24/01/2015 te oe a0 ep re $B Si ant Mea cee sort ‘seep apse a aah “us oa ana pn amp tw Boe eee Sree ceases Seca eae ee ae ay eds ie Arye snc rae a ‘Human Immunodeficiency Virus, bn Patan Eu Mess et Wr Bn Human Immunodeficiency Virus (HIV) + HIV Human immunodeficiency virus) s ius that attacks the human immune system and ean lead to AIDS. tack one type of white blood cells > lmenocytes that have CDS 38 marker ‘haters onthe surtace of lmphacytes @ + Discovered independently by Lue Montagnier of France and Robert Gallo of the US in 1983- Ba, Former names of the virus include: Human ¥ call yphetrophic virus (HTUWat) = Lymphadenopathy associated virus (AV) = AIDS associated retrovirus (ARV) HIV Taxonomy Kingdom : Virus Familia : Retroviridae Subfamilia : Orthoretrovirinae Genus : Lentivirus Spesies: Human Immunodeficiency virus 1 Spesies: Human immunodeficiency virus 2 History HIV Is estimated to have originated in Aftica where it originated from chimpanzees. The virus that atfects ‘mankeysis very similar to HIV and called sWWepe [simian immunodeficiency veut. ‘Many sxperts argue that HIV enters the human body ea result of canta with other primates, for Instance during hunting or cuts of eat24/01/2015 Types of HIV Virus suiva “= Mast common in sub-Saharan Alien and ‘throughout the world = Groups M, Nando = Pandamie dominated by Group 14 * Geoup Mcompreed af rubyBeE 1 -utv2 =Mostoften found in West Africa Epidemiology + HIV / AIDS eases in Indonesia [souce:Orjen PPRPLRerenkes fl Sectember 2012), Cumulative AIDS Cases by Mode of Transmission Cumulative AIDS Cases by Age Group, Cumulative HIV/AIDS Cases by Province Structure of the HIV virus ce Rees ‘i ean)24/01/2015 Characteristics of the virus + retroviruses. “+ Retroviruses tansenibe RNA to ONA. + Two ral strands of RNA found in core surrounded by protein outer coat spect ial pheoprotune ara meade — Thace note tucres essere or binding to ae Having three enzymes : Reverse transcriptase - builds @ DNA copy of ‘he viral RNA genome, which is then used to build new viruees, Integrase -> takes the DNA copy af the viral genome and inserts it into the infected cellular genome. Protease > essentlal for the maturation of HIV particles, Viral Replication + firststep, HIV attaches to susceptible host cel ~ Stwofonacrment 56 COs ames owed on avaiy of ls Early Phase HIV Infection + Their envelope lyeoprotein gp 120 ie ananemaon + The gp120 protein on virus binds specifically 10 CD4 receptor on host cell with high affinity. + GpAt causes fusion of the virus to the cel membrane. After fucton Vitus particle enters cl = Vital genome exposed by uncoating particle + Reverse transcriptase produces viral DNA from RNA, = Becomes 2 provirus which intogrates into host NA = Period of latency occurs24/01/2015 How is HIV Transmitted? + Methods of teansmission = Sexsitanemiion,srezence af STD neestettheincos ofranenaton| = Exgetratonfced bod o blo produce, ~ Sanne contaminated needs [dru wer) = Mocharto fas, paraa trarmsion vrei, degendent on vil load and mother’ CD cout. Transmission OW THE HIV VIRUS CAN ENTER THE BODY High risk: + Intercourse vaginal / anel without a condom + Fellatio with ejaculation + Cunitingus time of menstruation + Contact oral: anat Low risk ‘Transmission does not occur through + kiss with mouth + Handshake + Vaginal intorcourse with a condom + Public toilets, showers, swimming pool and + Anal intercourse with @ condom towels Falster + Telephone, furniture, stationery + Cunltingus outside of menstruation * Public seating + Insect bites (mosquitees)24/01/2015 HIV — Stages of infection + Acute HIV Infection Symptoms usually develop In days to weeks after intial infection “Include fever, lymphadenopathy, rash, pharyngitis, headache (aseptic meningitis) HIV antibody will be negative at this point ~ Patient hs postive HW actbody et = Usual occurs to 10 weak ata ction, + Gronie/Laont NV dense ~ Wellton to intense sou, CDS count demise slowly = Average 10 years {aly Smptomatic HIV infection Symaramati Winston HIV Disease Progression Oral manifestations Lesions closely associated with HIV infection = Candidiasis (Erythematous Candidiasis, Pseudomembranous Candidiasis) Hairy teukplakia Periodontal diseases (Linear Gingival Erythema Necrotizing Ulcerative Gingival. Necrotizing Ulcerative Periodontal) Kaposi sarkoma Oral Candidiasis + 004 «300 se/inm? + Blo candida albicans + consists of = Pseudomembrancus ‘Candidiasi (Thrush) —Enythematous ‘Candidiasis Hyperplastle Candidiasis Ulcerative Periodontitis (NUP) lean Gngrine ba Praalence95% : (4200 elf? + cheater dep osseous pan ft) ears / eer, te q habvoais24/01/2015 Linear Gingival Erythema (LGE) = Red Band Gingivitis Discomfort, snentancous bleeding in the gingival Such as 2.3 mm wide red bond alone the zing! macgin, ofan with petectise ot respon to scaling and root planing Location: gingival > petechiae- ie potches Angular Cheilitis + The formation of fissure accompanied by erythema onthe comers ofthe mouth Cananse with | without: Erythematous ‘andiaiats/ pseudomembranous 4 Can las along time if ih nat treated Oral Hairy Leukoplokia (OH) Oral Vira! Leukoptakia + Etiology: Epstein-Barr virus (ey + 004 < 200 cli * sohitestrinewertie! / wavy (corrugated) / plaque flat Fising with hair like projections ofkeratin-> can not be scraped Hand not pain Sarkoma Kaposi + Decved om edt! cals causa bi econ wh HH ‘orinaly an asmaxamate ear ih seco pate + Fura r pspules nodes oF luce that canbe accpesee bypan rolleyes pri 2:7he eons ae not sey eae HV oeton Vaycobscteralinctors Malan pigmarestion uecotane (ucenontorstis Cc sshrany Band desease Thrombocrtopent purpura Nopiseate wearston ‘ia ieteion heres snleerte ete, PV wneton) (Fetdionemsn 2003) Diagnosis of HIV 41.Clinical diagnosis ; + Diagnosis based on symptoms of major and minor + 2major symptoms with 2 minor symptoms24/01/2015 Major symptoms: + Lost weight > 1036 in 4 month * Chronic diarrhea> 1 month + Fever> 1 month * loss of consciousness + neurological disorders + Dementia / HIV encephalopathy Minor symatoms + Persistent cough> 1 month + generalized dermatitis “+ Herpes roster and recurrent multisegmental + oropharyngeal eanciciasis + Hempes simplex chronic progressive + generalized lymphadenopathy + Recurrent genital yeast infection + Gvtomegalovirus 2. Definite Diagnosis aaa iz Shen Management Specific = Provision of Ant Retro Virus ~ Treatment of opportunist infections = treatment of malignancy General = Providing Nutrition Moral supaor family, ends, community) = counseling Provider initiated Testing and Counseling) ~ Therapy analgesic (pain relief] + Starting antiretroviral therapy in all patients ‘with CD4 counts «350 cells / mm? regardless of clinical stage, + ARV therapy is recommended in all patients with active TB, oregnant women and hepatitis B co-infection regardless of CD4 count, Oral Management + CDA > 200 cells/mm > same treatment with non-hiv patients + C4 < 200 cells/mm “> require referral and consultation with hespital care team24/01/2015 Current antiretroviral targets vemos Sir Amiretroviral Drugs 2013 Proteainhbior (20) eeene 0 + nese Inde 091 5 nr 0 Seu + pana + brome iP ce hire Neceoiar toque tea ra seep) Reference 5,920 Esenof Poly anc (hashes binky oats SP ge, bn MeshaeandPetayats nce Micrel aehont Unies = 997 Orestes tant Sertnaatineons 8 acy Une Sae cfama n-5