In 2018, there were 37.9 million people living with HIV worldwide. HIV targets and destroys components of the human immune system. Sub-Saharan Africa has the highest prevalence of HIV in the world, with 68% of people living with HIV residing there. HIV is transmitted through unprotected sex, sharing needles, mother-to-child transmission, and to a lesser extent oral sex and exposure to sharp injuries. Advanced HIV infection can lead to opportunistic infections as the immune system weakens. Treatment involves antiretroviral therapy with multiple drug combinations to suppress the virus and combat drug resistance. Adherence to treatment regimens is crucial to support positive health outcomes.

1. HIV/AIDS BASIC CONCEPT
Dwi Kartika Rukmi
kartikarukmi@ymail.com

2. In 2018, it was estimated that there were 37.9 million people living with HIV worldwide; 770,000 related
deaths were recorded that year (WHO, 2018)

3. HIV targets and destroys essential component of
human immune system
HIV is believed to have originated from West Africa.
Sub Saharan Africa is the highest prevalence of HIV in
the world. It is estimated 68% of PLHA lived there
First major cluster is in US in the early 1980s, in 1986
he virus had been isolated and identified, but had
already infected thousands of people across 85 coun-
tries worldwide

4. HIV STRUCTURE & LIFE CYCLE

5. IMMUNE
SYSTEM

9. HIV TRANSMISSION
Anal and
vaginal
Intercourse
Receiving a
transfussion
MTCT
Sharing
needle or
syringe
Uncommon:
Oral sex and
sharp injury

10. SIGNS AND SYMPTOMS

11. WHO
HIV
CLASSIFICATION
Chandra et al,2013

12. HIV CLINICAL SYMPTOM

13. ADVANCED HIV INFECTION

14. HIV/AIDS STAGING
Acute phase
Chronic
latent phase
Advanced
HIV Infection

15. CDC HIV CLASSIFICATION

16. CDC vs WHO CLASSIFICATION
CDC, 2008

17. MANAGEMENT PRINCIPLES
HIV
Management
Undetectable equals Untransmittable (U =U)
Viral load under 40 copies per milliliter
Cannot transmit virus if VL is undetectable for last six
months

18. GLOBAL TARGET OF HIV

19. HIV DIAGNOSING

21. HIV TESTING RECOMMENDED GROUP
• Key population (LGBT, MSM, Drug user, Sex workers)
• People attending health services associated with an increased risk of
HIV, such as tuberculosis clinics and substance-misuse services
• People presenting with symptoms or signs consistent with an HIV-
indicator condition, such as lymphoma
• People accessing healthcare in areas of high HIV prevalence

22. BARRIERS OF HIV TESTING
• Fear of judgement, for example among transsexual women, sex workers or drug
users;
• Fear of impact on immigration status;
• Lack of knowledge, training or staff in health care settings;
• Lack of funding or reimbursement for HIV testing across primary and secondary
care settings;
• Lack of awareness or low perception of individual risk-taking behaviour;
• Lack of clinician skill to communicate or risk assess;
• Lack of access or proximity to a testing provider;
• Fears around a positive result, including stigma, confidentiality, rejection and
discrimination;
• Fear of prosecution for reckless transmission.

23. CONTACT TRACING
• Passive notification – a trained professional encourages the
patient to share their diagnosis with their partner(s)
themselves, and is given support and counselling to achieve
this.
• Assisted notification – a trained provider, such as a health
adviser or specialist nurse, confidentially contacts the
patient’s sexual contacts to offer them counselling,
prevention advice and testing.

24. PRIMARY
PREVENTION
OF
HIV

25. Antiretroviral
Therapy

26. Antiretroviral
Therapy

27. ARV to combat drug resistance
combination therapy is now the standard treatment:
patients are given three or four drugs from at least
two classes  called highly active anti-retroviral
therapy (HAART)

28. ARV in Adult
Permenkes RI,no 87 tahun 2014

29. ARV in Children
Permenkes RI,no 87 tahun 2014

30. KEY PRACTICES POINTS
• All patients with HIV should be started on anti-retroviral therapy,
even if they have no symptoms or a good CD4 count;
• Patients who are treatment-naive (never having taken anti-
retroviral therapy) should, typically, be commenced on regimens
comprising three different fully active anti- retroviral agents;
• Support and holistic assessment from a wider group of
professionals is crucial to support adherence and individual
treatment plans;
• Treatment interruption or ‘holidays’ are not recommended.

31. FUTURE SERVICE IN HIV

32. Predictors of Negative Outcomes

33. ADHERENCE ON ARV https://aidsinfo.nih.gov

34. ARV
EVALUATION
FLOWCHART
Permenkes RI,no 87 tahun 2014

35. ARV FAILURE
Permenkes RI,no 87 tahun 2014

36. Opportunistic Infections
• Infections that occur more
often or are more severe in
people with weakened immune
systems than in people with
healthy immune systems.
People with weakened immune
systems include people living
with HIV
• See the opportunistic infection
on picture WHO HIV
Classification

37. Tanuma et al,2016

38. Kemenkes RI, 2010

39. Kemenkes RI, 2010
Sarcoma kaposi

40. Kemenkes RI, 2010

41. Management of OIs: an example
• Other OIs please
see at
https://www.cdc.g
ov/mmwr/preview
/mmwrhtml/rr58e
324a1.htm
• Nursing care
patient with
HIV/AIDS please
see at
https://www.fhi36
0.org/sites/default
/files/media/docu
ments/Nursing%2
0Care%20of%20Pa
tients%20with%20
HIV-AIDS%20-
%20Participants%
20Guide.pdf

42. REFERENCES
• Kemenkes RI.2010. Tes dan konseling hiv terintegrasi di sarana kesehatan/PITC. Tersedia online
• Depkes RI.2006. Pedoman pelayanan konseling dan testing HIV/AIDS secara sukarela/VCT. Tersedia online
• Permenkes RI no 87 tahun 2014, tersedia online
• https://aidsinfo.nih.gov/
• https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5710a3.htm
• Chandra, Amit & Firth, Jacqueline & Sheikh, Abid & Patel, Premal. (2013). Emergencies related to HIV infection and treatment (part
1). African Journal of Emergency Medicine. 3. 142-149. 10.1016/j.afjem.2013.03.005.
• Tanuma et al,2016. Incidence of AIDS-Defining Opportunistic Infections and Mortality during Antiretroviral Therapy in a Cohort
of Adult HIV-Infected Individuals in Hanoi, 2007-2014. available at
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0150781
• https://www.cdc.gov/mmwr/preview/mmwrhtml/rr58e324a1.htm
• https://www.fhi360.org/sites/default/files/media/documents/Nursing%20Care%20of%20Patients%20with%20HIV-AIDS%20-
%20Participants%20Guide.pdf
• Wilkins T (2020) HIV 3: treatment strategies and holistic nursing management. Nursing Times [online]; 116: 9, 45-48.
• Wilkins T (2020) HIV 2: prevention, symptoms, diagnosis and contact tracing. Nursing Times [online]; 116: 8, 35-38.
• Wilkins T (2020) HIV 1: epidemiology, pathophysiology and transmission. Nursing Times [online]; 116: 7, 39-41.