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Evy
Yunihastuti
Divisi
Alergi
Imunologi
Klinik
Departemen
Ilmu
Penyakit
Dalam
FKUI/RSCM
Pokdisus
AIDS
FKUI/Unit
Pelayanan
Terpadu
HIV
RSCM
10
Infeksi oportunistik
} Tuberkulosis
} CD4
<
200:
gambaran
klinis
Infeksi oportunistik
} Kandidiasis
orofaring
dan
kandidiasis esofagus
} Herpes zoster
Infeksi oportunistik
} Ensefalitis
toksoplasma
} Meningitis kriptokokus
Infeksi oportunistik
} Histoplasma
} Retinitis
OD
CMV
bening
} Kanker
leher
rahim
} Sarkoma
Kaposi
Cancer
related
virus
Hasil pengobatan
Perbaikan klinis nyata
Bisa produktif
Setelah 6 bulan terapi:
>90% mencapai kadar virus
undetectable: < 400 kopi/cc darah)
Efektivitas
" Respons komplit dan inkomplit 92%
" Gagal terapi 8% (Amir Fauzan, 2005)
Survival 1 tahun
v66% tetap hidup dalam 1 tahun
vSebagian besar meninggal pada 3 bulan
pertama pengobatan (Indah Mahdi, 2005)
% pasien dengan
keberhasilan virologik
80
70
60
50
40
30
20
10
0
95
90-95
80-90
70-80
<70
% Kepatuhan
Patterson, et al. Ann Intern Med. 2000;133:21-30.
Acute HIV+!
Production of HIV
proteins
Gp120, nef
Bacterial
Translocation
Incl. TLR ligand
Viral reactivation
In particular CMV
Sustained T-cell
apoptosis
Turn over and senescence
Secretion of proinflammatory
cytokines
e.g. IL-6, TNF, IL-1
Homeostatic mechanism
Cellular renewal
hematopoesis
HIV
replication
Exhaustion of immune
response
Decline of regenerative capacity
loss of effective anti-HIV immunity
= Immunosenescence?
Damage
To
Lymphoid
tissue
Inflammation-related
disorders
Osteoporosis
Atherosclerosis
Neurocognity deterioration
Frailty
= inflammation-ageing?
Non-AIDS cancers
Osteoporosis
CVD
Depression
Diabetes mellitus
Frailty
COPD
Cognitive disorders
Chronic renal
disease
Tissue"
Cell associated HIV DNA"
HIV RNA
Years on cART
Chun et al., Nature 1997; 387: 183; Lewin et al., J Virol 1999; 73:6099; Palmer et al., Proc Natl Acad Sci U S A.
2008;105:3879; Chun et al., J Infect Dis 1997;195:1762; Yukl J Infect Dis 2010;
EFEKTIVITAS
PENULARAN
Per
kejadian:
Hubungan
seksual
tak
aman
0,1-1%
Tusukan
jarum
/perlukaan
0,3%
Percikan
cairan
tubuh
pada
mukosa
0,09%
Transfusi
darah
>
90%
Dari
ibu
hamil
ke
bayi
35%
Unlinked or TBD
Transmissions: 11
Linked
Transmissions: 28
Immediate
ART: 1
Delayed
ART: 27
p < 0.001
Cohen et al NEJM 2011.
transmission
Immediate Arm
Delayed Arm (not on ART)
Delayed Arm (on ART)
Risiko 18%
melahirkan
Risiko 13%
Sesudah persalinan
Tanpa intervensi:
Risiko 7%
Risiko 18%
Intrauterin
intrapartum
Antiretrovirus
(ARV)
ARV
Operasi sesar
Risiko 13%
pascapersalinan
Bayi: ARV
Susu formula
Intervensi
Dapat menurunkan risiko penularan ke bayi menjadi <2%
GC Cianci
Dinh et al., PLosOne. 2012.
Male
circumcision
Auvert B, PloS Med 2005
Gray R, Lancet 2007
Bailey R, Lancet 2007
Treatment of
STIs
Grosskurth H, Lancet 2000
Microbicides
for women
HIV
Oral pre-exposure
PREVENTION
prophylaxis
combined
Grant R, NEJM 2010 (MSM)
Baeten J , NEJM 2012 (couples)
interventions
Thigpen, NEJM, 2012 (Heterosexuals)
Structural / legal
HIV Counselling
and Testing
Coates T, Lancet 2000
Post Exposure
prophylaxis (PEP)
Scheckter M, 2002
Treatment for
prevention
Donnell D, Lancet 2010
Cohen M, NEJM 2011
Behavioural
Intervention
Kelainan kulit:
Furunkulosis rekuren
Dermatitis seboroik berat
Eksaserbasi psoriasis
Herpes zoster
Sarkoma Kaposi
Klamidia, HPV
Anemia
Neutropenia
Trombositopenia
Limfopenia
Hepatitis:
Hepatitis C
Hepatitis B
Pneumonia:
Pneumonia rekuren
Pneumocystis pneumonia
Tuberkulosis
Infeksi jamur paru
Limfadenopati yang tak ditemukan
penyebabnya
Wanita hamil
Acceptability of HIV
testing is high in large
scale campaigns and
Home based community
testing
Testing must be linked to
services & not simply
numbers
Requires systems for
effective linkage to
services
Navneet
Garg
| Global
Business
Manager
| Vestergaard
Frandsen outreach
In
Kenya:
41,040
people
tested
in 1 week
during a community
TERIMA KASIH
Pokdisus
AIDS
FKUI/RSCM
www.pokdisusaids.com
pokdisus@centrin.net.id
Telp.
021-3905250,
021-3162788