FAKTA

TENTANG
HIV/AIDS
1
HIV & AIDS ARE
DIFFERENT ENTITIES
 • 38 million people live with
HIV/AIDS worldwide.

• Sub-Saharan Africa is home

to 70% of the people living
with HIV.

• 2.1 million children are infected

HIV/AIDS Worldwide
with HIV/AIDS in the world
SITUASI HIV & AIDS PROVINSI ACEH
TAHUN 2004 S/D APRIL 2013
JUMLAH KASUS
TAHUN HIV AIDS TOTAL
NO

1. 2004 0 1 1
2. 2005 0 2 2
3. 2006 3 4 7
4. 2007 1 9 10
5. 2008 2 9 11
6. 2009 0 15 15
7. 2010 7 18 25
8. 2011 27 33 60
9. 2012 7 26 33
10 SAMPAI DENGAN 12 27 39
30 Juni 2013
TOTAL 59 144 203
 Top HIV/AIDS-Infected Countries
1. South Africa 9. United States
2. Nigeria 10. Russian Federation
3. Zimbabwe 11. China
Sub- 4. Tanzania 12. Brazil
Saharan
5. The Congo 13. Thailand
Africa
6. Ethiopia
7. Kenya
8. Mozambique

Source: Steinbrook R. The AIDS epidemic in 2004. NEJM. 2004;351:115-117.

 Catalyse HIV treatment, care
and support

HIV has become the 2 nd biggest cause of death for

adolescents globally

Source: Health of the world’s adolescent, WHO 2014

 Figure 1
The U.S. Epidemic: Snapshot of
Key Data
New infections 40,000
each year
People living with 1,039,000 –
HIV/AIDS 1,185,000
People with 42 – 59%
HIV/AIDS not in
care
People with HIV 24 – 27%
who don’t know
they’re infected

Note: Data are estimates.

Sources: CDC, 2005; Glynn, K. et al., CDC, "Estimated HIV prevalence in the United States at the
end of 2003", Presentation at the National HIV Prevention Conference, 2005; Fleming, P., et al., “HIV
Prevalence in the United States 2000”, 9 th Conference on Retroviruses and Opportunistic Infections,
2002.
 Perjalanan Klinis Infeksi HIV.

TERINFEKSI 2-3 mgg Acute Retroviral

Syndrome

2-3 mgg

Sembuh
Seroconvesion

1,3 TH AIDS 8 THN ASIMTOMATIK

IS THERE A CURE?

