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Faridha S Ilyas
Aquired
Immunodefciency
Syndrome (AIDS)
Copyright © 2005 by Garland Science Publishing
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PENDAHULUAN• AIDS: kumpulan gejala akibat penurunan imunitas yang
didapat akibat inf. HIV sehingga mudah terkena berbagai
infeksi oportunistik dan penyakit keganasan.
• Transmisi melalui !ara" yaitu:
#$% &ertikal dari ibu ke anak
#'% transeksual #homoseksual maupun heteroseksual%
#% hori(ontal yaitu kontak dengan darah terinfeksi
Air liur bukti yang meyakinkan )
1
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HIV infections caused millions ofmorbidity and mortality around the world
20 millions has died from AIDS, 40 millions are alive with HIV
HIV!" world wide# HIV2" $est Africa and India %200!&
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Kondisi Terbaru
Situasi 'asus I(SHIV dan AIDS )rov Sulsel *anuari + *uni200
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• *anifestasi AIDS rata+rata timbul $, tahun sesudah infeksi.
• -enderita yang sistem imunitasnya sudahsangat menurun jumlah sel D/ yang
rendah 0 hilangnya fungsi sel D/ infeksioportunistik yang sistemik.
• 1 2,3 penderita HIV mengalami infeksi
oportunistik" #bakteri" jamur" &irus" sertainfeksi parasit%.
2
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PERJALANANPERJALANAN
PENYAKITPENYAKIT
Ter
tular
PositipPositip
WINDOW
PERIOD 3-6 BL
6 – 12 TH RATA-RATA ! TH6 – 12 TH RATA-RATA ! TH
TANPA "E#ALA A$I%TO%ATI$TANPA "E#ALA A$I%TO%ATI$
AID$
%ATI DL% 2 TH%ATI DL% 2 TH
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AIDS Characeri!ic!
- Susce.tibility to infection with o..ortunistic .atho/ens
or by the occurrence of a//ressive form of certain
mali/nancies
- D41 cells ↓
- S.read by contact with body 3uid
- ransmission"
+ Seual intercourse
+ ontaminated needles
+ 5reast feedin/
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HIV is a retrovirus that infects D4 cells,
dendritic cells and macro.ha/es throu/h their
chemo6ine rece.tors
78 %78 virus& and 974 %94 virus&
Free virus: - blood - vaginal fluid
- semen - mother’s milk
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HIV
Variants
7ece.t
or
o
rece.tor
ell
lines
7e:uireme
nt of entry
78 78 ;<
;4
;8
D
(=
cells
;ow level of
D4
74 974 9;!2 cell Hi/h level of
D4
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Immune res.onse to HIV %Fi/> !!2?&
D4 cells declines, D
cells and antibody titer hi/h D4 low, Dlow, antibodylow
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"ira# Enry- (ucosal e.ithelia
+ @.osed to forei/n anti/ens+ )rovide a milieu of immune system activity in which
HIV re.lication occurs readily
- 2 ty.es of e.ithelial cell linin/+ Va/ina, .enis, cervi, anus %stratied s:uamous
e.ithelium&
- D with Dsi/n + bind viral /. !20 HIV is internaliBed
brou/ht to lym.h tissue .resent it to D4 cells+ 7ectum, endocervi %sin/le layer of e.ithelial cells&
- @.ithelium e.ress 78 translocate 78 variants to
submucosal D4 cell and D
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Lae in in$ecion%
- 80C of cases
- Viral .henoty.e switches to 94 ty.e
- sa/e of 974- Associate with ra.id decline of D4 count
- (echanism loss of D4
+ Direct viral 6illin/ of infected cells
+ E susce.tibility to induction of a.o.tosis in infected cell
+ 'illin/ of infected D4 cells by ;
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Virus HIV merupakan retro&irus obligat inraseluler
dengan replikasi sepenuhnya di dalam sel host
16Sumber: deshya.wordpress.com/
category/uncategorized/
http://deshya.wordpress.com/category/uncategorized/http://deshya.wordpress.com/category/uncategorized/http://deshya.wordpress.com/category/uncategorized/http://deshya.wordpress.com/category/uncategorized/http://deshya.wordpress.com/category/uncategorized/
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Sumber: thefutureofthings.com/articles.php?itemId=21/! 1&
http://thefutureofthings.com/articles.php?itemId=21/60/http://thefutureofthings.com/articles.php?itemId=21/60/http://thefutureofthings.com/articles.php?itemId=21/60/http://thefutureofthings.com/articles.php?itemId=21/60/
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he infection of D4 cells by HIV
974
78or
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Tat: transcription regulatorRev: export transcr from nucleus
Gag: core & matrix
Pol: RT, protease, integrase
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reatment ar/ets
974
Viral reverse
transcri.taseinhibitor
78or
Further cycles of infection
is prevented
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Viral .roteaseinhibitor
Releasing virionsare not infectious
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reatment ar/ets
974
78or
.e.tide analo/s of the carboy terminal .e.tide of /.4! % decline .lasma HIV 7A levels
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- )hase !> Viral .roductions declines, virus level in .lasma
decrease G ?8C
- )hase 2> Activation of restin/ D4 cells and macro.ha/es,
virus level declines to undetected level
- )hase )rovirus in memory cells and other reservoirs
Virus decay o
dru/ treatme
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Variety ofo..ortunistic
infections and
cancers can 6illAIDS .atients>
%Fi/ure !!
