Dr.

ERLINDA, SpPD
 Definitions
H - Human

I - Immunodeficiency

V - Virus
 Definitions
A - Acquired

I - Immune

D - Deficiency

S - Syndrome
Normal Immune Response

T-cells make
antibodies
Virus binds to T-cells
Antibod
Virus T- ies bind
cell to virus
s Antibodies
Normal response: Virus kill virus
Vir
invades blood stream and us
binds to lymphocytes.
Lymphocytes make antibodies
to the virus. Antibodies bind
to the virus and destroy
the virus.
Immune Response to HIV

HIV HIV destroys

T-cells (CD4
cells)

T-cells cannot
produce antibodi

Cannot destroy virus

Opportunistic Infections
associated with AIDS

Parasitic
Pneumocystis
carinii

Fungal
Candida
Cryptococcus
Is HIV and AIDS the
same thing?
 Whats the difference
between HIV and AIDS?
HIV, a virus, eventually causes AIDS,

a syndrome.
Spectrum of HIV

Infecti
on
Possible Minor
Symptoms
Blood tests Healthy, HIV+ Symptomat
positive can last for ic
years HIV/AIDS
 HIV
Human Immunodeficiency
Syndrome
A specific type of virus (a
retrovirus)
HIV invades the helper T cells to
replicate itself.
No Cure
 AIDS
Acquired Immunodeficiency Syndrome
HIV is the virus that causes AIDS
Disease limits the bodys ability to
fight infection
A person with AIDS has a very weak
immune system
No Cure
 T-Cell Count
If 1,200 or higher, the individual has a
normal immune system.
If 800 or less, the immune system is
weakened and individual is susceptible to
infection.
If 200 or less, AIDS is diagnosed.
Once a person is diagnosed with AIDS, she
or he is always categorized as having AIDS,
even if her or his T-cell count increases.
Criteria for Diagnosing AIDS

A CD4 cell (type of T-cell) count of 200

or less,
or
One opportunistic infection.
An opportunistic infection is an infection
that typically does not affect individuals
with
normal immune systems.
Four Stages of HIV
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
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

Influenza (flu)
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
 Opportunistic Infections
Mycobacterium Avium Complex Herpes Simplex
Salmonellosis Herpes Zoster
Syphilis and Neurosyphilis Human Papillomavirus
Tuberculosis
Molluscum Contagiosum
Oral Hairy Leukoplakia
Bacillary angiomatosis Progressive Multifocal
Aspergillosis Leukoencephalopathy
Candidiasis AIDS Dementia Complex
Coccidioidomycosis Peripheral Neuropathy
Cryptococcal Meningitis Apthous Ulcers
Histoplasmosis Malabsorption
Kaposis Sarcoma Depression
Systemic Non-Hodgkins Lymphoma Diarrhea
Primary CNS Lymphoma
Thrombocytopenia
Wasting Syndrome
Cryptosporidiosis Idiopathic Thrombocytopenic Purpura
Isosporiasis Listeriosis
Microsporidiosis Pelvic Inflammatory Disease
Pneumocystis Carinii Pneumonia Burkitts Lymphoma
Toxoplasmosis Immunoblastic Lymphoma
Cytomegalovirus Valley Fever
Hepatitis MRSA

Source: AIDS Education Global Information System

TB & HIV CO-INFECTION

TB is the most common opportunistic infection in

HIV and the first cause of mortality in HIV infected
patients (10-30%)
10 million patients co-infected in the world.
Immunosuppression induced by HIV modifies
the clinical presentation of TB :
1. Subnormal clinical and roentgen presentation
2. High rate of MDR/XDR
3. High rate of treatment failure and relapse (5% vs < 1% in
HIV)
Modes of HIV/AIDS
Transmission
Through Bodily Fluids

Blood products
Semen
Vaginal fluids
Breast Milk
 Through IV Drug Use
Sharing Needles
Without sterilization
Increases the chances of contracting HIV
 Mother-to-Baby

Before Birth
During Birth
Postpartum
After the birth
Testing Options for HIV
 Administration

Blood
Urine
Oral
 Timeline
New Test
Test Date
Date
Three-
month
window
Firstfrom Second Three-
exposurfirst exposure month
window
e exposure
from
second
exposure
 Testing
The test is for antibodies against HIV, not for the
virus itself.
It can take up to three months for the body to
produce antibodies against HIV.
A negative test result may mean recent infection.
It is possible to infect others during this
stage.
An individual should be tested three months after
possible exposure to guarantee an accurate result.
 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
Blood Detection Tests
HIV enzyme-linked
immunosorbent assay (ELISA)
Western blot
HIV rapid antibody test
Absolute CD4 lymphocyte
count
HIV viral load tests
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
Best test for diagnosis of acute HIV infection
Correlates with disease progression and
response to HAART
 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!
Counseling
 Pre-test Counseling

Transmission
Prevention
Risk Factors
Voluntary & Confidential
Reportability of Positive Test
Results
Treatment Options
 Antiretroviral Drugs

Nucleoside Reverse Transcriptase

inhibitors
AZT (Zidovudine)
Non-Nucleoside Transcriptase inhibitors
Viramune (Nevirapine)
Protease inhibitors
Norvir (Ritonavir)
 Koinfeksi TB-HIV
1. Pemberian terapi ARV pd semua
pasien HIV dengan TB aktif tanpa
melihat nilai CD4
2. OAT diberikan lebih dulu, diikuti ARV
( dalam 2-8 minggu pemberian OAT)
3. efavirens(gol.NRTII) direkomendasikan
dlm ARV karena interaksi dg rifampisin
lebih ringan dibandingkan evirapin.
 Kriteria gagal terapi:
1. kegagalan klinis (kondisi stad 4, atau
stad 3dg TB paru berat/gagal terapi)
2. kegagalan imunologis (CD4 kembali
seperti awal,atau penurunan
sebesar50%, atau tetap <100 sel/mm3)
3. kegagalan virologis ( viral load > 5000
kopi/ml)
Fluids and HIV
Transmission
Fluids that can transmit
HIV

