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SYNDROME (AIDS)
Etiology:
Human Immunodeficiency Virus
(HIV) Infection
Opportunistic infections
Wasting syndrome
Bacillary Angiomatous
Toxoplasmosis
Central nervous system lymphoma
AIDS dementia complex
Cryptococcal meningitis
HIV myelopathy
Progressive multifocal leukoencephalopathy (PML)
Oral candidiasis
Candidal esophagitis
Hepatic disease neoplasma & infection
Biliary disease cholecystitis
Enterocolitis
9. Endocrinologic manifestation
hypogonadism
10. Skin manifestations
INFEKSI OPORTUNISTIK
Kaposis sarcoma
Non-Hodgkins lymphoma
Anal dysplasia & squamous cell carcinoma
Cervical dysplasia & neoplasia
Treatment
There are 5 catagories:
A. Supportive therapy
B. Opportunistic infections & malignancies
C. Prophylaxis of opportunistic infections
D. Antiretroviral treatment (ARV/ART)
E. Hematopoietic stimulating factors recormon?
A. Supportive therapy
1. Sympthomatic
2. Fluid and electrolite
3. Anti depressant
TREATMENT
Pneumocystic infection
(PCP)
Mycobactrium avium
complex infection (MAC)
Clarithromycin + ethambutol
Rifabutin
Toxoplasmosis
Lymphoma
Combination chemotherapy
Cryptococcus meningitis
Amphotricin B
TREATMENT
Fluconazole
- Acyclovir
- Famciclovir
- Valacyclovir
- Foscamet
Herpes zoster
- Acyclovir
- Famciclovir
- Falaciclovir - Foscamet
Kaposis sarcoma:
- Cutaneous
- Extensive/aggressive cutaneous
disease
- Visceral diseases
Primary prophylaxix
Pneumocystis carinii
Cotrimoxazole, pentamidin,
dapson, atovaquone
Secondary prophylaxix
Kaposiss sarcoma
Oesophagyal
candidiasis
Fluconazole, Itraconazole,
Voriconazole
Azithromycin, Clariromycin,
minus Rifabutin
Mycobacterium
tuberculosis
Toxoplasmosis
Cotrimoxazole, Dapsone 50
mg+ pyrimethamine 50-100
mg
Sulfasiazine 2 g +
pyrimethamine 25 mg or
clindamycin 1.2 g+
pyrimethamine 25 mg
Cryptococcosis
Fluconazole 100-200 mg
Fluconazole 200-400 mg
Cryptosporidiosis
Clarithromycin, rifabutin
Cytomegalovirus
Convenience, gansciclovir
Microsporidiosis
Albendazole
???
OI
MANAGEMENT
Pneumocystis carinii
Kaposiss sarcoma
Oesophagyal candidiasis
Rifampicin/rifabutin+isoniazid+pyrazina
mide+ethambutol (with pyridoxin) for 912 months
Cryptococcosis
Cryptosporidiosis
Cytomegalovirus
Microsporidiosis
Albendazole 2 x 400 mg
Window period
Source of Infection
uninfectious
tears
Vaginal discharge
feces
Semen man
urine
Pericardial fluid
saliva
Pleural fluid
nose secrettion
Cerebrospinal fluid
sputum
vomit
Peritoneal fluid
sweat
Sinovial fluid
Clothes CAKAR
Breast-feed
kitchenware
D. Antiretroviral treatment
ANTIRETROVIRAL(ARV) DRUGS
1. Nucleoside reverse transcriptase inhibitors
(NRTI)
2. Nonnucleoside reverse transcriptase
inhibitors (NNRTIs)
3. Nucleotide reverse transcriptase inhibitors
4. Protease inhibitors (PIs)
5. Entry inhibitor
DOSE
SIDE EFFECTS
400 mg/daily
Zalcitabine (ddC)
3 x 0375-0.75
mg/daily
Stavudine (d4T)
2 x 40 mg/daily
Rash, PN
Emtricitabine
Abacavir (ABC)
DOSE
SIDE EFFECTS
Nevirapine
(Viramune)
Rash
Delavirdine
(Rescriptor)
3 x 400 mg/daily
Rash ???
Efavirenz (Sustiva)
Neurologic
disturbances
Tenofovir (TDF)
DOSE
1 x 300 mg/daily
SIDE EFFECTS
Gastrointestinal distress
DOSE
SIDE EFFECTS
Gastrointestinal
distress
3 x 1200 mg/daily
Gastrointestinal
distress
Ritonavir (Norvir)
Gastrointestinal
distress, PN
Indinavir (Crixivan)
3 x 800 mg
Kidney stones
Nelvinavir (Viracept)
3 x 750 mg/daly
Diarrhea
Amprenavir (Agenerase)
2 x 1200 mg
Gastrointeratinal,
rash
Fosamprenavir (Lexiva)
2 x 1400 mg or 1 x 1400 mg +
ritonavir 1x 200 mg/daily
Same as
amprenavir
Lopinavir/ ritonavir
(Kaletra)
Diarrhea
Atazanavir (Reyatas)
1 x 400 mg
Hyperbilirubinemia
5. Entry inhibitor
DRUGS
Enfuvirtide
(Fuzeon)
DOSE
SITE EFFECTS
2nd line
Substitute
Switch
Salvage
DUVIRAL
AZT, d4T,
3TC, NVP
EFV
Recommended 1st Line
ARV Drugs
ABC,
TDF
Frequently
Recommended as 2nd
line drugs, but also as
alternative drugs in 1st
line regimens
ddI,
PI/r
30
25
No therapy
% of
20
patients
progressing
Monotherapy
Dual therapy
15
10
Triple therapy
5
0
0
months
10
11
12
13
14
15
NVP
d4T
X
AZT
3TC
EFZ
Switching to
second line drugs in Indonesia
LPV/r
TDF
10 x more expensive than first line
Renal toxicity, metabolic complications
More drug interactions
ddI
PACK
DOSAGE
Tenofovir
(TDF)
300 mg/tab
300 mg / day
Didanosine
(ddI)
Lopinavir/rito 133.3/33.3
navir (LPV/r) mg/cap
CD4 200350
WHO, 2003
Prognosis
With improvements in therapy, patients are living
longer after the diagnosis of AIDS. This has
resulted in dramatic decreases in AIDS deaths.
Despite new therapeutic options, people
continue to die from HIV infection.
Depend on:
The stage of HIV/AIDS (I, II, III, IV)
The Adherence of ARV
The number of CD4 count
SJS AZT/Zidovudin
SJS
Lipodystrophy
d4T atau PI
Lipodystrophy
Fat accumulation
central obesity
d4T atau PI