¼ö ÀÖ´Â HIV-1ÀÇ Ag: gp120/160, gp41, gp24

27. HIV infectionȯÀÚÀÇ Ã¤Ç÷½Ã ÁÖ»ç±â¿¡ Âñ·ÈÀ» ¶§ ¿¹¹æ¿ä¹ý

2Á¦(zidovudine + lamivudine) or 3Á¦(zidovudine + lamivudine + indinavir)¸¦

4ÁÖ°£ º¹¿ëÇÑ´Ù.

28. AIDSȯÀÚ°¡ ÀÓ½ÅÇÏ¿´À» ¶§ ¼öÁ÷°¨¿° ¿¹¹æ¹ý

ZidovudineÅõ¿©

14-34ÁÖºÎÅÍ Åõ¿©Çϱ⠽ÃÀÛÇÏ¿© ºÐ¸¸½Ã¿£ IV, ºÐ¸¸ÈÄ ½Å»ý¾Æ¿¡ 6ÁÖ°£ Åõ¿©

29. AIDSÄ¡·áÁß Ä¡·á¾àÁ¦¸¦ ¹Ù²Ù¾î¾ß µÇ´Â °æ¿ì

i) ÇѰ¡Áö or µÎ°¡Áö NRTI(nucleoside reverse transcriptase inhibitor)·Î ºÒ¿ÏÀüÇÏ°Ô Ä¡·á¸¦

¹ÞÀº °æ¿ì

ii) PI(protease inhibitor)¸¦ Æ÷ÇÔÇÑ °­·ÂÇÑ º´¿ë¿ä¹ýÀ» Çϰí ÀÖÀ¸³ª Ãʱ⿡ ÃøÁ¤¼öÁØ ÀÌÇÏ·Î

°¨¼ÒÇÏ¿´´Ù°¡ ´Ù½Ã Áõ°¡ÇÏ´Â °æ¿ì

iii) Ç÷Áß virus°¡ ÃøÁ¤¼öÁØ ÀÌÇÏ·Î °¨¼ÒÇÏÁö ¾Ê´Â °æ¿ì