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 ģȷÂÀ¸·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