1

Pertama Kali Timbul di Afrika, Haiti dan USA

1978
1979 Sarkoma Kaposi pada orang Afrika
yang mukim di Eropa
1981 USA . Sarkoma Kaposi di kalangan
Homo Seks
1982 Luc Montagnier ,Paris.
LAV (Limphadenonathy Associated
Virus)
1984 Transmisi Heteroseks, Galo dkk.
HTLV IIII
1986 Penyebab AIDS adalah HIV
Characteristics of the virus
HIV
The outer shell of the virus is
known as the Viral enevlope.
Embedded in the viral
envelope is a complex protein
known as env which consists
of an outer protruding cap
glycoprotein (gp) 120, and a
stem gp14. Within the viral
envelope is an HIV protein
called p17(matrix), and within
this is the viral core or capsid,
which is made of another viral
protein p24(core antigen).
Life Cycle
(a) HIV (red) attaches to two cell-surface receptors
(the CD4 antigen and a specific chemokine
receptor).
(b) The virus and cell membrane fuse, and the virion
core enters the cell.
(c) The viral RNA and core proteins are released
from the virion core and are then actively
transported to the nucleus.
(d) The viral RNA genome is converted into double-
stranded DNA through an enzyme unique to viruses,
reverse transcriptase (red dot).
(e) The double-stranded viral DNA moves into the
cell nucleus.
(f) Using a unique viral enzyme called integrase, the
viral DNA is integrated into the cellular DNA.
(g) Viral RNA is synthesized by the cellular enzyme
RNA polymerase II using integrated viral DNA as a
template. Two types of RNA transcripts shorter
spliced RNA (h) and full-length genomic RNA (j) are
produced.
(h) Shorter spliced RNAs are transported to the
cytoplasm and used for the production of several
viral proteins that are then modified in the Golgi
apparatus of the cell (i).
(j) Full-length genomic RNAs are transported to the
cytoplasm (k).
(l) New virion is assembled and then buds off.
(m) Mature virus is released.
Viral Replication
First step, HIV attaches to susceptible host cell.
Site of attachment is the CD4 antigen found on a
variety of cells
helper T cells
macrophages
monocytes
B cells
microglial brain cells
intestinal cells
T cells infected later on.

Early Phase HIV Infection
In early phase HIV
infection, initial
viruses are M-tropic.
Their envelope
glycoprotein gp120 is
able to bind to CD4
molecules and
chemokine receptors
called CCR5 found on
macrophages
http://www.cat.cc.md.us/courses/bio141/lecguide/unit2/viruses/hivad.html

In late phase HIV
infection, most of the
viruses are T-tropic,
having gp120 capable
of binding to CD4 and
CXCR4 found on T4-
lymphocytes.
HIV (arrows) Infecting a T-lymphocyte

HIV




AIDS
Human
Immunodeficiency
Virus
Virus penyebab AIDS
Melemahkan sistem kekebalan
tubuh (sel darah putih)
Acquired
Immune
Deficiency
Syndrome
Kumpulan beberapa gejala akibat
menurunnya sistem kekebalan
tubuh yang disebabkan oleh HIV.

Siapapun bisa tertular HIV, jika perilakunya
berisiko.
Penampilan luar bukan jaminan bebas HIV.
Orang dengan (+)HIV sering terlihat sehat
dan merasa sehat.
Jika belum melakukan tes HIV, orang
dengan (+)HIV tidak tahu bahwa dirinya
sudah tertular HIV dan dapat menularkan
HIV pada orang lain.
Tes HIV adalah satu-satunya cara untuk
mendapatkan kepastian tertular HIV atau
tidak.

