Persiapan Anestesi pada Pasien HIV

By : Bramantyo D.M

WHAT IS HIV??
Human Immunodeficiency Virus A unique type of virus (a retrovirus)

Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Threatening a global epidemic.
Preventable, managable but not curable.

WHAT IS AIDS ???

Acquired Immunodeficiency Syndrome HIV is the virus that causes AIDS Disease limits the bodys ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death.

AIDS (definition)
Opportunistic infections and malignancies that rarely occur in the absence of severe immunodeficiency (eg, Pneumocystis pneumonia, central nervous system lymphoma). Persons with positive HIV serology who have ever had a CD4 lymphocyte count below 200 cells/mcL or a CD4 lymphocyte percentage below 14% are considered to have AIDS.

THE VIRAL GENOME

Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA.
Two viral strands of RNA found in core surrounded by protein outer coat.

Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell.

HIV dan AIDS...

HIV: Human Immunodeficiency Virus, adalah virus menyerang dan bertahap merusak sistem immunitas badan dan berkembang menjadi AIDS.

AIDS: Acquired Immune Deficiency Syndrome adalah sekumpulan tanda atau gejala berat dan kompleks yang disebabkan oleh penurunan respon immunitas tubuh.
HIV tidak sama dengan AIDS

Perjalanan Infeksi HIV dan Komplikasi Umum

1000 900 800 700 600 500 400 300 200 100 0

CD4

CD4

Viral Load Infeksi Opportunistik

0 1 2 3 4 5 Bulan

3 4 5 6 7 8 9 10 11 Tahun setelah infeksi HIV

New HIV Infections in 2002 by Age Group

Opportunistic Infections associated with AIDS

Parasitic
Pneumocystis carinii

Fungal
Candida Cryptococcus

Modes of HIV/AIDS Transmission

Through Bodily Fluids

Blood products Semen Vaginal fluids

IntraVenous Drug Abuse

Sharing Needles
Without sterilization Increases the chances of

contracting HIV

Unsterilized blades

Through Sex
Unprotected Intercourse
Oral Anal

Mother-to-Baby

Before Birth During Birth

Myths about transmission

Stage 1 - Primary
Short, flu-like illness - occurs one to six weeks after infection Mild symptoms

Infected person can infect other people

Stage 2 - Asymptomatic
Lasts for an average of ten years

This stage is free from symptoms

There may be swollen glands

The level of HIV in the blood drops to low levels

HIV antibodies are detectable in the blood

Stage 3 - Symptomatic

The immune system deteriorates Opportunistic infections and cancers start to appear.

Stage 4 - HIV AIDS

The immune system weakens too much as CD4 cells decrease in number.

Opportunistic Infections associated with AIDS CD4<500

Bacterial infections Tuberculosis (TB) Herpes Simplex Herpes Zoster Vaginal candidiasis Hairy leukoplakia Kaposis sarcoma

Opportunistic Infections associated with AIDS

CD4<200 Pneumocystic carinii Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporiosis Non hodgkins lymphoma

CD4 <50 Disseminated mycobacterium avium complex (MAC) infection Histoplasmosis CMV retinitis CNS lymphoma Progressive multifocal leukoencephalopathy HIV dementia

Blood Detection Tests

HIV enzyme-linked immunosorbent assay (ELISA) Western blot Screening test for HIV Sensitivity > 99.9% Confirmatory test Speicificity > 99.9% (when combined with ELIZA) Screening test for HIV Simple to perform Predictor of HIV progression Risk of opportunistic infections and AIDS when <200

HIV rapid antibody test Absolute CD4 lymphocyte count

HIV viral load tests

Best test for diagnosis of acute HIV infection Correlates with disease progression and response to HAART

HAART = highly active anti-retroviral treatment

Antiretroviral Drugs (HAART)

Nucleoside Reverse Transcriptase inhibitors
AZT (Zidovudine)

Non-Nucleoside Transcriptase inhibitors

Viramune (Nevirapine)

Protease inhibitors
Norvir (Ritonavir)

LIVING WITH HIV/AIDS

Rencana pengelolaan anestesi

Pengelolaan multisistem :
Riwayat , termasuk faktor risiko Pemeriksaan fisik Tes laboratorium Menilai keterlibatan organ Riwayat obat dan efek samping.

Pemeriksaan penunjang
Hitung darah lengkap Hitung waktu pembekuan dan waktu perdarahan Biokimia tes termasuk glukosa, elektrolit, ginjal & fungsi hati untuk menyingkirkan kemungkinan kelainan metabolisme, seperti gangguan hati atau gangguan ginjal Viral load test dan hitung jumlah CD4+ Radiografi infeksi oportunistik dan TBC Elektrokardiografi dan ekokardiografi kardiomiopati

Perioperatif pertimbangan pasien dengan HIV

Minimalkan terapi ARV yang berlebihan untuk mengurangi resistensi obat Pertimbangkan interaksi penggunaan obat dengan ARV terutama untuk obat-obat yang dimetabolisme oleh enzim di hati. Teknik aseptik yang ketat harus dilaksanakan pada pasien terinfeksi HIV yang immunocompromised dikarenakan rentan terhadap infeksi bakteri Rencana anestesi harus disesuaikan dengan masingmasing pasien dan jenis operasi yang sesuai.