PAPER

HIV/AIDS

MADE BY:

ANDI RAVIDA RAHMA S. K011171807

REZA PUTRANDA R. K011171803

HASANUDDIN UNIVERSITY
INTERNATIONAL 2017
 FOREWORD
Praise the presence of God Almighty for all his blessings so that this paper can be arranged to
completion. Do not forget we also support a lot of thanks for the help of those who have
contributed by contributing both material and thoughts.

And our hope is that this paper can increase the knowledge and experience of the readers, to
ensure that it can add to the contents of the paper to make it even better.

Due to the limitations of our knowledge and experience, we believe there are still many
shortcomings in this paper, therefore we are looking forward to constructive suggestions and
criticisms from readers for the perfection of this paper.

Makassar, 20 March 2019

 CHAPTER I

INTRODUCTION

A. Background

Acquired immunodeficiency syndrome (AIDS) is the leading infectious cause of adult

death in the world. Untreated disease caused by the human immunodeficiency virus (HIV) has
a case fatality rate that approaches 100%. Not since the bubonic plague of the 14th century has
a single pathogen wreaked such havoc. AIDS has torn apart families and caused untold suf-
fering in the most heavily burdened regions. In hard-hit areas, including some of the poorest
parts of the world, HIV has reversed gains in life expectancy registered in the last three dec-
ades of the 20th century. HIV/AIDS is a major global health emergency.

HIV and AIDS are health problems throughout the world, namely transmission of
infections, morbidity and mortality rates. Globally HIV cases in 2011, an estimated 34 million
people were living with HIV, of which 30.7 million were adults. As many as 16.7 million
infected were women and as many as 3.3 million children under the age of 15 years. The
number of newly infected people with HIV is 2.5 million, with 2.2 million adults and 330
thousand children under the age of 15 years. The number of deaths from AIDS is 1.8 million
people, with 1.5 million of whom are adults and as many as 230 thousand are children less than
15 years (WHO, 2011).

Human Immunodeficiency Virus (HIV), is a retrovirus that infects cells of the human
immune system (especially CD4 positive T-cells and macrophages, the main components of
the cell's immune system), and destroys or interferes with its function. This viral infection
results in an ongoing immune system decline, which will result in immune deficiency. Whereas
Acquired Immunodeficiency Syndrome (AIDS) describes various symptoms and infections
associated with a decrease in the immune system. HIV infection has been established as a cause
of AIDS, HIV levels in the body and the emergence of certain infections are indicators that
HIV infection has developed into AIDS (Hoyle, 2006).

B. FORMULATION OF PROBLEM

The author has compiled several that will be discussed in this paper, including:

a. Definition of HIV/AIDS?
b. how HIV/AIDS appears in Indonesia?
c. how is how is the etiology and pathology of HIV?
d. How HIV infection occurs?
e. How HIV method of transmission?
f. How the Process of Developing the HIV Virus?
g. Reactions to the conditions of HIV/AIDS?
h. What Clinical Symptoms of HIV / AIDS?
 i. how to avoid HIV / AIDS?

C. GOALS

Based on the formulation of the problem above, the objectives of writing this paper are:

a. To know what HIV/AIDS is.

b. To know how HIV/AIDS appears in Indonesia.
c. To know how how is the etiology and pathology of HIV.
d. To find out how HIV infection occurs.
e. To find out HIV method of transmission.
f. To know how the Process of Developing the HIV Virus.
g. To find out reactions to the conditions of HIV/AIDS.
h. To know what Clinical Symptoms of HIV / AIDS.
i. To know how to avoid HIV / AIDS.
 CHAPTER 2

DISCUSSION

a. Definition

HIV (Human Immunodeficiency Virus) is a typical lymphotropic retrovirus that infects

cells of the immune system, destroys or damages specific white blood cells called T-helper
lymphocytes or carriers of T4 (CD4) factor lymphocytes. This virus is classified in the
Retroviridae family, subfamily Lentiviridae, Lentivirus genus. During the infection, the
immune system becomes weak and people become more susceptible to infection. HIV levels
in the body and the emergence of certain infections are indicators that HIV infection has
developed into AIDS (Acquired Immunodeficiency Syndrome.

