Dr.

ERLINDA, SpPD

Definitions

H - Human

I - Immunodeficiency

V - Virus

Definitions

A - Acquired

I - Immune

D - Deficiency

S - Syndrome

Normal Immune Response

T-cells make
antibodies

Virus binds to T-cells

Virus
Tcell
s
Normal response: Virus
invades blood stream and
binds to lymphocytes.
Lymphocytes make antibodies
to the virus. Antibodies bind
to the virus and destroy
the virus.

Vir
us

Antibod
ies bind
to virus
Antibodies
kill virus

Immune Response to HIV

HIV HIV destroys

T-cells (CD4
cells)

T-cells cannot
produce antibodi
Cannot destroy virus

Opportunistic Infections
associated with AIDS

Parasitic

Pneumocystis
carinii

Fungal
Candida
Cryptococcus

Is HIV and AIDS the

same thing?

Whats the difference

between HIV and AIDS?
HIV, a virus, eventually causes AIDS,
a syndrome.

Spectrum of HIV

Infecti
on
Possible Minor
Symptoms
Blood tests
positive

Healthy, HIV+
can last for
years

Symptomat
ic
HIV/AIDS

HIV

Human Immunodeficiency
Syndrome
A specific type of virus (a
retrovirus)

HIV invades the helper T cells to

replicate itself.

No Cure

AIDS

Acquired Immunodeficiency Syndrome

HIV is the virus that causes AIDS

Disease limits the bodys ability to

fight infection

A person with AIDS has a very weak

immune system

No Cure

T-Cell Count

If 1,200 or higher, the individual has a

normal immune system.
If 800 or less, the immune system is
weakened and individual is susceptible to
infection.
If 200 or less, AIDS is diagnosed.
Once a person is diagnosed with AIDS, she
or he is always categorized as having AIDS,
even if her or his T-cell count increases.

Criteria for Diagnosing AIDS

A CD4 cell (type of T-cell) count of 200

or less,
or

One opportunistic infection.

An opportunistic infection is an infection
that typically does not affect individuals
with
normal immune systems.

Four Stages of HIV

Stage 1 - Primary

Short, flu-like
illness - occurs
one to six weeks
after infection

Mild symptoms

Infected person
can infect other
people

Stage 2 Asymptomatic

Lasts for an average of ten years

This stage is free from symptoms

There may be swollen glands

The level of HIV in the blood drops to

very low levels

HIV antibodies are detectable in the

blood

Stage 3 - Symptomatic

The symptoms are mild

The immune system deteriorates

emergence of opportunistic
infections and cancers

Stage 4 - HIV AIDS

The immune
system weakens

The illnesses
become more
severe leading to
an AIDS
diagnosis

Opportunistic Infections
associated with AIDS

Bacterial
Tuberculosis (TB)
Strep pneumonia

Viral
Kaposi Sarcoma
Herpes
Influenza (flu)

Opportunistic Infections
associated with AIDS
CD4<500

Bacterial infections
Tuberculosis (TB)
Herpes Simplex
Herpes Zoster
Vaginal candidiasis
Hairy leukoplakia
Kaposis sarcoma

Opportunistic Infections
associated with AIDS
CD4<200
Pneumocystic carinii
Toxoplasmosis
Cryptococcosis
Coccidiodomycosis
Cryptosporiosis
Non hodgkins
lymphoma

CD4 <50

Disseminated mycobacterium avium

complex (MAC) infection
Histoplasmosis
CMV retinitis
CNS lymphoma
Progressive multifocal
leukoencephalopathy
HIV dementia

Opportunistic Infections

Mycobacterium Avium Complex

Salmonellosis
Syphilis and Neurosyphilis
Tuberculosis
Bacillary angiomatosis
Aspergillosis
Candidiasis
Coccidioidomycosis
Cryptococcal Meningitis
Histoplasmosis
Kaposis Sarcoma
Systemic Non-Hodgkins Lymphoma
Primary CNS Lymphoma
Cryptosporidiosis
Isosporiasis
Microsporidiosis
Pneumocystis Carinii Pneumonia
Toxoplasmosis
Cytomegalovirus
Hepatitis

Herpes Simplex
Herpes Zoster
Human Papillomavirus
Molluscum Contagiosum
Oral Hairy Leukoplakia
Progressive Multifocal
Leukoencephalopathy
AIDS Dementia Complex
Peripheral Neuropathy
Apthous Ulcers
Malabsorption
Depression
Diarrhea
Thrombocytopenia
Wasting Syndrome
Idiopathic Thrombocytopenic Purpura
Listeriosis
Pelvic Inflammatory Disease
Burkitts Lymphoma
Immunoblastic Lymphoma
Valley Fever
MRSA

Source: AIDS Education Global Information System

TB & HIV CO-INFECTION

TB is the most common opportunistic infection in

HIV and the first cause of mortality in HIV infected
patients (10-30%)
10 million patients co-infected in the world.
Immunosuppression induced by HIV modifies
the clinical presentation of TB :
1.
2.
3.

