HIV/AIDS

Dr Endang Soentoro

By eArth2013
Right or Wrong?

HIV = AIDS
Key Points

1 Definition
Differences between HIV and AIDS 4 Prevention

2 Mode of Transmission 5 Laboratory Work Up

3 Sign and Symptoms 6 HIV-AIDS in Indonesia

Basic Informations

DEFINITION OF TERMS
 Infects only Weakens the immune Type of Micro
human beings system, increases organism
infection risk
Human Virus
Immunodeficiency
Manusia Virus

Penurunan Kekebalan Tubuh

HIV is the virus (germ) that infects blood
and damages the immune system and
ones ability to fight disease

HIV
HIV adalah nama virus yang menyebabkan
penurunan kekebalan tubuh manusia
H
I

HIV, a virus, eventually causes AIDS,

a syndrome.
The origin of HIV

HIV is believed to have originated

in non-human primates in sub-Saharan
Africa and was transferred to humans
late in the 19th or early in the 20th
century.
 Weakens the immune system, Group of
Not increases infection risk illness/
inherited symptoms
Immune Deficiency
Acquired Syndrome
Kekebalan Tubuh Kelemahan
Didapat Kumpulan gejala
penyakit

AIDS is the collection of illnesses which may

be contracted by an HIV-infected person.

AIDS
AIDS adalah kumpulan gejala penyakit akibat
kelemahan sistem kekebalan tubuh yang didapat
dari orang lain
Whats the difference between
HIV and AIDS?

HIV, a virus, eventually causes AIDS,

a syndrome.

When the immune system becomes

weakened by HIV, the illness progresses to
AIDS
Basic Informations

MODE OF TRANSMISSION
Body Fluids and HIV Transmission
FLUIDS THAT DO TRANSMIT HIV

The key to
Blood protecting yourself FLUIDS THAT DO NOT
from infection is to TRANSMIT HIV
Semen avoid these four
Vaginal Fluid bodily fluids. Saliva
Breast Milk Tears
(in order of the highest Mucus
concentration of HIV)
Urine
Sweat
Feces
HIV Transmission
o HIV is transmitted when one or more of the four fluids
is transferred from one person to another; Enters via
mucous membranes or into blood stream
oThe most common ways HIV is transmitted is by:
o Unprotected sexual intercourse (oral, anal or vaginal sex
o Sharing needle
o Contaminated blood products
o During pregnancy or childbirth
o Breastfeeding from infected mother to baby
HIV is not transmitted by

Coughing, Sneezing Public baths

Touching, hugging Handshakes

Water, food Using telephones

Insect bites Sharing cups, glasses,

Kissing plates, or other utensils

Work or school contact

HIV attacks the bodys
immune system
The immune system is the bodys natural defense
against disease and infections

White blood cells help fight infections

HIV attacks and destroys T-cells, which are a type of

white blood cell (also known as CD4 cells)

HIV replicates itself and attacks more T-cells to

weaken the immune system so that it no longer
functions
This electron microscope photo shows
newly formed HIV particles budding
from a human cell.

http://www.avert.org/virus.htm
Normal Immune Response

Virus binds to T-cells

Antibodies
Virus T-cells bind to virus

Antibodies
kill virus
Virus

Normal response: Virus invades blood

stream and 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 antibodies

Cannot destroy virus

Basic Informations

SIGNS AND SYMPTOMS

Virus can be transmitted
during each stage
Infection Spectrum of HIV
Possible Minor Symptoms

Blood tests Healthy, HIV+ Symptomatic

positive can last for years HIV/AIDS

Virus can be transmitted during each stage

Seroconversion
Infection with HIV, antibodies develop
Asymptomatic
No signs of HIV, immune system controls
virus production
Symptomatic
Physical signs of HIV infection, some
immune suppression
AIDS
Opportunistic infections, end-stage
disease
HIV infection
(3 to 6 months)

Few symptoms
(3 mo to 10 years)
AIDS

Progression of HIV to AIDS

Stage 1 Stage 2 Stage 3 Stage 4

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
Opportunistic Infections associated
with AIDS

CD4 <50
Disseminated mycobacterium avium complex (MAC) infection
Histoplasmosis
CMV retinitis
CNS lymphoma
Progressive multifocal leukoencephalopathy
HIV dementia
HIV Disease
Progression of HIV disease is measured by:
CD4+ count
Degree of immune suppression
Lower CD4+ count means decreasing
immunity
Viral load
Amount of virus in the blood
Higher viral load means more immune
suppression
Severity of illness is
determined by amount of
virus in the body (increasing
viral load) and the degree
of immune suppression
(decreasing CD4+ counts)

Higher the viral load, the

sooner immune suppression
occurs
Progression of HIV Infection
HIGH viral load (number of copies of HIV in
the blood)

LOW CD4 count (type of white blood cell)

Increasing clinical symptoms (such as

opportunistic infections)

DR. S.K CHATURVEDI

Basic Informations

HIV ANTIBODY TESTING

How can you tell if someone has
HIV or AIDS?
You tell if a person has HIV or AIDS simply by
looking at her/him.
People infected with HIV can live 10 or more
years without showing any symptoms.
Ones HIV status can be known only by the use
of an HIV test.
What do you know about
HIV antibody testing?
How HIV testing works
All HIV tests look for HIV antibodies, 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 window period

It is possible to infect others during this stage.
An individual should be tested three months after possible exposure
to guarantee an accurate result.

