HIV- AIDS

Puspita Kusuma
Rigan Ndaru
M. Taufik Mahar
WHAT IS HIV

Human Immunodeficiency Virus

A unique type of virus (a retrovirus)
Invades the helper T cells (CD4 cells)
in the body of the host (defense
mechanism of a person)
Threatening a global epidemic.
Preventable, managable but not
curable.
Etiologi

RNA virus
Subfamily
Lentivirus
Family Retroviridae
Struktur HIV
Struktur HIV
Sel Target HIV
Patogenesis HIV
Grafik antara jumlah CD4 dengan
HIV
Resiko Penularan HIV dari Cairan
Tubuh
 Kelompok Resiko Tinggi (Depkes RI 2007)

Penjaja seks laki-laki atau perempuan

Pengguna napza suntik (dahulu atau sekarang)

Berhubungan seks sesama laki-laki & transgender (waria)

Pernah / sedang mengidap penyakit infeksi menular seksual

(IMS)

Pernah berhubungan seks tanpa pelindung dengan PSK

Pernah mendapatkan transfusi darah atau resipient produk

darah

Suntikan, tato, tindik, dengan menggunakan alat non steril

 Perjalanan penyakit HIV
HIV masuk ke tubuh

Oleh APC ke KGB regional

Virus bereplikasi di KGB

Viremia

- Demam
- Ruam - Nyeri Menelan
- Pembesaran GEJALA INFEKSI HIV AKUT - Batuk
KGB - Diare

Terjadi pembentukan Ab,

ditandai dengan viremia menurun

Replikasi
1 2 3
Stage 1 - Primary
Short, flu-like
illness - occurs
one to six
weeks after
infection
Mild
symptoms
Infected
person can
infect other
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 low levels
HIV antibodies are detectable in
the blood
Stage 3 - Symptomatic

The immune system deteriorates

Opportunistic infections and
cancers start to appear.
Stage 4 - HIV AIDS

The immune
system
weakens too
much as CD4
cells decrease
in number.
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
 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. Subnormal clinical and roentgen presentation
2. High rate of MDR/XDR
3. High rate of treatment failure and relapse (5% vs < 1% in
HIV)
Testing Options for HIV
Anonymous Testing

No name is used
Unique identifying number
Results issued only to test
recipient
23659874515

Anonymous
Blood Detection Tests
HIV enzyme-linked
immunosorbent assay (ELISA)
Western blot
HIV rapid antibody test
Absolute CD4 lymphocyte
count
HIV viral load tests
Screening test for HIV
Sensitivity > 99.9%
Confirmatory test
Speicificity > 99.9% (when combined with
ELIZA)
Screening test for HIV
Simple to perform
Predictor of HIV progression
Risk of opportunistic infections and AIDS when
<200
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
Should be confirmed with
western blot test or ELIZA
Draws blood-derived
fluids from the gum
tissue.
NOT A SALIVA TEST!
Treatment Options
HAART = highly active anti-
retroviral treatment
Antiretroviral Drugs (HAART)

Nucleoside Reverse Transcriptase

inhibitors
AZT (Zidovudine)
Non-Nucleoside Transcriptase
inhibitors
Viramune (Nevirapine)
Protease inhibitors
Norvir (Ritonavir)
EFFECTIVENESS OF HAART IN REDUCING
MORTALITY
HEALTH CARE FOLLOW UP OF HIV INFECTED PATIENTS

For all HIV-infected individuals:

CD4 counts every 36 months
Viral load tests every 36 months and 1 month following a change in
therapy
PPD
INH for those with positive PPD and normal chest radiograph
RPR or VDRL for syphilis
Toxoplasma IgG serology
CMV IgG serology
Pneumococcal vaccine
Influenza vaccine in season
Hepatitis B vaccine for those who are HBsAb-negative
Haemophilus influenzae type b vaccination
Papanicolaou smears every 6 months for women
 For HIV-infected individuals with
CD4 < 200 cells/mcL:
Pneumocystis jiroveci1 prophylaxis

For HIV-infected individuals with
CD4 < 75 cells/mcL:
Mycobacterium avium complex prophylaxis
For HIV-infected individuals with
CD4 < 50 cells/mcL:
Consider CMV prophylaxis
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