Tertular Periode HIV AIDS
HIV Jendela* Positif


2 minggu - 6 bulan 3 - 10 1 - 2
Tahun Tahun
* Masa antara masuknya HIV Tanpa Gejala Timbul
kedalam tubuh manusia Tampak sehat infeksi
sampai terbentuknya antibody Dapat berakti- oportunistik
terhadap (+)HIV. vitas biasa.
Sudah bisa menularkan HIV
kepada orang lain.

symptoms
HIV-1 p24 antigen
0 1 2 3 4 5 6 / 2 4 6 8 10
weeks years
HIV antibodies
Time following infection
HIV viral load
HIV proviral DNA
symptoms
window
period
1 infection
Short, flu-like illness - occurs one to six weeks after
infection
no symptoms at all
Infected person can infect other people
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


The symptoms are mild
The immune system deteriorates
emergence of opportunistic infections and cancers

The immune system
weakens

The illnesses become
more severe leading to
an AIDS diagnosis

Bacterial
Tuberculosis (TB)
Strep pneumonia

Viral
Kaposi Sarcoma
Herpes
Influenza (flu)
Parasitic
Pneumocystis carinii

Fungal
Candida
Cryptococcus
CD4 count drops below 200 person is considered to have
advanced HIV disease
If preventative medications not started the HIV infected
person is now at risk for:
Pneumocystis carinii pneumonia (PCP)
cryptococcal meningitis
toxoplasmosis
If CD4 count drops below 50:
Mycobacterium avium
Cytomegalovirus infections
lymphoma
dementia
Most deaths occur with CD4 counts below 50.

Menggunakan jarum suntik :
secara bergantian
bekas pakai
tidak steril
Hubungan seks berganti-gantian
pasangan
Dari ibu ke bayi melalui :
Hamil
Melahirkan
menyusui
HIV menular melalui :
Modes of HIV/AIDS Transmission
Transmission
Through Bodily Fluids
Blood products
Semen
Vaginal fluids
Breast Milk

Penularan AIDS dapat melalui:
Hubungan seksual yang memungkinkan
pemindahan virus dari sperma dan cairan vagina/
serviks

Pemindahan darah yang mengandung HIV

Penularan kepada janin dari ibu penderita AIDS
Kelompok Resiko Tinggi

1. Aktif dalam perilaku seksualnya( WTS, PTS )

2. Homoseksual.

3. Mereka yg suka/ pernah melakukan hubungan
seksual dgn orang asing yang berasal dari
daerah dimana insidens AIDS tinggi.
4. Penyalah guna obat/narkotika
Through Sex
Intercourse (penile penetration into the vagina)
Oral
Anal
Digital Sex
Mother-to-Baby

Before Birth
During Birth
Postpartum
After the birth
Oral Candidiasis (thrush)
Oral Hairy Leukoplakia
Being that HIV reduces immunologic activity, the intraoral
environment is a prime target for chronic secondary
infections and inflammatory processes, including OHL,
which is due to the Epstein-Barr virus under
immunosuppressed conditions
Kaposis sarcoma (KS)
Kaposis sarcoma (shown)
is a rare cancer of the
blood vessels that is
associated with HIV. It
manifests as bluish-red
oval-shaped patches that
may eventually become
thickened. Lesions may
appear singly or in
clusters.
HIV tidak menular melalui :
Gigitan nyamuk atau serangga lain
Berenang bersama
Memakai toilet umum
Bersalaman, pelukan ataupun ciuman
Terpapar batuk atau bersin
Berbagi makanan atau menggunakan
alat makan bersama
Air kotor, Udara
Status HIV hanya dapat diketahui melalui
Konseling dan Testing HIV Sukarela
Testing HIV merupakan pengambilan
darah dan pemeriksaan laboratium disertai
konseling pre dan pasca testing HIV
Konseling dan Testing HIV Sukarela
dilakukan dengan prinsip tanpa paksaan,
rahasia, tidak membeda-bedakan serta
terjamin kualitasnya.


Anda tidak melakukan seks bukan
dgn pasangannya
Bersikap saling setia dengan
pasangan
Cegah dengan memakai kondom
lateks
Jangan menggunakan narkoba suntik
BEBERAPA ATURAN POKOK KEPERAWATAN
Perawat disarankan memakai baju penutup dan
sarung tangan bila memegang tubuh penderita,
khususnya bila ada kemungkinan terkena sekret
tubuhnya.
Memberi makan, sama seperti pada penderita
Hepatitis B.
Beri pelindung pada jasur dan bantal ( plastik )
Sprei, perlu diketahui bahwa HIV sgt mudah
dibunuh dgn detergen.
Jarum suntik: sama sekali jangan dimasukkan
kembali kedalam penutup jarum dan gunakan botol
plastik/ kaleng pembuangan khusus untuk semua
alat tajam.( Perawat yg telah dilatih )
BEBERAPA ATURAN POKOK KEPERAWATAN
Bersihkan ruangan seperti biasa

Kamar mandi/ WC , pemeliharaan seperti biasa.

