HIV/AIDS

Definisi
 Human Immunodeficiency Virus (HIV)
virus yang menyerang sel imun manusia
dan mengubahnya menjadi ‘pabrik virus’
tempat reproduksi HIV
 Acquired Immunodeficiency Syndrome
(AIDS)
kondisi simtomatik akibat HIV, membuat
penderitanya rentan terhadap infeksi
oportunistik yang dapat menyebabkan
berbagai disabilitas atau kematian
Cara penularan
 Melalui cairan tubuh yang terinfeksi
Kontak seksual
Transfusi darah
Berbagi pakai jarum suntik
Perinatal (ibu ke anak)  darah dan ASI
Patofisiologi
 HIV merupakan retrovirus dengan
diameter 0.1 mikron, sekitar 1/70
diameter sel imun CD4 (T-helper).
 Menyerang banyak sel dalam tubuh: sel
GI, sel organ, dan sel imun.
 Sindrom imunodefisiensi yang terjadi
berhubungan dengan infeksi CD4 aktif
pabrik virus
Patofisiologi
Infeksi HIV primer
 Flu-like symptoms
 Penurunan jumlah sel CD4
 Pertahanan tubuh terhadap infeksi dan
keganasan menurun
 Jumlah sel CD4 – HIV viral load (jumlah
per ml) – diagnosis AIDS
 Penurunan jumlah dan fungsi CD4
berhubungan dengan meningkatnya
insidens penyakit oportunistik
WHO Clinical and Immune Cell
Categories of HIV Infection
HIV/AIDS & Gizi
 Memberikan tantangan yang luas dan beragam
untuk mempertahankan status gizi
 Perubahan status gizi pada pasien dapat
diakibatkan oleh:
Infeksi HIV
Komplikasi penyakit dan ko-infeksi
Terapi penyakit
 Perubahan terjadi dalam hal:
Asupan
Absorpsi
Metabolisme
Ekskresi
HIV in the GI tract
 The response of the intestinal tract includes
the rapid turnover of gut tissue and activation
of immune cells on the intestinal surface.
 HIV infection is associated with depletion of
CD4 cells in the GI tract, which is where more
than 60% of the body’s T lymphocytes reside.
This provides a large reservoir of HIV-infected
cells in the gut and increases risk for the
malabsorption of nutrients
Oral manifestations
 Can be caused by fungal infection, viral
infection, bacterial conditions, neoplastic
problems, salivary gland disease, and other
problems.
 Oral lesions can lead to mouth itching, pain,
a burning sensation (especially when eating
spicy or acidic foods), and taste changes
AIDS-related wasting syndrome (AWS)
 Defined by the Centers for Disease Control and
Prevention (CDC) as a 10% weight loss without
an identifiable cause that is accompanied by
fever or diarrhea for 30 days or more.
 The etiology of wasting may be related to
hormonal deficiencies (testosterone or thyroid),
the cytokine dysregulation often associated with
chronic inflammation/infection, and metabolic
demands of medications
Kriteria diagnosis wasting pada HIV
 Penurunan BB
Penurunan 10% selama 12 bulan atau 7.5%
selama 6 bulan
 IMT <20
 Massa sel tubuh
Kehilangan 5% selama 6 bulan atau
Kehilangan <35% BB jika IMT <27 ♂
Kehilangan <23% BB jika IMT <27 ♀
Lipodystrophy Syndrome
 Loss or absence of fat, or the abnormal
distribution of fat in the body
 In HIV infection; these changes are likely
hormonally mediated.
 Subcutaneous fat loss is most apparent in
peripheral limbs and facial areas.
 Fat deposits are most commonly central,
located in the dorsocervical area, breast
area, and abdominal region.
Metabolisme zat gizi pada HIV berubah
 Infeksi kronis HIV  inflamasi  protein
fase akut terus diproduksi
 Perubahan zat gizi mikro:
Menurunnya kadar selenium, zinc,
magnesium, kalsium, besi, mangan,
tembaga, karoten, choline, glutathione, dan
vit A, B6, B12, dan E dalam serum.
Meningkatnya kadar folat, niacin, dan
karnitin
Anti retroviral drugs (ARV)
 Suppression of viral load by antiretrovirals
has shown varying effects on nutritional
status.
 Weight gains are commonly seen in patients
on successful ARV therapy.
ARV & Its side effects
 Diarrhea
 Nausea/vomiting
 Appetite loss
 Abdominal pain
 Taste change
 Lipid alterations  ↑lipids, total cholesterol
 Glucose intolerance
 Lipodystrophy
Conclusion
 HIV infection creates a number of challenges to
the maintenance of nutritional status.
 While weight loss and wasting are not an
inevitable part of the natural history of HIV
infection, chronic inflammation due to HIV
infections, co-conditions, and complications
assault nutritional status continuously.
 Treatments for HIV infection can both support
and inhibit nutritional status maintenance and
improvement.