TENTANG
HIV/AIDS
1
HIV & AIDS ARE
DIFFERENT ENTITIES
• 38 million people live with
HIV/AIDS worldwide.
1. 2004 0 1 1
2. 2005 0 2 2
3. 2006 3 4 7
4. 2007 1 9 10
5. 2008 2 9 11
6. 2009 0 15 15
7. 2010 7 18 25
8. 2011 27 33 60
9. 2012 7 26 33
10 SAMPAI DENGAN 12 27 39
30 Juni 2013
TOTAL 59 144 203
Top HIV/AIDS-Infected Countries
1. South Africa 9. United States
2. Nigeria 10. Russian Federation
3. Zimbabwe 11. China
Sub- 4. Tanzania 12. Brazil
Saharan
5. The Congo 13. Thailand
Africa
6. Ethiopia
7. Kenya
8. Mozambique
2-3 mgg
Sembuh
Seroconvesion
There is
NO
cure for
HIV/AIDS
Figure 20
HIV Prevention
Centers for Disease Control
HIV Prevention Funding
and Prevention (CDC)
at CDC, FY 1995-2005
(US $ Millions) ◦ Most prevention
funding
$589.8 ◦ Funds go to states;
$616.8 some cities;
All Other community based
51% ($6.0B)
Medicare $656.6 organizations; other
$749.7 entities/programs
Ryan
White Additional prevention
$793.6 funding also at: Department
$731.7 of Veterans Affairs,
SAMHSA, and other
agencies
Sources: CDC, Personal Communication, 2006; CDC, HIV Prevention
National HIV prevention goal
Strategic Plan Through 2005.
SEJARAH AIDS
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
Indonesia :
Kasus pertama ( BALI ) :April 1987.
Wisatawan Belanda
Kasus kedua ( Jakarta ) :Nopember 1987.
Warga Kanada tinggal di JKT.
Kasus ketiga ( Jakarta ) : 1989. Warga
Perancis tinggal di JKT
Orang Indonesia Pertama di Bali: Juni
1988
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).
15
16
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.
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
Cell free
HIV
T-cell
Immature
Dendritic cell PEP
HIV Immunodeficiency
Virus
Virus penyebab AIDS
Melemahkan sistem kekebalan
tubuh (sel darah putih)
Acquired
Immune
Deficiency
Syndrome
The CD4 cell , also known as "T4" or "helper T cell“ is responsible for
signaling other parts of the immune system to respond to an infection.
Normal counts range from 500 to 1500 cells per cubic millimeter of blood
Initially in HIV infection there is a sharp drop in the CD4 count and then
the count levels off to around 500-600 cells/mm3.
CD4 counts can also be used to predict the risks for particular conditions
such as Pneumocystis carinii pneumonia, CMV disease or MAI disease.
Treatment decisions are often based on Viral Load and CD4 count.
Siapa bisa tertular
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.
Perjalanan Infeksi
HIV
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.
‘typical’ primary HIV-1 infection
symptoms symptom
s
HIV proviral DNA
HIV antibodies
‘window’
period
0 1 2 3 4 5 6 / 2 4 6 8 10
1° infection weeks years
Time following infection
Natural History of Untreated HIV
Infection
Four Stages of HIV
Stage 1 - Primary
Short, flu-like illness - occurs one to six weeks after
infection
no symptoms at all
Infected person can infect other people
Stage 2 - Asymptomatic
Bacterial
Tuberculosis (TB)
Strep pneumonia
Viral
Kaposi Sarcoma
Herpes
Influenza (flu)
Opportunistic Infections
associated with AIDS
Parasitic
Pneumocystis
carinii
Fungal
Candida
Cryptococcus
AIDS
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.
HIV menular melalui :
Menggunakan jarum suntik :
secara bergantian
bekas pakai
tidak steril
Hubungan seks berganti-gantian
pasangan
Dari ibu ke bayi melalui :
Hamil
Melahirkan
menyusui
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
2. Homoseksual.
Before Birth
During Birth
Postpartum
After the birth
Oral Candidiasis (thrush)
Oral Hairy Leukoplakia
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
EnzymeLinked 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 bloodderived fluids
from the gum tissue.
NOT A SALIVA TEST!
TREATMENT OPTIONS
ANTIRETROVIRAL DRUGS
Nucleoside Reverse Transcriptase inhibitors
AZT (Zidovudine)
NonNucleoside 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 patient’s 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 waterbased rather than oilbased 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 person’s use
The Move Toward Lower Pill Burdens
Regimen Dosing Daily pill burden
1996
Zerit/Epivir/Crixivan 10 pills, Q8H
1998
Retrovir/Epivir/Sustiva 5 pills, BID
2002
Combivir (AZT/3TC)/EFV 3 pills, BID
2003
Viread/ Emtriva/Sustiva 3 pills, QD
2004
Truvada/Sustiva 2 pills, QD
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
Vaccines?
Whole virus vaccines
Attenuated viruses: Essentially intact, living HIV virions that have
been chemically or genetically damaged.
Whole killed virus: Intact virions that have been damaged so badly
that they are completely nonfunctional (dead).
Subunit vaccines
Clone one gene from HIV, express the protein and use it to vaccinate
patients. The disadvantage is that the person only raises antibodies
against one target. With free virus, the targets are mainly the
envelope proteins; however, these are extremely variable proteins.
Six amino acids of the V3 loop of gp120 appear to be relatively
constant (some variability exists but most antibodies cross react with
the variants). Antibodies against cocktails of different V3's are being
tried.
ZERO DEATH
ZERO DISCRIMINATION