Subnormal clinical and roentgen presentation

High rate of MDR/XDR
High rate of treatment failure and relapse (5% vs < 1% in
HIV)

Modes of HIV/AIDS
Transmission

Through Bodily Fluids

Blood products

Semen

Vaginal fluids

Breast Milk

Through IV Drug Use

Sharing Needles

Without sterilization

Increases the chances of contracting HIV

Mother-to-Baby

Before Birth
During Birth
Postpartum

After the birth

Testing Options for HIV

Administration

Blood
Urine
Oral

Timeline
Test
Date

New Test
Date

Threemonth
window
Second ThreeFirstfrom
first
exposure month
exposur
window
e exposure
from
second
exposure

Testing

The test is for antibodies against HIV, not for the

virus itself.

It can take up to three months for the body to

produce antibodies against HIV.

A negative test result may mean recent infection.

It is possible to infect others during this

stage.

An individual should be tested three months after

possible exposure to guarantee an accurate result.

Blood Detection Tests

Enzyme-Linked Immunosorbent
Assay/Enzyme Immunoassay (ELISA/EIA)
Radio Immunoprecipitation
Assay/Indirect Fluorescent Antibody
Assay (RIP/IFA)
Polymerase Chain Reaction (PCR)
Western Blot Confirmatory test

Blood Detection Tests

HIV enzyme-linked
immunosorbent assay (ELISA)

Screening test for HIV

Sensitivity > 99.9%

Western blot

Confirmatory test
Speicificity > 99.9% (when combined with
ELIZA)

HIV rapid antibody test

Screening test for HIV

Simple to perform

Absolute CD4 lymphocyte

count

Predictor of HIV progression

Risk of opportunistic infections and AIDS when
<200

HIV viral load tests

Best test for diagnosis of acute HIV infection

Correlates with disease progression and
response to HAART

Urine Testing

Urine Western Blot

As sensitive as testing
blood
Safe way to screen for HIV
Can cause false positives in
certain people at high risk
for HIV

Oral Testing

Orasure

The only FDA

approved HIV
antibody.
As accurate as blood
testing
Draws blood-derived
fluids from the gum
tissue.
NOT A SALIVA TEST!

Counseling

Pre-test Counseling

Transmission
Prevention
Risk Factors
Voluntary & Confidential
Reportability of Positive Test
Results

Treatment Options

Antiretroviral Drugs

Nucleoside Reverse Transcriptase

inhibitors

Non-Nucleoside Transcriptase inhibitors

AZT (Zidovudine)
Viramune (Nevirapine)

Protease inhibitors

Norvir (Ritonavir)

Koinfeksi TB-HIV

1. Pemberian terapi ARV pd semua

pasien HIV dengan TB aktif tanpa
melihat nilai CD4
2. OAT diberikan lebih dulu, diikuti ARV
( dalam 2-8 minggu pemberian OAT)
3. efavirens(gol.NRTII) direkomendasikan
dlm ARV karena interaksi dg rifampisin
lebih ringan dibandingkan evirapin.

Kriteria gagal terapi:

1. kegagalan klinis (kondisi stad 4, atau

stad 3dg TB paru berat/gagal terapi)
2. kegagalan imunologis (CD4 kembali
seperti awal,atau penurunan
sebesar50%, atau tetap <100 sel/mm3)
3. kegagalan virologis ( viral load > 5000
kopi/ml)

Fluids and HIV

Transmission

Fluids that can transmit

HIV
Fluids that DO
transmit HIV:

Blood
Semen
Vaginal Fluid
Breast Milk

(in order of the highest

concentration of HIV)

Fluids that DO NOT

transmit HIV:

Saliva
Tears
Mucus
Urine
Sweat
Feces

Relative Risk
High risk:

Sharing needles
Unprotected sex
Breast feeding

Lower risk:

Protected sex
Any opportunity for exchange of body fluids

No risk:

Casual contact

Universal Precautions

Wash your hands!

Disinfect utensils and living space.
Use barrierspreferably latex.

