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Faridha S Ilyas

Aquired

Immunodefciency

Syndrome (AIDS)

Copyright © 2005 by Garland Science Publishing

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PENDAHULUAN• AIDS: kumpulan gejala akibat penurunan imunitas yang

didapat akibat inf. HIV sehingga mudah terkena berbagai

infeksi oportunistik dan penyakit keganasan.

• Transmisi melalui !ara" yaitu:

#$% &ertikal dari ibu ke anak

#'% transeksual #homoseksual maupun heteroseksual%

#% hori(ontal yaitu kontak dengan darah terinfeksi

Air liur bukti yang meyakinkan )

1

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HIV infections caused millions ofmorbidity and mortality around the world

20 millions has died from AIDS, 40 millions are alive with HIV

HIV!" world wide# HIV2" $est Africa and India %200!&

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Kondisi Terbaru

Situasi 'asus I(SHIV dan AIDS )rov Sulsel *anuari + *uni200

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• *anifestasi AIDS rata+rata timbul $, tahun sesudah infeksi.

• -enderita yang sistem imunitasnya sudahsangat menurun jumlah sel D/ yang

rendah 0 hilangnya fungsi sel D/ infeksioportunistik yang sistemik.

• 1 2,3 penderita HIV mengalami infeksi

oportunistik" #bakteri" jamur" &irus" sertainfeksi parasit%.

2

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PERJALANANPERJALANAN

PENYAKITPENYAKIT

Ter

tular

PositipPositip

WINDOW

PERIOD 3-6 BL

6 – 12 TH RATA-RATA ! TH6 – 12 TH RATA-RATA ! TH

TANPA "E#ALA A$I%TO%ATI$TANPA "E#ALA A$I%TO%ATI$

AID$

%ATI DL% 2 TH%ATI DL% 2 TH

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AIDS Characeri!ic!

- Susce.tibility to infection with o..ortunistic .atho/ens

or by the occurrence of a//ressive form of certain

mali/nancies

- D41 cells ↓

- S.read by contact with body 3uid

-  ransmission"

+ Seual intercourse

+ ontaminated needles

+ 5reast feedin/

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HIV is a retrovirus that infects D4 cells,

dendritic cells and macro.ha/es throu/h their

chemo6ine rece.tors

78 %78 virus& and 974 %94 virus&

Free virus: - blood - vaginal fluid

  - semen - mother’s milk  

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HIV

Variants

7ece.t

or

o

rece.tor

ell

lines

7e:uireme

nt of entry

78 78 ;<

;4

;8

D

(=

  cells

;ow level of

D4

74 974 9;!2 cell Hi/h level of

D4

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Immune res.onse to HIV %Fi/> !!2?&

D4 cells declines, D

cells and antibody titer hi/h D4 low, Dlow, antibodylow

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"ira# Enry- (ucosal e.ithelia

+ @.osed to forei/n anti/ens+ )rovide a milieu of immune system activity in which

HIV re.lication occurs readily

- 2 ty.es of e.ithelial cell linin/+ Va/ina, .enis, cervi, anus %stratied s:uamous

e.ithelium&

- D with Dsi/n + bind viral /. !20  HIV is internaliBed

 brou/ht to lym.h tissue  .resent it to D4 cells+ 7ectum, endocervi %sin/le layer of e.ithelial cells&

- @.ithelium e.ress 78  translocate 78 variants to

submucosal D4 cell and D

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Lae in in$ecion%

- 80C of cases

- Viral .henoty.e switches to 94 ty.e

- sa/e of 974- Associate with ra.id decline of D4 count

- (echanism loss of D4

+ Direct viral 6illin/ of infected cells

+ E susce.tibility to induction of a.o.tosis in infected cell

+ 'illin/ of infected D4 cells by ;

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Virus HIV merupakan retro&irus obligat inraseluler

dengan replikasi sepenuhnya di dalam sel host

16Sumber: deshya.wordpress.com/

category/uncategorized/

http://deshya.wordpress.com/category/uncategorized/http://deshya.wordpress.com/category/uncategorized/http://deshya.wordpress.com/category/uncategorized/http://deshya.wordpress.com/category/uncategorized/http://deshya.wordpress.com/category/uncategorized/

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 Sumber: thefutureofthings.com/articles.php?itemId=21/! 1&

http://thefutureofthings.com/articles.php?itemId=21/60/http://thefutureofthings.com/articles.php?itemId=21/60/http://thefutureofthings.com/articles.php?itemId=21/60/http://thefutureofthings.com/articles.php?itemId=21/60/

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 he infection of D4 cells by HIV

974

78or

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Tat: transcription regulatorRev: export transcr from nucleus

Gag: core & matrix

Pol: RT, protease, integrase

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 reatment ar/ets

974

Viral reverse

transcri.taseinhibitor

78or

Further cycles of infection

is prevented

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Viral .roteaseinhibitor

Releasing virionsare not infectious

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 reatment ar/ets

974

78or

.e.tide analo/s of the carboy terminal .e.tide of /.4! %   decline .lasma HIV 7A levels

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- )hase !> Viral .roductions declines, virus level in .lasma

decrease G ?8C

- )hase 2> Activation of restin/ D4 cells and macro.ha/es,

virus level declines to undetected level

- )hase  )rovirus in memory cells and other reservoirs

Virus decay o

dru/ treatme

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Variety ofo..ortunistic

infections and

cancers can 6illAIDS .atients>

%Fi/ure !!