There is
NO
cure for
HIV/AIDS
 Figure 20

HIV Prevention
 Centers for Disease Control
HIV Prevention Funding
and Prevention (CDC)
at CDC, FY 1995-2005
(US $ Millions) ◦ Most prevention
funding
$589.8 ◦ Funds go to states;
$616.8 some cities;
All Other community based
51% ($6.0B)
Medicare $656.6 organizations; other
$749.7 entities/programs
Ryan
White  Additional prevention
$793.6 funding also at: Department
$731.7 of Veterans Affairs,
SAMHSA, and other
agencies
Sources: CDC, Personal Communication, 2006; CDC, HIV Prevention
 National HIV prevention goal
Strategic Plan Through 2005.
 SEJARAH AIDS
Pertama Kali Timbul di Afrika, Haiti dan USA
1978
 1979 Sarkoma Kaposi pada orang Afrika yang
mukim di Eropa
 1981 USA . Sarkoma Kaposi di kalangan
Homo Seks
 1982 Luc Montagnier ,Paris.
LAV (Limphadenonathy Associated Virus)
 1984 Transmisi Heteroseks, Galo dkk. HTLV
IIII
 1986 Penyebab AIDS adalah HIV
 Indonesia :
 Kasus pertama ( BALI ) :April 1987.
Wisatawan Belanda
 Kasus kedua ( Jakarta ) :Nopember 1987.
Warga Kanada tinggal di JKT.
 Kasus ketiga ( Jakarta ) : 1989. Warga
Perancis tinggal di JKT
 Orang Indonesia Pertama di Bali: Juni
1988
Characteristics of the virus
HIV
 The outer shell of the
virus is known as the Viral
enevlope. Embedded in
the viral envelope is a
complex protein known as
env which consists of an
outer protruding cap
glycoprotein (gp) 120,
and a stem gp14. Within
the viral envelope is an
HIV protein called
p17(matrix), and within
this is the viral core or
capsid, which is made of
another viral protein
p24(core antigen).
15
16
Life Cycle
 (a) HIV (red) attaches to two cell-surface
receptors (the CD4 antigen and a specific
chemokine receptor).
 (b) The virus and cell membrane fuse, and
the virion core enters the cell.
 (c) The viral RNA and core proteins are
released from the virion core and are then
actively transported to the nucleus.
 (d) The viral RNA genome is converted into
double-stranded DNA through an enzyme
unique to viruses, reverse transcriptase (red
dot).
 (e) The double-stranded viral DNA moves into
the cell nucleus.
 (f) Using a unique viral enzyme called
integrase, the viral DNA is integrated into the
cellular DNA.
 (g) Viral RNA is synthesized by the cellular
enzyme RNA polymerase II using integrated
viral DNA as a template. Two types of RNA
transcripts shorter spliced RNA (h) and full-
length genomic RNA (j) are produced.
 (h) Shorter spliced RNAs are transported to
the cytoplasm and used for the production of
several viral proteins that are then modified
in the Golgi apparatus of the cell (i).
 (j) Full-length genomic RNAs are transported
to the cytoplasm (k).
 (l) New virion is assembled and then buds off.
Viral Replication
 First step, HIV attaches to susceptible host
cell.
 Site of attachment is the CD4 antigen found on
a variety of cells
 helper T cells
 macrophages
 monocytes
 B cells
 microglial brain cells
 intestinal cells
 T cells infected later on.
Early Phase HIV Infection
 In early phase HIV
infection, initial
viruses are M-
tropic. Their
envelope
glycoprotein gp120
is able to bind to
CD4 molecules and
chemokine
receptors called
CCR5 found on
macrophages
http://www.cat.cc.md.us/courses/bio141/lecguide/unit2/viruses/hivad.
html

 In late phase HIV

infection, most of
the viruses are T-
tropic, having
gp120 capable of
binding to CD4 and
CXCR4 found on
T4-lymphocytes.
 Early Phases of HIV Infection of
Mucosal Surfaces
21

Cell free
HIV

T-cell
Immature
Dendritic cell PEP

Skin or Via lymphatics or Burst of HIV

mucosa circulation replication
24 hours 48 hours

1. HIV co-receptors, 2. Selective of 3. Mature Dendritic cell in

CD4 + chemokine macrophage- regional LN undergoes
receptor CC5 tropic HIV a single replication,
which transfers HIV to
T-cell
HIV (arrows) Infecting a T-
lymphocyte
 Human

HIV Immunodeficiency
Virus
 Virus penyebab AIDS
 Melemahkan sistem kekebalan
tubuh (sel darah putih)
Acquired
Immune
Deficiency
Syndrome

AIDS Kumpulan beberapa gejala


akibat menurunnya sistem
kekebalan tubuh yang
disebabkan oleh HIV.
CD4 COUNT IN HIV INFECTION

 The CD4 cell , also known as "T4" or "helper T cell“ is responsible for
signaling other parts of the immune system to respond to an infection.

 Normal counts range from 500 to 1500 cells per cubic millimeter of blood

 Initially in HIV infection there is a sharp drop in the CD4 count and then
the count levels off to around 500-600 cells/mm3. 

 CD4 count is a marker of likely disease progression. CD4 percentage tends

to decline as HIV disease progresses.

 CD4 counts can also be used to predict the risks for particular conditions
such as Pneumocystis carinii pneumonia, CMV disease or MAI disease.

