HIV / AIDS

Gatoet Ismanoe, Dr , SpPD, KPTI

Niniek Burhan, Dr, SpPD, KPTI

Didi Chandradikusuma, Dr, SpPD

Div Tropik Infeksi, Lab/SMF Penyakit Dalam FKUB/RSSA Malang

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
CD4 < 200 Ul copy No Cure

Between 34 - 46 million people living with HIV/AIDS worldwide

Eastern Europe & Central Asia

1.2 - 1.8 million

North America

Western Europe

790K - 1.2 million

Caribbean

520K - 680K
North Africa & Middle East

East Asia & Pacific

700K - 1.3 million 550K - 730K

South and Southeast Asia

350K - 590K
Latin America

4.6 - 8.2 million

1.3 - 1.9 million

Sub-Saharan Africa

25 - 28.2 million

Australia & New Zealand

12K - 18K

Source: UNAIDS December 2003

Struktur HIV
Envelop gp 120 gp41 Enzym Reverse

transcriptase Integrase Protease

Inti P17 (matrix) P24 (kapsid) P7/P9

(nucleocapsid)

Infeksi HIV akut

Primary infection 3-6 weeks Plasma viremia (wide disemination of virus) Retrafifcking of lymphocytes

Acute syndrome 1 weeks 3 months

Immunoresponse to HIV Curtailment of plasma viremia 1-2 weeks Clinical latency Establishment of chronic persistent infection in lympoid tissue

Four Stages of HIV

WHO staging system for HIV infection

The

World Health Organization (WHO) has categorized the natural progression of HIV disease into 4 stages.
These categories are part of the WHOs guidelines for

treating HIV patients

They are as follows:

Stage 1 - Primary
Short, flu-like illness - occurs one to six weeks

after infection
no symptoms at all
Performance scale I: asymptomatic, normal activity

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 Weight loss <10% of body weight Minor mucocutaneous manifestations (seborrheic dermatitis, fungal nail infections, recurrent oral ulcers, angular chelitis) Herpes zoster within the past 5 years Recurrent upper respiratory tract infections (bacterial sinusitis) and/or performance scale 2: symptomatic, normal activity

Clinical stage III

Weight loss >10% of body weight Unexplained chronic diarrhea > 1 month

Unexplained prolonged fever (intermittent or constant)

> 1 month Oral candidiasis (thrush) Oral hairy leukoplakia Pulmonary tuberculosis, with 1 year Severe bacterial infections (pneumonia, pyomyositis) and/or performance scale 3: bed-ridden, <50% of the day during past month

 Clinical stage IV AIDS-defining illness TBC- extra pulmonary Kaposi Sarkoma Candidiasis Esophagus and/or performance : bed-ridden, >50% of the day during past month

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

Through Sex
Intercourse (penile penetration into the vagina) Oral Anal Digital Sex

Mother-to-Baby

Before Birth During Birth Postpartum

After the birth

Testing Options for HIV

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

23659874515
Anonymous

When to start antiretroviral therapy?

WHO recommends that, in resource limited settings, HIV infected adults and adolescents should start ARV when they have:
Stage I disease (Asymptomatic) All patients with CD4 count <200

Stage II or III disease (Symptomatic HIV disease) All patients with CD4 < 200 or Total lymphocyte count < 1200
Stage IV disease (AIDS) All patients

Confidential Testing
Persons name is recorded along with HIV results
Name and positive results are reported to the State

Department and the Centers for Disease Control and Prevention

Results issued only to test recipient

Administration
Blood Urine Oral

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

Counseling

Pre-test Counseling
Transmission

Prevention
Risk Factors Voluntary & Confidential Reportability of Positive Test Results

Post-test Counseling
Clarifies test results
Need for additional testing Promotion of safe behavior

Release of results

Treatment Options

Which antiretroviral drugs to use?

Which antiretroviral drugs to use?

WHO Recommended HAART Combinations
3-drug therapy 2 NRTI + 1 NNRTI AZT + 3TC + efavirenz d4T + 3TC + nevirapine 3 NRTI AZT + 3TC + abacavir

2 NRTI + PI AZT + 3TC + nelfinavir AZT + 3TC + lopinavir, indinavir or saquinavir

Antiretroviral Drugs
Nucleoside Reverse Transcriptase inhibitors
AZT (Zidovudine)

Non-Nucleoside Transcriptase inhibitors

Viramune (Nevirapine)

Protease inhibitors
Norvir (Ritonavir)

Why NOT to use dual and monotherapy Progression to AIDS/Death

30 25

No therapy
20 15 10

Mono-therapy Dual-therapy

Triple therapy
5 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Months

JAMA 1998 & CMAJ 1999

Opportunistic Infection Treatment

Issued in an event where antiretroviral drugs are

not available

Four ways to protect from HIV?

Abstinence Monogamous Relationship Protected Sex Sterile needles

Abstinence
It is the only 100 % effective method of not

acquiring HIV/AIDS. Refraining from sexual contact: oral, anal, or vaginal. Refraining from intravenous drug use

Monogamous relationship
A mutually monogamous (only one sex

partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected

Protected Sex

Use condoms (female or male) every time you have

sex (vaginal or anal) Always use latex or polyurethane condom (not a natural skin condom) Always use a latex barrier during oral sex

Needle Exchange Program

Non-profit

Organization, which provides sterile needles in exchange for contaminated ones

The world we have made as a result of the level of thinking we have done thus far creates problems that we cannot solve at the same level at which we have created them... We shall require a substantially new manner of thinking if humankind is to Albert Einstein survive. .

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