Angina in HIV infection

Angina in HIV infection is included in the class of vulgar angina, since the anginal process occurring in the pharynx refers to secondary diseases caused by AIDS caused by the T-lymphotropic human type 3 virus, which causes the rapid development of the so-called opportunistic infection, in abundant vegetative in the mucous membrane of the pharynx and its lymphadenoidal formations.

[1], [2], [3], [4], [5], [6], [7]

What causes angina in HIV?

Along with banal pyogenic infection, the defeat of the upper respiratory tract in AIDS can cause fungi, pneumocysts, herpes viruses, Epstein-Barra viruses, cytomegaloviruses, etc. AIDS in a fully clinically developed stage is manifested by secondary infectious or tumor processes.

Symptoms of angina in HIV

As several authors note, in 30-50% of patients 3-6 weeks after infection, in essence, in the latent period of HIV infection, phenomena resembling angina in mononucleosis develop: fever up to 38-39.5 ° С, inflammation of lymphadenoid formations pharynx, regional lymphadenitis, enlarged liver and spleen, as well as inflammatory foci in other organs. Symptoms of angina quickly go away, but the lymphopenia that occurs during this period is an indirect indication of the possibility of HIV infection.

In the latent period, the content of antibodies to HIV increases. At the same time, there is an increase in lymph nodes, which undergo further changes characterizing the stage of persistent generalized adenopathy, which for a long time (months and years) may be the only manifestation of AIDS. Adverse external conditions, alimentary dystrophy, avitaminosis, alcoholism, drug addiction, intercurrent infectious diseases exacerbate the clinical course of HIV infection and lead either to the generalization of opportunistic infection that progresses towards a clinically developed disease in every 3rd patient over the next five years.

Diagnosis of angina in HIV

In principle, every banal inflammation of the mucosa and lymphoid apparatus of the pharynx should alert the physician to the presence of AIDS, therefore, each patient, especially in the presence of an acute inflammatory process in the throat and at the same time - lymphopenia, must undergo a special hematological examination for HIV infection.

[8], [9], [10], [11], [12], [13]

Treatment of angina with HIV

Treatment of angina at HIV complex with the appointment of intensive immunomodulatory treatment, drugs that increase the overall resistance of the body and antiviral agents active against HIV-1 and HIV-2. These drugs include zidovudine and zalcitabine.

Zidovudine acts on viral DIC polymerase (reverse transcriptase), disrupting the synthesis of viral DNA and reducing viral replication. The reverse transcriptase of HIV is 20 to 30 times more sensitive to the inhibitory effect of zidovudine than the polymerase of mammalian cells. The drug is well absorbed in the intestine and penetrates most tissues and body fluids, including in the cerebrospinal fluid, where its concentration reaches 60% of the serum content.

It is indicated for early use (with a T4 cell count of less than 500 / μl) and late stages of HIV infection, as well as for preventing transplacental HIV infection of the fetus.

How to use: per os; Adults with an initial dose of 200 mg every 4 hours (1200 mg / day). The dosage range is 500-1500 mg / day. The maintenance dose is 1000 mg / day in 4-5 receptions.

Zalcitabine is especially active in the early stages of AIDS. The mechanism of its action is due to the inhibition of the synthesis of viral DNA and the suppression of viral replication. It penetrates through the BBB and is found in the cerebrospinal fluid. The intracellular metabolite formed under the influence of the preparation is used by the reverse transcriptase of the virus as a substrate competing with dioxycidin triphosphate, resulting in the biosynthesis of the viral DNA and the formation of phosphodiester bridges between the chains necessary for elongation are impossible.

The high efficacy of treatment, begun early, justifies the need for treatment of HIV-infected patients in the absence of AIDS symptoms. With prolonged (more than 1 year) treatment in a small number of patients there is a decrease in the effectiveness of the drug. Stability of the virus is explained by point mutations of the viral genome in the region of the reverse transcriptase gene. Possible cross-resistance to zidovudine, stavudine and lamivudine, also used against HIV infection.

The drug is indicated for HIV infection in adults with clinical manifestations such as exacerbations of chronic tonsillitis, recurrent candidiasis of the pharynx and tonsils, hairy leukoplakia of the oral cavity, chronic or unexplained fever, night sweats, weight loss. With insensitivity to zidovudine or decreased activity of the latter, zalcitabine is used as a monotherapeutic agent.

Method of administration: adults per os with a clinically pronounced stage of HIV infection, 0.75 mg every 8 hours (monotherapy). The daily dose of 2.25 mg. Treatment of a primary infection is recommended for at least 6 months. Combined treatment with zidovudine: 1 tablet (0.75 mg) of zalcitabine together with 200 mg of zidovudine every 8 hours. The daily dose of drugs is 2.25 mg and 600 mg, respectively.

In addition, in HIV infection, the use in various combinations of immunoglobulins against megaloviruses (pitotec), immunomodulators (interferon, methylglucamine acrydon acetate, cycloferon, thymogen), antiviral agents (abacavir, didanosine, zidovudine, etc.) is shown in HIV infection.

What is the prognosis of angina with HIV?

With early initiation of specific treatment, in combination with other treatments, angina in HIV has a relatively favorable prognosis, with advanced stages - doubtful.