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Perjalanan Infeksi HIV
HI' tu(u) *+s i+,u(asi -1. t) /e0ala AID$
Ta*pa, se)at
Berta)ap
(erta*(a) (erat
*e+i+//al
Perioe 0e+elai+o perio4
3-6 (l
HI' -4
*e+ular
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Gejala klinis HIV/AIDS
staiu* pe+5a,it staiu* aal i+7e,si HI'
$taiu* ta+pa /e0ala
$taiu* si*to*ati, i+i
$taiu* AID$ si*8la+0ut
$taiu* para)
Stadium awal infeksi HIV
sa,it ((rp )ari9*// sesua) i+7e,si
/e0ala *irip i+7lue+sa e*a*
lesu9le*a)
+5eri se+i
(atu,9sa,it te+//oro,a+
pe*(esara+ ,ele+0ar
Hila+/ se+iri
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Stadium tanpa gejala
tia, ti*(ul /e0ala apapu+
ta*pa, se)at
HI' :4
pt (erla+/su+/ -& t) ;irus terus *e+5era+/ perta)a+a+ tu(u)
Stadium simtomatik dini
istila) ,li+is (ila ter0ai 2 atau le(i) /e0ala ,li+is 5/
(erla+/su+/ 3 (l9le(i) ,elai+a+ ara)
e*a* < 3! = ,eri+/at *ala* (er,ala9terus *e+erus
BB turu+ < 1. > l* 3 (l
?ele*a)a+ tu(u) *e+//a+//u a,ti;itas 7isi, se)ari-)ari
L++8 %e*(esar *ultipel le)er i+/ui+al a@ila
iare (er,ala9terus la*a se(a( ta, 0elas
(atu, sesa, < 1 (l
,ulit /atal (era, *era)-,e(irua+
sa,it te+//oro,a+
pe+ara)a+ ta, 0elas se(a(+5a
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Stadium AIDS (simp.lanjut)
,e,e(ala+ tu(u) sa+/at rusa,
i+7e,si oportu+isti,
TB=
=a+iiasis To@oplas*osis
P+eu*o5stis
$ar,o*a ,aposi
Li*7o*a
Stadium AIDS (simp.lanjut) ,e,e(ala+ tu(u) sa+/at rusa,
i+7e,si oportu+isti,
TB=
=a+iiasis To@oplas*osis
P+eu*o5stis
$ar,o*a ,aposi
Li*7o*a
,e*atia+
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"#santem $I%/ retro&irus
Infeksi primer
$taiu* aal
St di #li i# l t
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'()
Sindrom *eiter:
+alanitis sirsinata
,ll dpt t-d flu#tuatif
Stadium #lini# laten
#Stadium simtomatik dini%
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$taiu* la+0ut
i+7e,si oportu+isti,4
Lesi oral seri+/ *u+ul se(a/ai ta+a aal ari i+7e,si HI'
Ta+pa pe*eri,saa+ seara )ati-)ati seri+/ tia, terpi,ir,a+
Lesi oral seri+/ tia, terasa +5eri lesi isrete
?aa+/ satu-satu+5a ta+a i+7e,si HI' 5/ ite*u,a+
%aa* *a+i7estasi I+7e,si HI' paa oral18 I+7e,si 0a*ur
28 I+7e,si (a,teri
38 I+;e,si ;irus
C8 Neoplas*a
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I+7e,si 0a*ur
•I+7e,si 0a*ur terseri+/ aala) a+iiasis
•#i,a ite*u,a+ a+iiasis oral p pasie+ *ua a+ se)atHI'
Di,e+al C tipe a+iiasis oral
18 Tipe pseuo*e*(ra+ous t)rus) terseri+/ i0u*pai i*a+a sa0a p a;u* oris
28 Tipe H5perplasti
%irip pseuo*e*(ra+ous tetapi *ele,at erat paa 0ari+/a+
38 Tipe Er5t)e*atous
Ta*pa, se(a/ai lesi pat) erite* paa area *u,osa
Paa lia) ta*pa, se(a/ai aera) atro7i )alus ta+pa te@tur
C8 Tipe A+/ular )eilitis
Di0u*pai 7isura paa suut *ulut
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pseudomembrane type
'seudomembrane candidiasis
with geographic border
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$ypertropic candidiasis
at hard palate
$ypertrophic type
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Pe+isilosis
INFE?$I 'IRU$
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penderita $I%
$erpes labialisINFE?$I 'IRU$
Imuno#ompeten
H$'
$( d i
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penderita $I%
imuno
#ompeten.