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 Perjalanan Infeksi HIV 

HI' tu(u) *+s i+,u(asi -1. t) /e0ala AID$

Ta*pa, se)at

Berta)ap

(erta*(a) (erat

*e+i+//al

Perioe 0e+elai+o perio4

3-6 (l

HI' -4

*e+ular

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Gejala klinis HIV/AIDS 

staiu* pe+5a,it staiu* aal i+7e,si HI'

$taiu* ta+pa /e0ala

$taiu* si*to*ati, i+i

$taiu* AID$ si*8la+0ut

$taiu* para)

 Stadium awal infeksi HIV 

sa,it ((rp )ari9*// sesua) i+7e,si

/e0ala *irip i+7lue+sa e*a*

lesu9le*a)

+5eri se+i

(atu,9sa,it te+//oro,a+

pe*(esara+ ,ele+0ar

Hila+/ se+iri

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 Stadium tanpa gejala

tia, ti*(ul /e0ala apapu+

ta*pa, se)at

HI' :4

pt (erla+/su+/ -& t) ;irus terus *e+5era+/ perta)a+a+ tu(u)

 Stadium simtomatik dini 

istila) ,li+is (ila ter0ai 2 atau le(i) /e0ala ,li+is 5/

  (erla+/su+/ 3 (l9le(i) ,elai+a+ ara)

e*a* < 3! = ,eri+/at *ala* (er,ala9terus *e+erus

BB turu+ < 1. > l* 3 (l

?ele*a)a+ tu(u) *e+//a+//u a,ti;itas 7isi, se)ari-)ari

L++8 %e*(esar *ultipel le)er i+/ui+al a@ila

iare (er,ala9terus la*a se(a( ta, 0elas

(atu, sesa, < 1 (l

,ulit /atal (era, *era)-,e(irua+

sa,it te+//oro,a+

pe+ara)a+ ta, 0elas se(a(+5a

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 Stadium AIDS (simp.lanjut)

,e,e(ala+ tu(u) sa+/at rusa, 

i+7e,si oportu+isti, 

TB=

=a+iiasis To@oplas*osis

P+eu*o5stis

$ar,o*a ,aposi

Li*7o*a

 Stadium AIDS (simp.lanjut) ,e,e(ala+ tu(u) sa+/at rusa, 

i+7e,si oportu+isti, 

TB=

=a+iiasis To@oplas*osis

P+eu*o5stis

$ar,o*a ,aposi

Li*7o*a

,e*atia+

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"#santem $I%/ retro&irus

Infeksi primer 

$taiu* aal

St di #li i# l t

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'()

Sindrom *eiter:

+alanitis sirsinata

,ll dpt t-d flu#tuatif

Stadium #lini# laten

#Stadium simtomatik dini%

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$taiu* la+0ut

i+7e,si oportu+isti,4

Lesi oral seri+/ *u+ul se(a/ai ta+a aal ari i+7e,si HI'

Ta+pa pe*eri,saa+ seara )ati-)ati seri+/ tia, terpi,ir,a+

Lesi oral seri+/ tia, terasa +5eri lesi isrete

?aa+/ satu-satu+5a ta+a i+7e,si HI' 5/ ite*u,a+

%aa* *a+i7estasi I+7e,si HI' paa oral18 I+7e,si 0a*ur

28 I+7e,si (a,teri

38 I+;e,si ;irus

C8 Neoplas*a

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I+7e,si 0a*ur

•I+7e,si 0a*ur terseri+/ aala) a+iiasis

•#i,a ite*u,a+ a+iiasis oral p pasie+ *ua a+ se)atHI'

Di,e+al C tipe a+iiasis oral

18 Tipe pseuo*e*(ra+ous t)rus) terseri+/  i0u*pai i*a+a sa0a p a;u* oris

28 Tipe H5perplasti

  %irip pseuo*e*(ra+ous tetapi *ele,at erat paa 0ari+/a+

38 Tipe Er5t)e*atous

Ta*pa, se(a/ai lesi pat) erite* paa area *u,osa

  Paa lia) ta*pa, se(a/ai aera) atro7i )alus ta+pa te@tur

C8 Tipe A+/ular )eilitis

  Di0u*pai 7isura paa suut *ulut

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pseudomembrane type

'seudomembrane candidiasis

with geographic border 

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$ypertropic candidiasis

at hard palate

$ypertrophic type

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Pe+isilosis

INFE?$I 'IRU$

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  penderita $I%

$erpes labialisINFE?$I 'IRU$

Imuno#ompeten

H$'

$( d i

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penderita $I%

imuno

#ompeten.

