Stadia HIV

Prihatini
FKUWKS 2014

Prof Dr Prihatini dr SpPK(K) 2014 1

 Stadia HIV (WHO)
Clinical stage 1 (Asymptomatic)
Tanpa gejala
PGL(PGL: persistent generalized lymphadenopathy)
Clinical stage 2 (Mild disease)
Berat badan turun (perkiraan berat badan<10% )
Infeksi saluran napas yang kambuh (sinusitis,
tonsillitis, otitis media & pharyngitis)

Prof Dr Prihatini dr SpPK(K) 2014 2

 Clinical stage 2 (Mild disease)
Herpes zoster
Angular cheilitis
Recurrent oral ulcerations
PPE(PPE: pruritic papular eruptions)
Seborrhoeic dermatitis
Fungal nail infections

Prof Dr Prihatini dr SpPK(K) 2014 3

 Clinical stage 3 (Moderate disease)

Unexplained severe weight loss (>10% of presumed or measured body

weight )
Unexplained chronic diarrhoea for longer than one month
Unexplained persistent fever (above 37.5 C, intermittent or constant, for
longer than one month)
Persistent oral candidiasis
Oral hairy leukoplakia (OHL)
Pulmonary TB
Severe bacterial infections (such as pneumonia, empyema, pyomyositis,
bone or joint infection, meningitis, bacteraemia)
Acute necrotizing ulcerative stomatitis, gingivitis or periodontitis
Unexplained anaemia (<8 g/dl ), neutropenia (<0.5 x 109 /litre) or chronic
thrombocytopenia (<50 X 109 /litre3)
Laboratory

Prof Dr Prihatini dr SpPK(K) 2014 4

 Clinical stage 4 (Severe disease)
HIV wasting syndrome
Pneumocystis jiroveci pneumonia (PCP)
Recurrent severe bacterial pneumonia
Chronic herpes simplex infection (orolabial,
genital or anorectal, of more
than one months duration or visceral at any site)
Oesophageal candidiasis (or candidiasis of the
trachea, bronchi or lungs)
Extrapulmonary TB (EPTB)

Prof Dr Prihatini dr SpPK(K) 2014 5

 Clinical stage 4 (Severe disease)
Kaposi sarcoma
Cytomegalovirus (CMV) infection (retinitis or infection
of other organs)
Toxoplasmosis of the central nervous system (CNS)
HIV encephalopathy
Extrapulmonary cryptococcosis including meningitis
Disseminated non-tuberculous mycobacterial infection
Progressive multifocal leukoencephalopathy (PML)

Prof Dr Prihatini dr SpPK(K) 2014 6

 Clinical stage 4 (Severe disease)
Penicilliosis
Chronic cryptosporidiosis
Chronic isosporiasis
Disseminated mycosis (extrapulmonary
histoplasmosis, coccidiodomycosis)

Prof Dr Prihatini dr SpPK(K) 2014 7

 Clinical stage 4 (Severe disease)
Recurrent septicaemia (including due to non-
typhoidal Salmonella)
Lymphoma (cerebral or B-cell, non-Hodgkin)
Invasive cervical carcinoma
Atypical disseminated leishmaniasis
Symptomatic HIV-associated nephropathy or
HIV-associated
cardiomyopathy
PGL: persistent generalized lymphadenopathy;
PPE: pruritic papular eruptions

Prof Dr Prihatini dr SpPK(K) 2014 8

 CD or cluster of differentiation
Tdr protein dipermukaan sel sistem hemopoietik
ungkapan protein digunakan sbg tatanama
(nomenclature) limposit
>300 CD molekul
Protein sesuai dgn fungsi sel ,sel berbeda fungsi
berbeda molekul CD
Mis.:CD3+ keseluruhan sel T limposit, CD4+ sel T
helper , CD8+ sel sitotoksikT limposit, & CD19+
B limposit, )

Prof Dr Prihatini dr SpPK(K) 2014 9

 Peran CD4 sbg pusat pengatur
kekebalan
CD4 T limposit sasaran pertama HIV,
Kerusakan CD4 T limposit langsung/tak
langsung kehilangan kekebalan spesifik
thd HIV
akhir stadia AIDS : tanggap tidak spesifik
kekebalan (non-specific immune response)

Prof Dr Prihatini dr SpPK(K) 2014 10

 Perkiraan CD4
Sebagai alat pemantau keparahan penyakit
Ketepat gunaan pengobatan antiretroviral
(ART).
Indikator tanggap ART
Muatan plasma virus HIV indikator peka
keparahan penyakit HIV
Penting sbg indikator untuk awal & memantau
dan evaluais ART

Prof Dr Prihatini dr SpPK(K) 2014 11

 Starting antiretroviral therapy based on
clinical staging

WHO clinical stage Recommendation

1 Do not treat
2* Do not treat
3 Treat
4` Treat
*Consider starting treatment in patients with WHO
stage 2 disease and TLC <1200 cells/mm3

Prof Dr Prihatini dr SpPK(K) 2014 12

Immunological criteria for failure
Pattern 1: CD4 count <100 cells/mm3 (some experts
recommend <50 cells/mm3) after one year of
therapy
Pattern 2: Return to or a fall below the pre-therapy
baseline CD4 count after one year of therapy
Pattern 3: 50% decline from the on-treatment peak CD4
value (if known)
CD4 cell count can also be used to determine when not
to switch therapy. For example, in a patient
with a new clinical stage 3 event for whom a switch is
being considered, switching is not recommended
if the CD4 cell count is >200 cells/mm3.

Prof Dr Prihatini dr SpPK(K) 2014 13

Prof Dr Prihatini dr SpPK(K) 2014 14
 WHO classification of HIV-associated
immunodeficiency using CD4 count
(Age-related CD4 values)

Classificati
on of 11 12-35 36-59 5 years
HIV- months month months (cells/mm3
associated (CD4%) (CD4%) Or CD4%)
immunode
ficiency
Not 35 30 25 500
significant
Mild 30-35 25-30 20-25 350-499
Advanced 25-29 20-24 15-19 200-349
Severe < 25 < 20 < 15 < 200 or
< 15%
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