HIV is a retrovirus that causes AIDS. It is believed to have originated in Africa in the 20th century and has now spread into a global pandemic, infecting over 38 million people worldwide. AIDS has killed over 25 million people since being recognized in 1981, making it one of the most deadly pandemics in history. HIV belongs to the retrovirus family and contains enzymes like reverse transcriptase that allow it to integrate into a host's genes. There are two types of HIV, HIV-1 and HIV-2, which both ultimately cause AIDS if not treated, although HIV-2 has a longer asymptomatic stage and is less easily transmitted.

1. HIVHIV
((HHUMANUMAN IIMMUNODEFICIENCYMMUNODEFICIENCY VVIRUS)IRUS)

2. Kebanyakan ilmuwan meyakini bahwa AIDS
berasal dari Afrika Sub-Sahara selama abad ke-20
kini penyakit pandemik AIDS
diperkiraan telah menginfeksi 38,6 juta orang
di seluruh dunia.
Pada Januari 2006, UNAIDS sebagai badan PBB
yang menangani penanggulangan penyakit AIDS dan HIV
(Joint United Nations Programme on HIV/AIDS)
bekerjasama dengan WHO (World Health Organization), badan PBB
untuk kesehatan dunia,
memperkirakan AIDS telah membunuh lebih dari 25 juta orang
sejak pertama kali diakui pada tanggal 5 Juni 1981.
Oleh karena itu, penyakit ini merupakan salah satu wabah
paling mematikan dalam sejarah.

3. Pita Merah terlipat sebagai simbol solidaritas
untuk orang yang positif terinfeksi virus HIV dan AIDS.

7. The proteins gp120 and gp41 together
make up the spikes that project from HIV particles,
while p17 forms the matrix and p24 forms the core.
Inside the core are three enzymes required for HIV replication called
reverse transcriptase, integrase and protease.

9. How can we prove that HIV causes AIDS?
Koch's Postulates
In the nineteenth century, the German scientist Robert Koch developed
a set of four "postulates" to guide people trying to prove that a germ causes a disease.
Scientists agree that if HIV satisfies all of these conditions with regard to AIDS
then it must be the cause of AIDS:12
Koch 1: The germ must be found in every person with the disease
Koch 2: The germ must be isolated from someone who has the disease
and grown in pure culture
Koch 3: The germ must cause the disease when introduced
into a healthy person
Koch 4: The germ must be re-isolated from the infected person

10. DESKRIPSIDESKRIPSI
•HIV termasuk golongan Retrovirus
•Mula-mula dikenal sebagai LAV (Lymphadenopathy Associated Virus),
kemudian dikenal sebagai HTLV-III (Human T cell Lymphotropic Virus)
dan akhirnya disebut sebagai HIV (Human Immunodeficiency Virus)

11. How many genes does HIV have?
•HIV has just nine genes
(compared to more than 500 genes in a bacterium,
and around 20,000-25,000 in a human).
•Three of the HIV genes, called gag, pol and env,
contain information needed to make structural proteins
for new virus particles.
•The other six genes, known as tat, rev, nef, vif, vpr and vpu,
code for proteins that control the ability of HIV to infect a cell,
produce new copies of virus, or cause disease.

12. What is the difference between HIV-1 and HIV-2?
There are two types of HIV: HIV-1 and HIV-2.
Both types are transmitted by sexual contact, through blood,
and from mother to child,
and they appear to cause clinically indistinguishable AIDS.
However, it seems that HIV-2 is less easily transmitted,
and the period between initial infection
and illness is longer in the case of HIV-2.

15. How many subtypes of HIV-1 are there?
This diagram illustrates the different levels of HIV classification.
Each type is divided into groups, and each group is divided into subtypes and CRFs.

16. Are there differences in transmission?
It has been observed that certain subtypes/CRFs
are predominantly associated with specific modes of transmission.
In particular, subtype B is spread mostly by homosexual contact
and intravenous drug use (essentially via blood),
while subtype C and CRF A/E tend to fuel heterosexual epidemics
(via a mucosal route).