AIDS is a collection of symptoms or diseases caused by decreased immunity due to the

HIV virus. Most people affected by HIV, if they don't get treatment, will show signs of AIDS
within 8-10 years. AIDS is identified based on certain infections grouped by the World Health
Organization (World Health Organization) into 4 stages of the clinical stage, where at the most
recent stage of HIV disease (stage IV) is used as an indicator of AIDS. Most of these conditions
are opportunistic infections which, if suffered by a healthy person, can be treated.

HIV virus is classified into the lentivirus or retroviridae group. This virus is a genetic
material that is an RNA virus that depends on the reverse transcriptase enzyme to infect
mammalian cells, including humans, and cause pathological abnormalities slowly. This virus
consists of 2 groups, namely HIV-1 and HIV-2. Each group has a variety of subtypes, and each
subtype is evolutionarily mutated. Among the two groups, the most prevalent and more
malignant disorder worldwide is the HIV-1 group (Zein, 2006).

AIDS stands for Acquired Immune Deficiency Syndrome, which means a collection of
symptoms or syndromes due to decreased immunity caused by infection with the HIV virus.
The human body has immunity to protect itself from external attacks such as germs, viruses,
and diseases. AIDS weakens or damages the body's defense system, so that other types of
diseases finally arrive (Yatim, 2006).

HIV is a type of obligate parasite, a virus that can only live in cells or live media. An
HIV sufferer will eventually fall into an AIDS condition, especially without treatment.
Generally this AIDS condition is characterized by various infections both due to viruses,
bacteria, parasites and fungi. This condition of infection is known as opportunistic infection
(Zein, 2006).

b. History

The first case of HIV / AIDS in the world was reported in 1981. According to UNAIDS,
one part of the WHO which deals with AIDS stated that the estimated number of people
infected with HIV / AIDS worldwide until the end of 2010 reached 34 million. Viewed from
1997 to 2011 the number of people with HIV / AIDS had increased by 21%. In 2011, UNAIDS
estimated that the number of new patients infected with HIV / AIDS was 2.5 million. The
number of people who died due to AIDS-related reasons in 2010 reached 1.8 million, a decrease
compared to mid-2000 which reached its peak of 2.2 million.

In Indonesia, the number of people with HIV / AIDS continues to increase from year
to year but the number of new cases infected with HIV / AIDS is relatively stable and even
tends to decrease. According to the 2012 Quarterly HIV-AIDS Report, the number of new
cases of HIV in the second quarter (April-June 2012) was 3,892 cases and the number of
cumulative HIV cases in January 1987- June 2012 was 86,762 cases. Whereas new AIDS cases
in the second quarter (April-June 2012) were 1,673 cases and the number of cumulative AIDS
cases in January 1987- June 2012 were 32,103 cases. In new cases of HIV, Central Java
Province was ranked 7th in Indonesia and in the new case of AIDS, Central Java Province was
ranked 2nd in Indonesia. Cases of HIV according to age in January-June 2012 were highest in
25-49 years. In AIDS cases, the majority are 30-39 years old. Gender in HIV cases were 57%
male and 43% female. Gender in AIDS cases was 61.8% male and 38.1% female. So it can be
concluded, the number of HIV and AIDS cases according to sex is more for men. In 2012 the
AIDS mortality rate decreased to 0.9% compared to 2011.

According to the Semarang City Health Office report, in 2011 the number of HIV cases
in Semarang City experienced a significant increase compared to 2010 amounting to 287
people and in 2011 amounted to 427 people. In AIDS cases in 2011 there were 59 cases and
10 deaths and AIDS cases from 1998 to 2011, which were 235 cases.

c. Etiology and Pathology

Human Immunodeficiency Virus (HIV) is considered the virus that causes AIDS. This
virus is included in the retroviruses of members of subfamily lentivirinae. The unique
characteristic morphology of HIV is the presence of cylindrical shaped nucleoids in the mature
virion. This virus contains 3 genes needed for retrovirus replication, namely gag, pol, env.
There are more than 6 additional genes regulating viral expression that are important in the
pathogenesis of the disease. One early phase replication protein, Tat protein, functions in
transactivation where viral gene products are involved in transcriptional activation of other
viral genes. Transactivity in HIV is very efficient for determining virulence from HIV
infection. Rev protein is needed for the structural expression of viral proteins. Rev helps to
release viral transcripts that are released from the nucleus. Nef protein induces the production
of chemokines by macrophages, which can
infect other cells (Brooks, 2005).
 Figure 1. HIV structure