 Treatment decisions are often based on Viral Load and CD4 count.
 Siapa bisa tertular
HIV ?
 Siapapun bisa tertular HIV, jika perilakunya
berisiko.
 Penampilan luar bukan jaminan bebas HIV.
 Orang dengan (+)HIV sering terlihat sehat dan
merasa sehat.
 Jika belum melakukan tes HIV, orang dengan
(+)HIV tidak tahu bahwa dirinya sudah tertular
HIV dan dapat menularkan HIV pada orang lain.
 Tes HIV adalah satu-satunya cara untuk
mendapatkan kepastian tertular HIV atau tidak.
 Perjalanan Infeksi
HIV
Tertular Periode HIV AIDS
HIV Jendela* Positif

2 minggu - 6 bulan 3 - 10 1 - 2
Tahun Tahun
* Masa antara masuknya HIV ▪ Tanpa Gejala ▪ Timbul
kedalam tubuh manusia ▪ Tampak sehat infeksi
sampai terbentuknya antibody ▪ Dapat berakti- oportunistik
terhadap (+)HIV. vitas biasa.
Sudah bisa menularkan HIV
kepada orang lain.
 ‘typical’ primary HIV-1 infection
symptoms symptom
s
HIV proviral DNA

HIV antibodies
‘window’
period

HIV viral load

HIV-1 p24 antigen

0 1 2 3 4 5 6 / 2 4 6 8 10
1° infection weeks years
Time following infection
Natural History of Untreated HIV
Infection
Four Stages of HIV
 Stage 1 - Primary
Short, flu-like illness - occurs one to six weeks after
infection
 no symptoms at all
 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

Parasitic
Pneumocystis
carinii

Fungal
Candida
Cryptococcus
AIDS
 CD4 count drops below 200 person is considered to have
advanced HIV disease
 If preventative medications not started the HIV infected
person is now at risk for:
 Pneumocystis carinii pneumonia (PCP)
 cryptococcal meningitis
 toxoplasmosis
 If CD4 count drops below 50:
 Mycobacterium avium
 Cytomegalovirus infections
 lymphoma
 dementia
 Most deaths occur with CD4 counts below 50.
HIV menular melalui :
 Menggunakan jarum suntik :
 secara bergantian
 bekas pakai
 tidak steril
 Hubungan seks berganti-gantian
pasangan
Dari ibu ke bayi melalui :
 Hamil
Melahirkan
menyusui
Modes of HIV/AIDS
Transmission
Transmission
 Through Bodily Fluids

Blood products
Semen
Vaginal fluids
Breast Milk
Penularan AIDS dapat
melalui:
Hubungan seksual yang memungkinkan
pemindahan virus dari sperma dan cairan
vagina/ serviks

Pemindahan darah yang mengandung HIV

Penularan kepada janin dari ibu penderita

AIDS
Kelompok Resiko Tinggi

1. Aktif dalam perilaku seksualnya( WTS,

PTS )

2. Homoseksual.

3. Mereka yg suka/ pernah melakukan

hubungan seksual dgn orang asing yang
berasal dari daerah dimana insidens AIDS
tinggi.
4. Penyalah guna obat/narkotika
 Through Sex

Intercourse (penile penetration into the

vagina)
Oral
Anal
Digital Sex
 Mother-to-Baby

Before Birth
During Birth
Postpartum
After the birth
Oral Candidiasis (thrush)
Oral Hairy Leukoplakia