Tempelkan stiker khusus dgn tulisan BAHAN
MENULAR pd semua botol spesimen yg akan
dikirim ke laboratorium

Tangan harus selalu dicuci selama dan sesudah
segala aktifitas pelayanan terhadap penderita,
walaupun mempergunakan sarung tangan.

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
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!
TREATMENT OPTIONS
ANTIRETROVIRAL DRUGS
Nucleoside Reverse Transcriptase inhibitors
AZT (Zidovudine)
Non-Nucleoside Transcriptase inhibitors
Viramune (Nevirapine)
Protease inhibitors
Norvir (Ritonavir)
WESTERN BLOT
Expensive $ 80 - 100
technically more difficult
visual interpretation
lack standardisation
- performance
- interpretation
- indeterminate reactions
resolution of ??
Gold Standard for
confirmation
POLYMERASE CHAIN REACTION
(PCR)
Looks for HIV DNA in the WBCs of a person.
PCR amplifies tiny quantities of the HIV DNA
present, each cycle of PCR results in doubling of
the DNA sequences present.
The DNA is detected by using radioactive or
biotinylated probes.
Once DNA is amplified it is placed on nitrocellulose
paper and allowed to react with a radiolabeled
probe, a single stranded DNA fragment unique to
HIV, which will hybridize with the patients HIV DNA
if present.
Radioactivity is determined.

VIRUS ISOLATION
Virus isolation can be used to definitively
diagnose HIV.
Best sample is peripheral blood, but can use
CSF, saliva, cervical secretions, semen,
tears or material from organ biopsy.
Cell growth in culture is stimulated, amplifies
number of cells releasing virus.
Cultures incubated one month, infection
confirmed by detecting reverse transcriptase
or p24 antigen in supernatant.
OPPORTUNISTIC INFECTION TREATMENT

Issued in an event where antiretroviral drugs are not
available
FOUR WAYS TO PROTECT YOURSELF?
Abstinence
Monogamous Relationship
Protected Sex
Sterile needles
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
WHEN USING A CONDOM
REMEMBER TO:
Make sure the package is not expired
Make sure to check the package for damages
Do not open the package with your teeth for risk of tearing
Never use the condom more than once
Use water-based rather than oil-based condoms
STERILE NEEDLES
If a needle/syringe or cooker is shared, it must be
disinfected:
Fill the syringe with undiluted bleach and wait at least 30
seconds.
thoroughly rinse with water
Do this between each persons use
The Move Toward Lower Pill Burdens
Dosing Daily pill burden Regimen
1996
Zerit/Epivir/Crixivan 10 pills, Q8H
2002
3 pills, BID Combivir (AZT/3TC)/EFV
1998
Retrovir/Epivir/Sustiva
5 pills, BID
2003
3 pills, QD Viread/ Emtriva/Sustiva
2004
2 pills, QD Truvada/Sustiva
TRUVADA
Truvada is made up of HIV drugs from a class
called nucleoside/nucleotide reverse transcriptase
inhibitors (NRTIs), also known as nukes.
The NRTIs block reverse transcriptase, a protein
that HIV needs to make more copies of itself. This
may slow down HIV disease
PENUTUP
Sesuai dgn sifat AIDS itu sendiri, maka
pencegahan AIDS relatif mudah, yaitu menghindari
pemakaian jarum suntik berganti ganti dan
menghindari hubungan seksual dgn pasangan
ganda.
Agama dan Pancasila melarang hubungan seksual
ekstra marital. Akan tetapi penggunaan jargon
jargon Agama atau Pancasila dalam batasan
ucapan verbal saja jelas tidak ada gunanya,
bahkan bisa membuat orang tertutup terhadap
informasi yang benar