$( pada penis

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$erpeti# hitlow

gangrenous

$( pada &ul&a

penderita $I%0

H" PD ANAL

5S6"* '"7, $I%

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• oster disseminasi

multidermatom

#ontralateral dan )0

multidermatom

#ontralateral #ronis ulseratif0

)

• *e#urensi• 'ersistensi•3 ulseras4

5S6"* '"7, $I%

P oral (o+e +erosis

  toot) e@7oliatio+

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SA45*A 6A-5SI

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LIPOHGPERTROPHG

LIPOHGPERTROPHG LIPOATROPHG

HI'-A$$=IATED

$GNDRO%ELIPODG$RROPHG

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86he Slim

,isease9

86he wasting

syndrome9

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es anti!odi HIV 

18 %a+7aat

- *eli+u+/i perseiaa+ ara) i (a+, ara)

- *e+//a*(ar,a+ (esar+5a *asala) HI'9AID$ i *s58- *e+/eta)ui status HI' seara i+i

28 %aa* tes

- ELI$A - sree+i+/

- I**u+o(lot atau Wester+ (lot - pasti

- P=R

38 I+terpretasi

  Bila :4 - pu+5a a+ti(oi t) HI'

  - teri+7e,si HI'

  - pt *e+ular,a+ HI'  ,o+7ir*asi ester+ (lot

  Bila -4 14 t, teri+7e,si HI'

  24 teri+7e,si perioe 0e+ela .-6 (l

  ula+/ 3-6 (l

DIA"NO$I$

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ujuan Pengo!atanujuan Pengo!atan

%e+e,a+ 0u*la) ;irus HI' seara *a,si*al

%e*uli),a+ i*u+itas tu(u)

%e*per(ai,i ,ualitas )iup

%e+e,a+ *or(iitas a+ *ortalitas

E;aluasi ,aar RNA HI' ala* plas*a *e+uru+  1 lo/ 1. ala* ! *i+//u a+ tia, 

  terete,si la/i ala* C-6 (ula+

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• 7umlah D/ bukan satu+satunya kriteria

 pemberian A4V

• -emberian A4V tidak segera diberikan pada

 penderita yang di!urigai langkah+langkah

 bijaksana" faktor kemampuan" kesanggupan

 pengobatan jangka panjang" resistensi obat"

efek samping" serta saat yang tepat memulai

terapi.3

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 Pengobatan (A,B,C)

A18 HI'

28 I+7e,si oportu+isti, 

38 %e*per(ai,i ?U

I+7us

Tra+s7usi ara)

Al(u*i+

Diet

C8 Lai+-lai+

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 Pengo!atan

8•*enjaga kebersihan

•Istirahat•5lahraga•4elaksasi" meditasi

-sikososial•D(ikir" doa bersama

•-ekerjaan•-enerimaan lingkungan

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 "apan mulai pengo!atan #

•-asien dg sindroma HIV akut•-asien dg serokon&ersi 9 bulan pertama

•-asien tahap AIDS

•-asien tanpa gejala:

D/ ; 1 ,",,, !opies?m> #bD@A%

  1

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 @4TI @@4TI -I

Aba!a&ir #A8%

Didanosin #ddi%

>ami&udin #T%Sta&udin #d/T%

ido&udin #DV

atau AT%

Bfa&iren( #BCV

atau BC%

 @e&irapine#@V-%

Indina&ir #DV%

4itona&ir #4TV" r%

>opina&ir ritona&ir #>-V?r%

 @elfina&ir #@CV%

SaEuina&ir #SFV%

22

AR' 5/ ire,o*e+asi,a+ WHO 2..24

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6olom A 6olom 8 @e&irapine

#@e&iralG%

 @elfina&ir 

AT ddI

ddI T

d/T ddIAT T

#Du&iralG%

AR' i I+o+esia Dep,es 2..34

$b bagus: 7e&iral   

  ,u&iral   

$b turun: 7e&iral   

  Sta&iral

$i&iral  

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SJ $HA

- &'ILITAS PENDDK YAN* TIN**I

- KRISIS EK'N'&I ERKEPANJAN*AN

- KE*IATAN PR'STITSI &EREAK - ADANYA KLP+ RESIK' TIN**I

- K'ND'& SE

- TREND D*E& , *AL

- KRISIS &'RAL- STATE&ENT N'++ DR*, *A&LIN*,

PR'STITTI'N

- ID &ENIN*KAT TAJA&

T-E PR'LE&A

How

Much ?

TERIMAKASIH

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TERIMAKASIH