FAKTA

TENTANG

HIV/AIDS
1

HIV & AIDS ARE

DIFFERENT ENTITIES

 38 million people live with

HIV/AIDS worldwide.

Sub-Saharan Africa is home

to 70% of the people living
with HIV.

2.1 million children are infected

HIV/AIDS Worldwide
with HIV/AIDS in the world

Top HIV/AIDS-Infected
Countries

SubSaharan
Africa

1.

South Africa

9.

United States

2.

Nigeria

10.

Russian Federation

3.

Zimbabwe

11.

China

4.

Tanzania

12.

Brazil

5.

The Congo

13.

Thailand

6.

Ethiopia

7.

Kenya

8.

Mozambique

Source: Steinbrook R. The AIDS epidemic in 2004. NEJM. 2004;351:115-117.

Figure 1

The U.S. Epidemic: Snapshot of

Key Data
New infections
each year

40,000

People living with 1,039,000

HIV/AIDS
1,185,000
People with
HIV/AIDS not in
care

42 59%

People with HIV

who dont know
theyre infected

24 27%

Note: Data are estimates.

Sources: CDC, 2005; Glynn, K. et al., CDC, "Estimated HIV prevalence in the United States at the
end of 2003", Presentation at the National HIV Prevention Conference, 2005; Fleming, P., et al., HIV
Prevalence in the United States 2000, 9 th Conference on Retroviruses and Opportunistic Infections,
2002.

Perjalanan Klinis Infeksi HIV.

TERINFEKSI

2-3 mgg

Acute Retroviral
Syndrome
2-3 mgg

Sembuh
Seroconvesion

1,3 TH

AIDS

8 THN

ASIMTOMATIK

IS THERE A CURE?

There is
NO
cure for
HIV/AIDS

Figure 20

Centers

for Disease Control

and Prevention (CDC)

HIV Prevention

Most prevention
funding
Funds go to states;
some cities;
community based
organizations; other
entities/programs

HIV Prevention Funding

at CDC, FY 1995-2005
(US $ Millions)

$589.8
$616.8

Medicare
Ryan
White

All Other
51% ($6.0B)

$656.6
$749.7
$793.6
$731.7

Additional prevention funding

also at: Department of
Veterans Affairs, SAMHSA,
and other agencies

National HIV prevention goal

(reduce new infections by
50% by 2005) was not met

Sources: CDC, Personal Communication, 2006; CDC, HIV Prevention

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).

13

14

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 fulllength 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 Mtropic. 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

In late phase HIV

infection, most of
the viruses are Ttropic, having
gp120 capable of
binding to CD4 and
CXCR4 found on
T4-lymphocytes.

Early Phases of HIV Infection of

Mucosal Surfaces
Cell free

HIV
T-cell

Immature
Dendritic cell
Skin or
mucosa

HIV co-receptors,
CD4 + chemokine
receptor CC5

Burst of HIV
replication

Via lymphatics or
circulation
24 hours

1.

PEP

2.

48 hours
Selective of
macrophagetropic HIV

3.

Mature Dendritic
cell in regional LN
undergoes a single
replication, which
transfers HIV to T19
cell

HIV (arrows) Infecting a Tlymphocyte

HIV

Human
Immunodeficiency
Virus

AIDS

Virus penyebab AIDS

Melemahkan sistem kekebalan
tubuh (sel darah putih)

Acquired
Immune
Deficiency
Syndrome

Kumpulan beberapa gejala

akibat menurunnya sistem
kekebalan tubuh yang
disebabkan oleh HIV.

CD4 COUNT IN HIV INFECTION

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 count is a marker of likely disease progression. CD4

percentage tends to decline as HIV disease progresses.

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
HIV

Periode

HIV

Jendela*

2 minggu - 6 bulan
Tahun

AIDS

Positif

3 - 10

1 - 2

Tahun

* Masa antara masuknya HIV Tanpa Gejala

kedalam tubuh manusia

Tampak sehat

sampai terbentuknya antibody

terhadap (+)HIV.
kepada orang lain.

infeksi

Dapat berakti- oportunistik

vitas biasa.