The HIV virus that causes AIDS attacks the human immune system. What is meant by
the immune system is a system in the body that serves to protect the body from the entry of
bacteria or viruses that aim to attack cells, attacking the body's defense. The organs where the
immune system is called lymphoid, have a major role in developing lymphocytes (white blood
cells) that specifically function to protect the body from virus attacks, called T cells, which are
divided into several cells (Sarafino, 2006), namely:

 Killer T cells (CD-8 cells), directly attack and destroy foreign cells, cancer cells, and
body cells that have been attacked by antigens (substances that trigger the immune
response), such as viruses.
 Memory T cells, working at the beginning of an infection by reminding the body of
foreign things that enter the body.
 Delayed-hypersensitivity T cell, serves to delay the immune response, and also produce
protein substances (lymphokines) that trigger other T cells for the body, produce and
attack antigens.
 Helper T cells (CD-4 cells), function to stimulate white blood cells to be produced and
attack viruses.
 Suppressor T cells, function to slowly stop the cell's work process and immunity.

Cells in an individual's body that are attacked by HIV are T-cell Helper lymphocytes,
also called CD-4 lymphocytes, which function in the body's immunity to regulate and cooperate
with other immune system components. If the number and function of CD-4 decreases, the
individual's immune system will be damaged so that it can be easily entered and attacked by
various germs. Immediately after infection the CD-4 number gradually decreases even though
there is a period called the period window, that is the period that does not show any symptoms,
which lasts from the entry of the virus to the individual tested positive for HIV. Severe clinical
features, which reflect the AIDS criteria, only arise after a CD-4 number of less than 200 /
mm3 in the blood. (Yayasan Spiritia, 2006).

d. journey of HIV infection

In summary the course of HIV infection can be explained in three phases, namely: 1. Acute
Infectious Phase (Acute Retroviral Syndrome); 2. Latent Infection Phase; 3. Chronic
Infection Phase

1. Acute Infectious Phase (Acute Retroviral Syndrome)

This condition is also called primary HIV infection. This acute syndrome associated
with primary HIV infection is characterized by a replication process that produces large
numbers of new (virion) viruses. The resulting virus can be detected in the blood about three
weeks after infection. During this period infectious viral and viral proteins can be detected in
plasma and also cerebrospinal fluid, the number of virions in the plasma can reach 106 to 107
per milliliter of plasma. Viremia due to viral replication in large numbers will trigger acute
infection syndrome with symptoms that resemble acute mononucleosis infections which
include: fever, lymphadenopathy, spotting on the skin, pharyngitis, malaise, and nausea
vomiting, which occurs around 3-6 weeks after infection. In this phase there will be a
significant decrease in T-CD4 lymphocyte cells around the first 2–8 weeks of primary HIV
infection, and then an increase in T lymphocytes due to an immune response begins. The
number of T lymphocytes in this phase is still above 500 cells / mm3 and will then decrease
after six weeks of being infected with HIV.

2. Latent Infection Phase

After the primary HIV infection occurs the body's specific immune response to the HIV
virus. B cytotoxic cells and T lymphocytes provide strong resistance to the virus so that most
viruses are lost from the systemic circulation. After an increase in cellular immune response,
there will be an increase in antibodies as a humoral immune response. During the period of a
strong immune response, more than 10 billion new HIV is produced each day, but quickly the
viruses are destroyed by the body's immune system and only have a half-life of about 5-6 hours.
Although virus particles can be detected in the blood up to 108 ml of blood, however, the
number of infectious virus particles is only obtained in smaller amounts, this indicates that a
large number of viruses have been successfully destroyed. The formation of specific immune
responses to HIV causes the virus to be controlled, the amount of virus in the blood decreases
and the course of infection begins to enter the latent phase. However, some viruses remain in
the body, although rarely found in plasma, the virus mainly accumulates in the lymph glands,
trapped in follicular dendritic cells, and still continues to replicate. So that the decrease in T-
CD4 lymphocytes continues to occur even though the virions in plasma are small in number.
In this phase the number of CD4 T-lymphocytes decreases to around 500 to 200 cells / mm.
The number of viruses, after reaching the highest number at the beginning of the
primary infection phase, will reach a number at a certain point or reach a "set point" during the
latent phase. This set point can predict the onset of the onset of AIDS. With less than 1000
copies / ml of virus, AIDS is likely to occur with a latent period of more than 10 years. Whereas
if the number of viruses is less than 200 copies / ml, HIV infection does not lead to AIDS. Most
of the patients with a virus number of more than 100,000 copies / ml, experienced a decrease
in the number of CD4 T-lymphocytes which was faster and developed into an AIDS disease in
less than 10 years. A number of patients who have not received therapy have viruses ranging
from 10,000 to 100,000 copies / ml in the latent infection phase. In this phase patients generally
do not show clinical or asymptomatic symptoms. The latent phase lasts about 8-10 years (can
be 3-13 years) after being infected with HIV.