$( pada penis
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$erpeti# hitlow
gangrenous
$( pada &ul&a
penderita $I%0
H" PD ANAL
5S6"* '"7, $I%
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• oster disseminasi
multidermatom
#ontralateral dan )0
multidermatom
#ontralateral #ronis ulseratif0
)
• *e#urensi• 'ersistensi•3 ulseras4
5S6"* '"7, $I%
P oral (o+e +erosis
toot) e@7oliatio+
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SA45*A 6A-5SI
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LIPOHGPERTROPHG
LIPOHGPERTROPHG LIPOATROPHG
HI'-A$$=IATED
$GNDRO%ELIPODG$RROPHG
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86he Slim
,isease9
86he wasting
syndrome9
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es anti!odi HIV
18 %a+7aat
- *eli+u+/i perseiaa+ ara) i (a+, ara)
- *e+//a*(ar,a+ (esar+5a *asala) HI'9AID$ i *s58- *e+/eta)ui status HI' seara i+i
28 %aa* tes
- ELI$A - sree+i+/
- I**u+o(lot atau Wester+ (lot - pasti
- P=R
38 I+terpretasi
Bila :4 - pu+5a a+ti(oi t) HI'
- teri+7e,si HI'
- pt *e+ular,a+ HI' ,o+7ir*asi ester+ (lot
Bila -4 14 t, teri+7e,si HI'
24 teri+7e,si perioe 0e+ela .-6 (l
ula+/ 3-6 (l
DIA"NO$I$
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ujuan Pengo!atanujuan Pengo!atan
%e+e,a+ 0u*la) ;irus HI' seara *a,si*al
%e*uli),a+ i*u+itas tu(u)
%e*per(ai,i ,ualitas )iup
%e+e,a+ *or(iitas a+ *ortalitas
E;aluasi ,aar RNA HI' ala* plas*a *e+uru+ 1 lo/ 1. ala* ! *i+//u a+ tia,
terete,si la/i ala* C-6 (ula+
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• 7umlah D/ bukan satu+satunya kriteria
pemberian A4V
• -emberian A4V tidak segera diberikan pada
penderita yang di!urigai langkah+langkah
bijaksana" faktor kemampuan" kesanggupan
pengobatan jangka panjang" resistensi obat"
efek samping" serta saat yang tepat memulai
terapi.3
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Pengobatan (A,B,C)
A18 HI'
28 I+7e,si oportu+isti,
38 %e*per(ai,i ?U
I+7us
Tra+s7usi ara)
Al(u*i+
Diet
C8 Lai+-lai+
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Pengo!atan
8•*enjaga kebersihan
•Istirahat•5lahraga•4elaksasi" meditasi
-sikososial•D(ikir" doa bersama
•-ekerjaan•-enerimaan lingkungan
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"apan mulai pengo!atan #
•-asien dg sindroma HIV akut•-asien dg serokon&ersi 9 bulan pertama
•-asien tahap AIDS
•-asien tanpa gejala:
D/ ; 1 ,",,, !opies?m> #bD@A%
1
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@4TI @@4TI -I
Aba!a&ir #A8%
Didanosin #ddi%
>ami&udin #T%Sta&udin #d/T%
ido&udin #DV
atau AT%
Bfa&iren( #BCV
atau BC%
@e&irapine#@V-%
Indina&ir #DV%
4itona&ir #4TV" r%
>opina&ir ritona&ir #>-V?r%
@elfina&ir #@CV%
SaEuina&ir #SFV%
22
AR' 5/ ire,o*e+asi,a+ WHO 2..24
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6olom A 6olom 8 @e&irapine
#@e&iralG%
@elfina&ir
AT ddI
ddI T
d/T ddIAT T
#Du&iralG%
AR' i I+o+esia Dep,es 2..34
$b bagus: 7e&iral
,u&iral
$b turun: 7e&iral
Sta&iral
$i&iral
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SJ $HA
- &'ILITAS PENDDK YAN* TIN**I
- KRISIS EK'N'&I ERKEPANJAN*AN
- KE*IATAN PR'STITSI &EREAK - ADANYA KLP+ RESIK' TIN**I
- K'ND'& SE
- TREND D*E& , *AL
- KRISIS &'RAL- STATE&ENT N'++ DR*, *A&LIN*,
PR'STITTI'N
- ID &ENIN*KAT TAJA&
T-E PR'LE&A
How
Much ?
TERIMAKASIH
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TERIMAKASIH