Sudah bisa menularkan HIV

Timbul

typical primary HIV-1 infection

symptoms

symptoms

HIV proviral DNA

HIV antibodies

window
period

HIV viral load

HIV-1 p24 antigen
0
1 infection

2
weeks

Time following infection

10
years

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
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 very low

levels
HIV antibodies are detectable in the blood

Stage 3 - Symptomatic
The symptoms are mild
The immune system deteriorates
emergence of opportunistic infections and

cancers

Stage 4 - HIV AIDS

The immune

system weakens
The illnesses

become more
severe leading to
an AIDS diagnosis

Opportunistic Infections
associated with AIDS
Bacterial
Tuberculosis

(TB)
Strep
pneumonia

Viral
Kaposi Sarcoma
Herpes

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
Pemindahan darah yang mengandung HIV
Penularan kepada janin dari ibu penderita

AIDS

Kelompok Resiko Tinggi

1. Aktif dalam perilaku seksualnya( WTS,

PTS )
2. Homoseksual.
3. Mereka yg suka/ pernah melakukan

hubungan seksual dgn orang asing yang

berasal dari daerah dimana insidens AIDS
tinggi.
4. Penyalah guna obat/narkotika

Through Sex
Intercourse (penile penetration into the

vagina)
Oral
Anal
Digital Sex

Mother-to-Baby

Before Birth
During Birth
Postpartum
After the birth

Oral Candidiasis (thrush)

Oral Hairy Leukoplakia

Being that HIV reduces immunologic activity, the

intraoral environment is a prime target for chronic

secondary infections and inflammatory processes,
including OHL, which is due to the Epstein-Barr
virus under immunosuppressed conditions

Kaposis sarcoma (KS)

Kaposis sarcoma

(shown) is a rare
cancer of the blood
vessels that is
associated with HIV. It
manifests as bluish-red
oval-shaped patches
that may eventually
become thickened.
Lesions may appear
singly or in clusters.

HIV tidak menular

melalui :
Gigitan nyamuk atau serangga lain
Berenang bersama
Memakai toilet umum
Bersalaman, pelukan ataupun

ciuman
Terpapar batuk atau bersin
Berbagi makanan atau
menggunakan alat makan bersama
Air kotor, Udara

Bagaimana mengetahui
status HIV ?
Status HIV hanya dapat diketahui melalui

Konseling dan Testing HIV

Sukarela
Testing HIV merupakan pengambilan
darah dan pemeriksaan laboratium
disertai konseling pre dan pasca
testing HIV
Konseling dan Testing HIV
Sukarela dilakukan dengan prinsip
tanpa paksaan, rahasia, tidak

N
A
R
A
L
U
N
E
P
H
A
G
E
C
N
E
M
A
R
CA
HIV :

Anda tidak melakukan seks

bukan dgn
pasangannya
Bersikap saling setia dengan
pasangan
Cegah dengan memakai
kondom lateks
Jangan menggunakan
narkoba suntik

BEBERAPA ATURAN POKOK

KEPERAWATAN
Perawat disarankan memakai baju penutup dan
sarung tangan bila memegang tubuh penderita,
khususnya bila ada kemungkinan terkena sekret
tubuhnya.
Memberi makan, sama seperti pada penderita
Hepatitis B.
Beri pelindung pada jasur dan bantal ( plastik )
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

Enzyme-Linked

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 blood-derived fluids
from the gum tissue.
NOT A SALIVA TEST!

TREATMENT OPTIONS

ANTIRETROVIRAL DRUGS

Nucleoside Reverse Transcriptase inhibitors

AZT

(Zidovudine)

Non-Nucleoside 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 patients 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 water-based rather than oil-based 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 persons use

The Move Toward Lower Pill Burdens

Regimen

Dosing

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

Daily pill burden

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.
Nucleic Acid Vaccines
Gene gun, muscle expression.

PENUTUP
Sesuai dgn sifat AIDS itu sendiri, maka
pencegahan AIDS relatif mudah, yaitu
menghindari pemakaian jarum suntik berganti
ganti dan menghindari hubungan seksual dgn
pasangan ganda.
Agama dan Pancasila melarang hubungan
seksual ekstra marital. Akan tetapi penggunaan
jargon jargon Agama atau Pancasila dalam
batasan ucapan verbal saja jelas tidak ada
gunanya, bahkan bisa membuat orang tertutup
terhadap informasi yang benar

ANY
QUestions?

Thank you!