HIV cannot be spread through

casual contact, but these are good
practices for preventing
opportunistic infections.

Barriers include:

Latex Gloves
Latex Condoms
Sheepskin condoms do NOT protect!
Latex Dental Dams
Anything that protects your skin
from a fluid

Prevention
What is the only 100% effective way to

prevent
HIV infection?

ABSTINENCE!

What does abstinence include?

Do not have sex with infected, possibly infected, or

multiple partners.
Do not share needles.

Thank You!

ACQUIRED IMMUNO DEFIENCY

SYNDROM
(AIDS)

Limfosit (salah satu jenis leukosit) berperan penting pada

system imun tubuh.Limfosit B berperan pada imunitas
humoral karena memroduksi antibodi, sedankan limfosit T
terutama pada imunitas karena bersifat sebagai efektor
melawan sel musuh. Limfosit ternyata merupakan kelompok
sel yang heterogen dengan dua jenis utama (subset) yaitu
limfosit penolong (CD4+) dan limfosit pembunuh (CD8+).
Pad keadaan normal, perbandingan jumlah CD4+ dan CD8+
secara kasar adalah 2 : 1, suatu perbandingan yang optimal
untuk menjalankan fungsi masing-masing.

HIV penyebab AIDS, merupakan virus yang limfotropik. Molekul

CD4+ merupakan reseptor (tempat hinggap) virus ini untuk masuk ke
dalam sel (limfosit penolong dan monosit karena monosit juga CD4+).
Di dalam sel virus ini memperbanyak diri (replikasi) sehinga merusak
limfosit tersebut. Virus-virus baru yang dihasilkan (virion) akan
mencari sel yang bau lagi untuk dimasssukinya. Pada infeksi lanjut
jumlah limfosit penolong ( CD4+ ) mulai menurun. Bila penurunan
jumlah sel telah cukup berat mulailah timbul manifestasi gangguan
imunitas sehingga pasien mudah terkena infeksi oportunistik dan
keganasan.
Selain limfotropik, HIV juga bersifat neutropikk karena ditemukan pada
SSP dan cairan otak serta menimbulkan kelainan neurologonik. Pada
infeksi HIV, jumlah limfosit B normal atau bahkan meningkat sebagai
respons tubuh sehingga terbentuk antibody spesifik terhadap HIV yang
dapat digunakan sebagai petanda bahwa seseorang pernah terpapar HIV.

Jenis sel imun yang lain yaitu natural killer cells ( sel NK ) juga
mengalami kelainan demikian pula limsofit B, sehingga pasien AIDS
lanjut sering timbul sarcoma Kaposi dan limforma sel.
A. Jenis dan metode pemeriksaan:
Deteksi antibody anti HIV (misalnya anti-p24, atau anti-glikoprotein
virus lainnya) menggunakan teknik aglutinasi, imunodot, Elisa,
Western blot, imunofluoresensi, atau radiomunopresipitasi.
Deteksi antigen virus (HIV): dilakukan dengan cara Elisa, kultur,
pelacak DNA, pelacak RNA.
Jumlah sel : Menghitung limfosit T penolong (CD4+) dan limfosit
pembunuh (CD8+) dengan teknik imunofluresensi / flowcytometry
menggunakan antibody monoclonal.
Fungsi sel : dapat dilakukan dengan cara stimulasi limfosit B atau T
menggunakan simulator PWM, PHA, Con-A, PPD, atau Tuberkulin.

Lain-lain : px lab. lainnya antara lain : Hematologi (Hb, jumlah dan

hitung jenis leukosit, trombosit, sediaan apus darah), penentuan
kadar lg G dan lgA darah, biarkan dan serologi (untuk protozoa,
jamur, HSV, CMV, EBV), untuk infeksi oportunistik Pneumocystis
carinii (perwarnaan langsung), Cryptosporidium dan Toxoplasma
(biakan), Strongyloides dan Candida (Histopatologik), Aspergillus,
serta sarcoma Kaposi Limfoma (Histopatologik).
B. Pemilihan tes untuk anti-HIV
1. Tes Penyaring : digunakan secara sederhana seperti tes aglutinasi,
dot enzyme immunoassay yang mempunyai sensitifitas tinggi, dan
teknik Elisa.
2. Tes konfirmasi : digunakan cara Western Blot, Imunofluoresensi,
atau Radioimunopresipitasi.
C. Periapan penderita dan bahan pemeriksaan:
Tidak ada persiapan khusus. Bahan pemeriksaan adalah darah
lengkap dengan antikoagulan sodium heparin.