AIDS

Fadillah Alma Putra

Structure and Composition
• Lentiviruses contain the four genes required
for a replicating retrovirus—gag, pro, pol, and
env —and follow the general pattern or
retrovirus replication
 Classification
• HIV-1 >> have group virus (M,N, and O) and
have 10 subtypes (A-J)
• HIV-2 >>have 5 subtypes (A-E)
• HIV-1 and HIV-2 were derived from primate
lentiviruses common in Africa.
 Epidemiology
• Over 33 million people worldwide are currently living
with HIV, with 2.7 million new infections and 2 million
deaths occurring annually
• The disease is most concentrated in sub-Saharan
Africa, where over 22 million people are living with HIV
and 1.9 million people are infected yearly, which
contributes to 71% of new infections globally
• Areas with increasing incidence include Eastern
Europe, Central Asia, and sub-Saharan Africa. Nearly
half of new infections occur in adolescents and young
adults 15 to 24 years of age
 Risk Factors
1. Unprotected sexual contact
2. Men who have sex with men in USA
3. Injection drugs
4. Perinatal transmission and breastfeeding
5. Transfusion blood who have infected HIV
Pathogenesis
HIV uses CD4 as a receptor; CD4 is expressed on
macrophages and T lymphocytes. Coreceptors
are the chemokine receptors CCR5 (for
macrophage-tropic strains of HIV-1) and CXCR4
(for lymphocyte-tropic strains of virus)
Clinical Findings
1. Acute infection : 40-90% patient developed an acute retroviral
syndrome like fever, fatigue, rash developing typically 7-14 days
after exposure
2. Pulmonary : Bacterial pneumonia and TB if CD4+ T cell count
decrease
3. Oral : Candidiasis oral, oral hairy leukoplakia. in patients with
CD4+ T-cell counts less than 350/mm3
4. Neurologic : toxoplasma gondii, cryptococcus neoformans if with
CD4+ T-cell counts less than 100/mm3, multifocal
leukoencephalopathy (PML) caused by JC virus.
5. Dermatologic : Herpes simplex virus, varicella-zoster virus, human
papilloma virus
6. Gastrointestinal : esophagitis and diarrhea
7. Malignancy : Non-hodkin’s lymphoma, Kaposi’s sarcoma, and
cervical cancer.
 Laboratory Findings
• Virus isolation >> Viral growth is detected by
testing culture supernatant fluids after about
7–14 days for viral reverse transcriptase
activity or for virus-specific antigens (p24).
Used PCR to findings specimens
• Serology >> EIA (enzyme-liked immunoassay)
• Detection of viral nucleic acid/antigens >> RT-
PCR, DNA PCR, bDNA test
Treatment
 Prevention and control
• Public health recommendations for persons reported to have an HIV infection include the following:
1. Almost all persons will remain infected for life and will develop the disease, if untreated.
2. Although asymptomatic, infected individuals may transmit HIV to others. Regular medical evaluation and follow-up are advised.
3. Infected persons should refrain from donating blood, plasma, body organs, other tissues, or sperm.
4. There is a risk of infecting others by sexual intercourse (vaginal or anal), by oral–genital contact, or by sharing of needles. The consistent
and proper use of condoms can reduce transmission of the virus, although protection is not absolute.
5. Toothbrushes, razors, and other implements that could become contaminated with blood should not be shared.
6. Women with seropositive sexual partners are themselves at increased risk of acquiring HIV. If they become pregnant, their offspring are at
high risk of acquiring HIV, if untreated.
7. After accidents that result in bleeding, contaminated surfaces should be cleaned with household bleach freshly diluted 1:10 in water.
8. Devices that have punctured the skin—eg, hypodermic and acupuncture needles—should be steam-sterilized by autoclaving before reuse
or should be safely discarded. Dental instruments should be heat-sterilized between patients. Whenever possible, disposable needles and
equipment should be used.
9. When seeking medical or dental care for intercurrent illness, infected persons should inform those responsible for their care that they are
seropositive, so that appropriate evaluation can be undertaken and precautions taken to prevent transmission to others.
10. Testing for HIV antibody should be offered to persons who may have been infected as a result of their contact with seropositive
individuals (eg, sexual partners, persons with whom needles have been shared, infants born to seropositive mothers).
11. Most persons with a positive test for HIV do not need to consider a change in employment unless their work involves significant potential
for exposing others to their blood or other body fluids. There is no evidence of HIV transmission by food handling.
12. Seropositive persons in the health care professions who perform invasive procedures should take precautions similar to those
recommended for hepatitis B carriers to protect patients from the risk of infection.
13. Children with positive tests should be allowed to attend school, since casual person-to-person contact of schoolchildren
poses no risk
• Control :
• Any sexual intercourse (outside of mutually
monogamous HIV antibody-negative relationships)
should be protected by a condom
• do not share unsterile needles or syringes
• all women who have been potentially exposed should
seek HIV antibody testing before becoming pregnant
and, if the test is positive, should consider avoiding
pregnancy
• HIV-infected mothers should avoid breastfeeding to
reduce transmission of the virus to their children if safe
alternative feeding options are available