17. UNIQUE CHARASTERISTICS OFUNIQUE CHARASTERISTICS OF
RETROVIRUSRETROVIRUS
•Virus has enveloped spherical virion that is 80 to 120 nm in diameter and that
encloses a capsid containing two copies of the positive-strand RNA genome
•RNA dependent DNA polymerase (reverse transcriptase) and integrase enzymes
are carried in the virion
•Virus receptor is the initial determinant of tissue tropism
•Replication proceeds through a DNA intermediate termed the provirus
•The provirus integrates randomly into the host chromosome and becomes
a celluler gene

22. In this computer generated image,
the large object is a human CD4+ white blood cell,
and the spots on its surface and
the spiky blue objects in the foreground represent HIV particles.

23. This electron microscope photo shows newly
formed HIV particles budding from a human cell.

25. DEFINISIDEFINISI AIDSAIDS
Penyakit akibat menurunnya daya tahan tubuh
yang didapat karena infeksi HIV

26. KLASIFIKASI INFEKSIKLASIFIKASI INFEKSI AIDSAIDS
•Kelompok I :Infeksi Akut
•Kelompok II :Infeksi kronik asimptomatik
•Kelompok III :PGL (Persistent Generalized Lymphadenopathy)
•Kelompok IV :Penyakit lain :
- Penyakit Neurologis
- Penyaakit infeksi sekunder
- Keganasan sekunder

27. GEJALA KLINIKGEJALA KLINIK
Gejala mayor:
•Berat badan menurun lebih dari 10 % dalam 1 bulan
•Diare kronis yang berlangsung lebih dari 1 bulan
•Demam berkepanjangan lebih dari 1 bulan
•Penurunan kesadaran dan gangguan neurologik
•Demensia/HIV ensefalopati
Gejala minor:
•Batuk menetap lebih dari 1 bulan
•Dermatitis generalisata
•Adanya herpes zoster muli segmental dan herpes zoster berulang
•Kandidiasis Orofaringeal
•Herpes Simpleks kronis progresif
•Limfadenopati generalisata
•Infeksi jamur berulang pada alat kelamin wanita
•Retinitis virus sitomegalo

28. When to Start Therapy
Clinical Category CD4+ Count Viral Load Recommendation
Symptomatic (AIDS
or
severe symptoms)
Any value Any value Treat
Asymptomatic,
AIDS
CD4+ < 200/mm3
Any value Treat
Asymptomatic
CD4+ > 200/mm3
but < 350/mm3 Any value
Offer treatment, but
controversial †
Asymptomatic CD4+ > 350/mm3
> 100,000 c/mL
Consider therapy
or observe † (Data
inconclusive for
either alternative)
Asymptomatic CD4+ > 350/mm3
< 100,000 c/ml
Defer therapy and
observe
•There are special considerations for pregnant women; consult Pregnancy Tables 1-3
† Patient readiness, probability of adherence, and prognos based on CD4 count
and HIV load need to be considered
Adult ART Table 1.

41. HIV and AIDS in the United Kingdom, 1990-2001

42. .
HIV and AIDS in Thailand, 1984-2000

43. DEFINISI KASUS DEWASADEFINISI KASUS DEWASA
Seorang dewasa (>12 tahun) dianggap AIDSSeorang dewasa (>12 tahun) dianggap AIDS
apabila menunjukkan tes HIV positif denganapabila menunjukkan tes HIV positif dengan
strategi pemeriksaan yang sesuai dengan se-strategi pemeriksaan yang sesuai dengan se-
kurang2nya didapatkankurang2nya didapatkan
2 gejala mayor2 gejala mayor dandan
1 gejala minor1 gejala minor,,
dan gejala ini bukan disebabkandan gejala ini bukan disebabkan
oleh keadaan lain yang tidak berkaitanoleh keadaan lain yang tidak berkaitan
dengan infeksi HIVdengan infeksi HIV

44. DEFINISI KASUS ANAKDEFINISI KASUS ANAK
 Anak umur lebih dari 18 bulan,menunjukkan tes HIV positif,Anak umur lebih dari 18 bulan,menunjukkan tes HIV positif,
dan sekurang-kurangnya didapatdan sekurang-kurangnya didapat
-2 gejala mayor dan 2 gejala minor dibawah ini dengan ibu-2 gejala mayor dan 2 gejala minor dibawah ini dengan ibu
HIV positif, dan gejala tersebut bukan disebabkan olehHIV positif, dan gejala tersebut bukan disebabkan oleh
keadaan lain yang tidak berkaitan dengan infeksi HIVkeadaan lain yang tidak berkaitan dengan infeksi HIV
 Anak umur 18 bulan atau kurang, ditemukanAnak umur 18 bulan atau kurang, ditemukan
-2 gejala mayor yang-2 gejala mayor yang berkaitanberkaitan dan 2 gejala minor dengandan 2 gejala minor dengan
ibu HIV positif, dan gejala tersebut bukan disebabkan olehibu HIV positif, dan gejala tersebut bukan disebabkan oleh
keadaan lain yang tidak berkaitan dengan infeksi HIVkeadaan lain yang tidak berkaitan dengan infeksi HIV