 Being that HIV reduces immunologic activity, the

intraoral environment is a prime target for chronic
secondary infections and inflammatory processes,
including OHL, which is due to the Epstein-Barr
virus under immunosuppressed conditions
Kaposi’s sarcoma (KS)
 Kaposi’s sarcoma
(shown) is a rare
cancer of the blood
vessels that is
associated with HIV. It
manifests as bluish-red
oval-shaped patches
that may eventually
become thickened.
Lesions may appear
singly or in clusters.
HIV tidak menular
melalui :
 Gigitan nyamuk atau serangga lain
Berenang bersama
Memakai toilet umum
Bersalaman, pelukan ataupun
ciuman
Terpapar batuk atau bersin
Berbagi makanan atau
menggunakan alat makan bersama
Air kotor, Udara
Bagaimana mengetahui
status HIV ?
Status HIV hanya dapat diketahui melalui
Konseling dan Testing HIV
Sukarela
 Testing HIV merupakan pengambilan

darah dan pemeriksaan laboratium

disertai konseling pre dan pasca
testing HIV
 Konseling dan Testing HIV

Sukarela dilakukan dengan prinsip

tanpa paksaan, rahasia, tidak
 A H P ENU LA R A N
CA R A M EN C EG
HIV :

 Anda tidak melakukan seks

bukan dgn pasangannya
 Bersikap saling setia dengan
pasangan
 Cegah dengan memakai
kondom lateks
 Jangan menggunakan
narkoba suntik
BEBERAPA ATURAN POKOK 
KEPERAWATAN
 Perawat disarankan memakai baju penutup dan 
sarung tangan bila memegang tubuh penderita, 
khususnya bila ada kemungkinan terkena sekret 
tubuhnya.
 Memberi makan, sama seperti pada penderita 
Hepatitis B.
 Beri pelindung pada jasur dan bantal ( plastik )

 Sprei, perlu diketahui bahwa HIV sgt mudah 
dibunuh dgn detergen.
 Jarum suntik: sama sekali jangan dimasukkan 
kembali kedalam penutup jarum dan gunakan 
botol plastik/ kaleng pembuangan khusus untuk 
semua alat tajam.( Perawat yg telah dilatih )
BEBERAPA ATURAN POKOK 
KEPERAWATAN
 Bersihkan ruangan seperti biasa

 Kamar mandi/ WC , pemeliharaan seperti biasa.

 Tempelkan stiker khusus dgn tulisan BAHAN 
MENULAR pd semua botol spesimen yg akan 
dikirim ke laboratorium

 Tangan harus selalu dicuci selama dan sesudah 
segala aktifitas pelayanan terhadap penderita, 
walaupun mempergunakan sarung tangan.
 ADMINISTRATION

 Blood
 Urine

 Oral
 BLOOD DETECTION TESTS

 Enzyme­Linked Immunosorbent 
Assay/Enzyme Immunoassay (ELISA/EIA)
 Radio Immunoprecipitation Assay/Indirect 
Fluorescent Antibody Assay (RIP/IFA)
 Polymerase Chain Reaction (PCR)

 Western Blot Confirmatory test
 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 blood­derived fluids 
from the gum tissue.
 NOT A SALIVA TEST!
TREATMENT OPTIONS
 ANTIRETROVIRAL DRUGS

 Nucleoside Reverse Transcriptase inhibitors
 AZT (Zidovudine)
 Non­Nucleoside Transcriptase inhibitors
 Viramune (Nevirapine)
 Protease inhibitors
 Norvir (Ritonavir)
WESTERN BLOT
 Expensive – $ 80 ­ 100
 technically more difficult

 visual interpretation

 lack standardisation
 ­ performance
 ­ interpretation
 ­ indeterminate reactions – 
resolution of ??
 ‘Gold Standard’ for 
confirmation
POLYMERASE CHAIN 
REACTION (PCR)
 Looks for HIV DNA in the WBCs of a person.
 PCR amplifies tiny quantities of the HIV DNA 
present, each cycle of PCR results in doubling of 
the DNA sequences present.
 The DNA is detected by using radioactive or 
biotinylated probes.
 Once DNA is amplified it is placed on 
nitrocellulose paper and allowed to react with a 
radiolabeled probe, a single stranded DNA 
fragment unique to HIV, which will hybridize 
with the patient’s HIV DNA if present.
 Radioactivity is determined.
VIRUS ISOLATION
 Virus isolation can be used to definitively 
diagnose HIV.
 Best sample is peripheral blood, but can 
use CSF, saliva, cervical secretions, 
semen, tears or material from organ 
biopsy.
 Cell growth in culture is stimulated, 
amplifies number of cells releasing virus.
 Cultures incubated one month, infection 
confirmed by detecting reverse 
transcriptase or p24 antigen in 
supernatant.
 OPPORTUNISTIC INFECTION
TREATMENT