3. Chronic Infection Phase

During this phase, viral replication continues to occur in the virus replication followed
by damage and death of follicular dendritic cells and CD4 T-lymphocyte cells which are the
main target of the HIV virus because of the large number of viruses. The function of the lymph
gland as a virus trap decreases or even disappears and the virus is poured into the blood. In this
phase there is an increase in the amount of virion excessively in the systemic circulation.
immune response is unable to cope with the very large number of virions. The number of CD4
T-lymphocyte cells decreases to below 200 cells / mm3, the number of viruses increases rapidly
while the immune response is increasingly depressed so that patients are more susceptible to
various types of secondary infections that can be caused by viruses, fungi, protozoa or bacteria.
The course of infection is increasingly progressive which drives AIDS. After AIDS, patients
rarely survive more than two years without therapeutic intervention. Secondary infections that
often accompany include pneumonia caused by Pneumocytis carinii, tuberculosis, sepsis,
toxoplasmosis encephalitis, diarrhea due to cryptosporidiasis, cytomegalo virus infection,
infection with herpes virus, esophageal candidiasis, tracheal candidiasis, bronchial or
pulmonary candidiasis and other types of fungal infections such as histoplasmosis and
koksidiodomikosis. Sometimes also found several types of cancers, namely, lymph node cancer
and Kaposi's sarcoma cancer.
In addition to the three phases mentioned above, during the course of HIV infection
there is a window period or "window period" that is, the period when testing for an antibody
test against HIV still shows a negative result even though the virus is already in the blood of a
large number of HIV-infected patients. The antibodies formed have not been adequately
detected through laboratory tests because the levels are not sufficient. This period can last for
six months before positive seroconversion occurs, although antibodies to HIV can begin to be
detected 3-6 weeks to 12 weeks after the primary infection. The window period is very
important because in this window period the patient is able and potentially transmits HIV to
others.

e. method of transmission

HIV is mainly in human body fluids. Fluids that have the potential to contain HIV are blood,
sperm fluid, vaginal fluid and breast milk (KPA, 2007c).HIV transmission can occur in
various ways, namely: sexual contact, contact with blood or secretions that are infectious,
mother to child during pregnancy, childbirth and administration of ASI (Mother's Milk).
(Zein, 2006)

a. Sexual
Heterosexual transmission is the most dominant of all modes of transmission. Sexual
transmission can occur during intercourse with men and women or men. Intercourse
means sexual contact with vaginal, anal (anus), oral (mouth) penetration between two
individuals. The highest risk is unprotected vaginal or anal penetration from HIV-
infected individuals.
b. Through blood transfusions or blood products that have been contaminated with the
HIV virus.
c. Through syringes or other medical devices that are inserted or pierced into the body
contaminated with the HIV virus, such as tattoo needles or injecting drug users
alternately. It can also occur when performing medical procedures or occurring as a
work accident (accidentally) for health workers.
d. Through a razor blade or knife, alternating beard shaving should be avoided because
it can transmit the HIV virus unless the objects are fully sterilized before use.
e. Through transplantation of organs with HIV.
 f. Transmission from mother to child
Most HIV infections in children are obtained from their mothers when they are
conceived, born and after birth through breast milk.
g. HIV transmission through work: Health workers and officers laboratory.