If HIV antibodies are discovered, it

is called being reactive or HIV
positive. If no HIV antibodies are
found, it is called being non-
reactive or HIV negative.
 Timeline

Test Date New Test Date

Three-month
window from
first exposure

Three-month
First Second window from
exposure exposure second exposure
Need for pre- and post-test counseling
Why pre-test counseling?
Give people information about at-risk activities and
encourage behavior change;
Thus people will know how to protect themselves and
others from HIV transmission.

Why post-test counseling?

Help people cope with emotional impact of their results;
Help them see options if positive, support them in
staying uninfected if negative.
 AIDS Diagnosis
Both the U.S. Centers for Disease
and the World Health Organisation
have developed criteria for diagnosis
of AIDS on the basis of laboratory
tests confirming HIV infection,
assessing number of CD4+ lymphocyte
cells, and on clinical observations.
aids aids Aids Positive HIV test
AND
presence of an indicator disease
or
CD4 T+ lymphocyte count
of less than 200
or less than 14% of total lymphocytes
Basic Informations

PREVENTION
HIV-AIDS prevention

bstinence

e faithful

ondoms

No rugs

ducation
How do you ensure you will never
catch HIV?

Abstaining from sex means not participating in sex

at all.
Abstinence is the only way to ensure they you will
never contract HIV.
Condoms reduce the risk for HIV, but they do not
eliminate the risks altogether.
Preventing HIV:
Safe Sexual Intercourse
Monogamous Marriage/Relationship

Using condoms correctly and consistently will reduce the risk of contracting
HIV through anal and vaginal sex. Using condoms and other latex barriers (like
dental dams) will reduce the risk of transmitting HIV through oral sex.
Preventing HIV:
DO NOT Sharing Needles
Needles should never be shared; injection drug
users should never share needles and stuff

When getting tattoos or piercings, make sure

that new needles and new ink bottles are used.
Preventing HIV:
AVOID Breastfeeding
Mothers living with HIV should not breastfeed
babies; prenatal care can help reduce the
chance that babies of HIV-infected mothers are
born with HIV.
Basic Informations

TREATMENT
Is there a cure?

NOIn the history of the world we have

never found a cure for any virus.

However, there are medications

which can add years to the lives
of people living with HIV or
AIDS
Anti-retroviral drugs are used in
combination, known as Highly Active
Anti-Retroviral Therapy (HAART).

Side effects can be severe, but

the risks of not being treated
are more severe.
From Terminal to Chronic

1980s 3 Months

Today 27 Yearsand counting!

Infection
Basic Informations

HIV-AIDS IN INDONESIA
Scale of problems

The WHO estimated that in 2009 about 33.4 million

people (including about 2.1 million children) were
infected with HIV.

Globally, infection rates are highest in sub-Saharan

Africa, but also are high in southeast Asia.
ESCALATING EPIDEMIC !!!

Source: WHO/UNAIDS/UN The Millennium Development Goals Report, 2009, p.32 and WHO.
 New HIV infections in Asia-Pacific region
New HIV infections (Number)

500,000

18 % decline
400,000

300,000
Stagnated decline
200,000 between 2008 and
2011
100,000

0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Significant decline in new HIV infections in the last

decade, but slow-down between 2008 and 2011
Source: Prepared by www.aidsdatahub.org based on HIV estimates and projections data for UNAIDS (2012). Global Report: UNAIDS Report on the Global AIDS Epidemic 2012
HIV prevalence among MSM vs. adults

Rising HIV epidemic among MSM in many regions across the world
Source: Beyrer, C., Baral, S. D., Griensven, F. v., Goodreau, S. M., Chariyalertsak, S., Wirtz, A. L., & Brookmeyer, R. (2012). Global epidemiology of HIV infection
in men who have sex with men. Lancet, 380(9839), 367-377.
Summary
HIV/AIDS is preventable, manageable, but not curable

When the immune system becomes weakened by HIV,

the illness progresses to AIDS

People do not die from AIDS, they die because their

bodies cannot fight off infections from other disease-
causing organisms

Some blood tests, symptoms or certain infections

indicate progression of HIV to AIDS
 Call to Action
What can I do to protect myself?
What can I do to help or protect others?

What can I do to protect my community

and the world we live in?
Thank You
Questions?