 Issued in an event where antiretroviral drugs are 
not available
FOUR WAYS TO PROTECT YOURSELF?

 Abstinence
 Monogamous Relationship

 Protected Sex

 Sterile needles
 MONOGAMOUS RELATIONSHIP

 A mutually monogamous (only one sex 
partner) relationship with a person who is 
not infected with HIV 
 HIV testing before intercourse is necessary 
to prove your partner is  not infected
 PROTECTED SEX

 Use condoms (female or male) every time you have sex 
(vaginal or anal)
 Always use latex or polyurethane condom (not a 
natural skin condom)
 Always use a latex barrier during oral sex
 WHEN USING A CONDOM
REMEMBER TO:

 Make sure the package is not expired
 Make sure to check the  package for damages

 Do not open the package with your teeth for risk of tearing

 Never use the condom more than once

 Use water­based rather than oil­based condoms
 STERILE NEEDLES

 If a needle/syringe or cooker is shared, it must be 
disinfected:
 Fill the syringe with undiluted bleach and wait at least 30 
seconds.
 thoroughly rinse with water
 Do this between each person’s use
The Move Toward Lower Pill Burdens
Regimen Dosing Daily pill burden

1996
Zerit/Epivir/Crixivan 10 pills, Q8H

1998
Retrovir/Epivir/Sustiva 5 pills, BID

2002
Combivir (AZT/3TC)/EFV 3 pills, BID

2003
Viread/ Emtriva/Sustiva 3 pills, QD
2004
Truvada/Sustiva 2 pills, QD
TRUVADA
 Truvada is made up of HIV drugs from a class 
called nucleoside/nucleotide reverse transcriptase 
inhibitors (NRTIs), also known as “nukes.” 
 The NRTIs block reverse transcriptase, a protein 
that HIV needs to make more copies of itself. 
This may slow down HIV disease 
 Vaccines?
Whole virus vaccines
Attenuated viruses: Essentially intact, living HIV virions that have
been chemically or genetically damaged.
Whole killed virus: Intact virions that have been damaged so badly
that they are completely nonfunctional (dead).

Subunit vaccines
Clone one gene from HIV, express the protein and use it to vaccinate
patients. The disadvantage is that the person only raises antibodies
against one target. With free virus, the targets are mainly the
envelope proteins; however, these are extremely variable proteins.
Six amino acids of the V3 loop of gp120 appear to be relatively
constant (some variability exists but most antibodies cross react with
the variants). Antibodies against cocktails of different V3's are being
tried.

Nucleic Acid Vaccines

Gene gun, muscle expression.
PENUTUP
 Sesuai dgn sifat AIDS itu sendiri, maka 
pencegahan AIDS relatif mudah, yaitu 
menghindari pemakaian jarum suntik berganti 
ganti dan menghindari hubungan seksual dgn 
pasangan ganda.
 Agama dan Pancasila melarang hubungan 
seksual ekstra marital. Akan tetapi penggunaan  
jargon jargon Agama atau Pancasila dalam 
batasan ucapan verbal saja jelas tidak ada 
gunanya, bahkan bisa membuat orang tertutup 
terhadap informasi yang benar
 2011: Dream
 
ZERO NEW INFECTION

ZERO DEATH

ZERO DISCRIMINATION

Promise and Accountability

72
73
 ANY
QUestions?
Thank you!