9.3. Hiv
9.3. Hiv
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.