f. The Process of Developing the HIV Virus

The process of developing the HIV virus in the body. The process according to Kaplan (1993);
Sarafino (2006) is as follows:
a. The appearance of signs of acute HIV primary infection (acute HIV infection).
b. Seroconversion
c. Decreased immune system
d. More severe symptoms

g. Reactions to the conditions

Kubler-Ross (in Sarafino, 2006) conducted interviews with 2000 individuals who experienced
terminal illnes and said that individual adjustments usually followed patterns that could be
predicted in 5 stages arranged hierarchically. These stages are:
a. Denial
The first reaction to the prognosis that leads to death involves the feeling of refusing to believe
it as truth.
b. Anger
Rejection will soon disappear and anger will emerge, with an angry reaction directed at the
people around him at that time.
c. Bargaining
At this stage, the person tries to change his condition by bargaining or trying to negotiate with
God.
d. Depression
Feelings of depression arise when negotiation efforts are not helpful and the person feels that
there is no time for opportunities and is helpless.
e. Acceptance
People with many opportunities for life will achieve this acceptance after they are no longer
depressed, but feel more calm and ready to face death.

h. Clinical Symptoms

According to KPA (2007) clinical symptoms consist of 2 symptoms, namely major symptoms
(common) and minor symptoms (not common):

Mayor:
a. Body weight decreased by more than 10% in 1 month
b. Chronic diarrhea that lasts more than 1 month
 c. Prolonged fever more than 1 month
d. Decreased consciousness and neurological disorders
e. Dementia / HIV encephalopathy

Minor symptoms:
a. Cough lasts more than 1 month
b. Generalized dermatitis
c. Zostermultisegmental their herpes and shingles repeatedly
d. Oropharyngeal candidi
e. Progressive chronic herpes simplex
f. Generalized lymphadenopathy
g. Sitomegalo virus retinitis

According to the Mayo Foundation for Medical Education and Research (MFMER) (2008),
clinical symptoms of HIV / AIDS are divided into several phases.
a. Initial phase
At the beginning of the infection, symptoms and signs of infection may not be found. But
sometimes flu-like symptoms are found such as fever, headache, sore throat, rash and swollen
lymph nodes. Although they do not have symptoms of infection, people with HIV / AIDS can
transmit the virus to others.
b. Further phase
Patients will remain free of symptoms of infection for 8 or 9 years or more. But along with the
development of the virus and the destruction of the body's immune cells, people with HIV /
AIDS will begin to show chronic symptoms such as enlarged lymph nodes (often a typical
symptom), diarrhea, decreased body weight, fever, cough and short respiration.
c. Final phase
During the final phase of HIV, which occurs around 10 years or more after being infected,
more severe symptoms begin to arise and the infection will end in a disease called AIDS.

h. Way to avoid

Ways to reduce the risk of AIDS transmission include safe sex by having sex without
penetration of the penis into the vagina, anus, or mouth. If semen does not enter the body of a
sexual partner, the risk of transmission will decrease. If you want to do intercourse with
penetration, safe sex is to use protective equipment in the form of condoms (Yatim, 2006).
Avoid changing partners where the more the amount of sexual contact a person has, the more
likely the infection will be. Avoid sexual intercourse and do outercourse where there is no
penetration. The types of outcourse include massage, embracing, touching, and touching the
body without vaginal, anal, or oral contact (Hutapea, 1995).
For drug users using injections, the risk of transmission will increase. Therefore it is
necessary to get knowledge about some preventive measures. Drug rehabilitation centers can
be used to stop using the drug.
For health workers, the tools recommended to be used as deterrents include gloves,
protective clothing, laboratory coats, face shields or masks, and eye protection. The choice of
tool is in accordance with the needs of work activities carried out by health workers (Lyons,
1997).
For a mother who is infected with AIDS can transmit the virus to her baby while still
in the womb, giving birth or breastfeeding. Breast milk can also transmit HIV, but if a woman
has been infected with HIV during pregnancy it is possible that the baby is infected with HIV.
So it is recommended that a mother continue to breastfeed her child even though HIV +. Infants
who are not breastfed are at greater risk of contracting other diseases or becoming
malnourished (Yatim, 2006).
If the mother who has HIV gets treatment during pregnancy it can reduce transmission
to her baby by 2/3 of those who do not get treatment (MFMER, 2008).