45. GEJALA MAYOR
• Berat badan menurun atau gagal tumbuh
•Diare terus menerus atau berulang dalam waktu lebih 1 bulan
•Demam terus menerus atau berulang > 1 bulan
•Infeksi saluran pernafasan bagian bawah yang parah atau menetap
GEJALA MINOR
•Limfadenopati generalisata atau hepatosplenomegali
•Kandidiasis oral
•Infeksi bakteridan/virus yang berulang
•Batuk kronis
•Dermatitis yang luas
•Ensefalitis

46. CARA PENULARANCARA PENULARAN
1. Hubungan seksual
2. Kontak langsung dengan darah/
produk darah/ jarum suntik
3.Vertikal

47. GOLONGAN RESIKO TINGGIGOLONGAN RESIKO TINGGI
1. Sering berganti pasangan seksual
2. PMS (Penyakit Menular Seksual Wanita Tuna Susila
3. Penyalahgunaan obat (pemakai narkoba suntikan)

48. PEMERIKSAAN LABORATORIUM IPEMERIKSAAN LABORATORIUM I
(spesifik HIV)(spesifik HIV)
•Dipstick
•ELISA
•Western Blot: p24, gp41, gp 120
•RT-PCR

49. PEMERIKSAAN LABORATORIUM IIPEMERIKSAAN LABORATORIUM II
1. Pemeriksaan laboratorium dasar
•Pemeriksaan darah lengkap, termasuk hitung jenis
•Tes faal ginjal
•Tes faal hepar
2. Menentukan tahapan infeksi
•Jumlah CD4 atau persentase limfosit atau viral load
3. Pemeriksaan Tambahan
•Foto toraks
•VDRL
•IgG anti Toxoplasma
•HBsAg/anti HBs/HBcAg, anti HCV

50. Such measurements can be made using PCR,
branched-DNA signal-amplification (bDNA)
or quantitative microculture techniques.
For example, the table below shows just how useful bDNA forecasts can be:68
Viral load (RNA copies per
millilitre of blood plasma)
Proportion of patients developing
AIDS within six years
less than 500 5.4%
501-3,000 16.6%
3,001-10,000 31.7%
10,001-30,000 55.2%
more than 30,000 80.0%

51. The immune deficiency definition of AIDS requires
a CD4+ cell count consistently
below 200 cells per cubic millimetre of blood,
which cannot be explained by any factor other than HIV
(such as cancer, malnutrition, radiation or chemotherapy).

52. •treatment of adults and adolescents
•treatment of children
•treatment of pregnant women and prevention
of mother-to-child transmission of HIV
•prevention of opportunistic infections
Treatment

53. Opportunistic infections:
Infections that usually don't cause disease in people
with normal immune systems,
but can affect people with damaged immune systems,
including people with HIV.

54. Topics covered in the guidelines include:
•the goals of anti-HIV therapy
•when to start treatment
•monitoring of patient health
•medication side effects and their management
•anti-HIV medications for use during pregnancy
•diagnosis of HIV infection in infants

55. Antiretroviral Agents Currently Available (generic name/Trade name)
Nucleoside Analogs
zidovudine/Retrovir (AZT, ZDV)
didanosine/Videx, Videx EC (ddI)
zalcitabine/HIVID (ddC)
stavudine/Zerit (d4T)
lamivudine/Epivir (3TC)
abacavir/Ziagen (ABC)
Non-Nucleoside Reverse Transcriptase Inhibitors
nevirapine/Viramune (NVP)
delavirdine/Rescriptor (DLV)
efavirenz/Sustiva (EFV)
Nucleotide Analogue
tenofovir DF/Viread (TDF)
Protease Inhibitors
indinavir/Crixivan
ritonavir/Norvir
saquinavir/Invirase, Fortovase
nelfinavir/Viracept
amprenavir/Agenerase
lopinavir/ritonavir, Kaletra

56. Terima Kasih !Terima Kasih !