Fluids that DO Fluids that DO NOT

transmit HIV: transmit HIV:

Blood Saliva
Semen Tears
Vaginal Fluid Mucus
Breast Milk Urine
(in order of the highest Sweat
concentration of HIV) Feces
 Relative Risk
High risk:
Sharing needles
Unprotected sex
Breast feeding

Lower risk:
Protected sex
Any opportunity for exchange of body fluids

No risk:
Casual contact
Universal Precautions
Wash your hands!
Disinfect utensils and living space.
Use barrierspreferably latex.

HIV cannot be spread through

casual contact, but these are good
practices for preventing
opportunistic infections.
 Barriers include:
Latex Gloves
Latex Condoms
Sheepskin condoms do NOT protect!
Latex Dental Dams
Anything that protects your skin
from a fluid
 Prevention
What is the only 100% effective way to
prevent
HIV infection?

ABSTINENCE!

What does abstinence include?

Do not have sex with infected, possibly infected, or
multiple partners.
Do not share needles.
Thank You!
ACQUIRED IMMUNO DEFIENCY
SYNDROM
(AIDS)
Limfosit (salah satu jenis leukosit) berperan penting pada
system imun tubuh.Limfosit B berperan pada imunitas
humoral karena memroduksi antibodi, sedankan limfosit T
terutama pada imunitas karena bersifat sebagai efektor
melawan sel musuh. Limfosit ternyata merupakan kelompok
sel yang heterogen dengan dua jenis utama (subset) yaitu
limfosit penolong (CD4+) dan limfosit pembunuh (CD8+).
Pad keadaan normal, perbandingan jumlah CD4+ dan CD8+
secara kasar adalah 2 : 1, suatu perbandingan yang optimal
untuk menjalankan fungsi masing-masing.
 HIV penyebab AIDS, merupakan virus yang limfotropik. Molekul
CD4+ merupakan reseptor (tempat hinggap) virus ini untuk masuk ke
dalam sel (limfosit penolong dan monosit karena monosit juga CD4+).
Di dalam sel virus ini memperbanyak diri (replikasi) sehinga merusak
limfosit tersebut. Virus-virus baru yang dihasilkan (virion) akan
mencari sel yang bau lagi untuk dimasssukinya. Pada infeksi lanjut
jumlah limfosit penolong ( CD4+ ) mulai menurun. Bila penurunan
jumlah sel telah cukup berat mulailah timbul manifestasi gangguan
imunitas sehingga pasien mudah terkena infeksi oportunistik dan
keganasan.
Selain limfotropik, HIV juga bersifat neutropikk karena ditemukan pada
SSP dan cairan otak serta menimbulkan kelainan neurologonik. Pada
infeksi HIV, jumlah limfosit B normal atau bahkan meningkat sebagai
respons tubuh sehingga terbentuk antibody spesifik terhadap HIV yang
dapat digunakan sebagai petanda bahwa seseorang pernah terpapar HIV.
 Jenis sel imun yang lain yaitu natural killer cells ( sel NK ) juga
mengalami kelainan demikian pula limsofit B, sehingga pasien AIDS
lanjut sering timbul sarcoma Kaposi dan limforma sel.
A. Jenis dan metode pemeriksaan:
Deteksi antibody anti HIV (misalnya anti-p24, atau anti-glikoprotein

virus lainnya) menggunakan teknik aglutinasi, imunodot, Elisa,

Western blot, imunofluoresensi, atau radiomunopresipitasi.
Deteksi antigen virus (HIV): dilakukan dengan cara Elisa, kultur,

pelacak DNA, pelacak RNA.

Jumlah sel : Menghitung limfosit T penolong (CD4+) dan limfosit

pembunuh (CD8+) dengan teknik imunofluresensi / flowcytometry

menggunakan antibody monoclonal.
Fungsi sel : dapat dilakukan dengan cara stimulasi limfosit B atau T

menggunakan simulator PWM, PHA, Con-A, PPD, atau Tuberkulin.

 Lain-lain : px lab. lainnya antara lain : Hematologi (Hb, jumlah dan
hitung jenis leukosit, trombosit, sediaan apus darah), penentuan
kadar lg G dan lgA darah, biarkan dan serologi (untuk protozoa,
jamur, HSV, CMV, EBV), untuk infeksi oportunistik Pneumocystis
carinii (perwarnaan langsung), Cryptosporidium dan Toxoplasma
(biakan), Strongyloides dan Candida (Histopatologik), Aspergillus,
serta sarcoma Kaposi Limfoma (Histopatologik).
B. Pemilihan tes untuk anti-HIV
1. Tes Penyaring : digunakan secara sederhana seperti tes aglutinasi,

dot enzyme immunoassay yang mempunyai sensitifitas tinggi, dan

teknik Elisa.
2. Tes konfirmasi : digunakan cara Western Blot, Imunofluoresensi,

atau Radioimunopresipitasi.
C. Periapan penderita dan bahan pemeriksaan:
Tidak ada persiapan khusus. Bahan pemeriksaan adalah darah
lengkap dengan antikoagulan sodium heparin.