REFERAT

HIV/AIDS

Disusun Oleh:
Trinita Yosephine Lamria
2115277

Pembimbing:
dr. Limdawati Kwee, Sp.PD

INTERNAL MEDICINE DEPARTMENT

IMMANUEL HOSPITAL
FACULTY OF MEDICINE MARANATHA CHRISTIAN UNIVERSITY
BANDUNG
2022
 CHAPTER I

PREFACE

Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome

(AIDS) remain a global health tragedy, in 2001 the United Nations held a special session that
recognized HIV/AIDS as a global public health crisis 1. The manifestations of HIV/AIDS were
defined with a CD4 count below 350 cells /μl or an AIDS-defining event regardless of CD4 count.
In 2017 there were approximately 36.9 million people living with HIV globally of whom 21.7
million received antiretroviral treatment2.
 CHAPTER II

LITERATURE REVIEW

2.1 Definition

Human Immunodeficiency Virus (HIV) is a virus that attacks cells that play a role in the
immune system and making a person more susceptible to infections and other diseases. HIV is
transmitted by contact with certain body fluids usually during unprotected sex or by sharing drug
injecting equipment. If not treated HIV can lead to Acquired Immunodeficiency Syndrome
(AIDS)3.
AIDS is an advanced HIV infection that occurs when the bodys immune system is severely
damaged by the virus. A person infected with HIV is considered to have AIDS when the CD4 level
is less than 200 cells per cubic millimeter of blood (200 cells/mm3). A person with a healthy
immune system has a CD4 count between 500 to 1600 cells/mm3. 3

2.2 Etiology
HIV disease is caused by infection with either HIV-1 or HIV-2 both of which cause very
similar conditions. HIV-1 probably originated from one or more interspecies infections from
chimpanzees in Central Africa. HIV-2 is closely related to the virus that infects Mangabey in West
Africa. Although genetically HIV-1 and HIV-2 are superficially similar each has unique genes and
unique reproductive processes4.
The risk of transmission of HIV-2 is slightly lower and the infection progresses more
slowly to become acquired immunodeficiency syndrome (AIDS). People infected with HIV-2 have
lower viral loads than those infected with HIV-1 and the higher the viral load in people with HIV-
1 the faster they progress to AIDS. HIV-2 is rare in developed countries. Much of the research and
development of vaccines and pharmaceuticals has focused on HIV-1.4
2.3 Risk Factors
In the United States HIV is transmitted primarily through sex or by sharing needles and
other injecting equipment with an HIV-infected person5. The other risk factors is infant from the
mother with HIV/AIDS, and when sexual partners have HIV 6.

2.4 Epidemiology
HIV infection is considered an epidemic, around 39 million people have died of HIV
infection since its discovery and more than 35 million people are currently living with HIV. The
incidence of HIV/AIDS has increased in recent years and advances in treatment have allowed
people living with HIV to live longer. Efforts have been made to define AIDS in education
prevention and research to reduce transmission and treat the virus. Efforts in developed countries
have reduced mortality quality of life and transmission rates HIV and AIDS rates vary greatly
around the world. For example in sub-Saharan Africa an estimated 25 million people of all ages
are living with HIV7.

2.5 Classification
There are three stages of HIV infection (1) acute HIV infection, (2) chronic HIV infection,
and (3) acquired immunodeficiency syndrome (AIDS).
2.5.1 Acute HIV Infection
Acute HIV infection is the first stage of HIV infection and usually occurs within 2-
4 weeks after HIV infection. During this time some people experience flu-like
symptoms such as fever headache and rash. In the acute phase of infection HIV
multiplies rapidly and spreads throughout the body. The virus attacks and destroys the
immune systems CD4 cells (CD4 T lymphocytes) that fight infection. Level HIV in the
blood during the acute phase of infection is very high, which greatly increases the risk
of HIV transmission8.

2.5.2 Chronic HIV Infection

Chronic HIV infection also known as asymptomatic or clinically latent HIV
infection. At this stage HIV continues to multiply in the body but at very low level.
People with chronic HIV infection may not have HIV-related symptoms. Chronic HIV
infection can progress to AIDS over 10 years or more without antiretroviral therapy
although it can progress more quickly in some people. People who are taking ART may
be in this stage for several decades8.

2.5.3 Acquired Immunodeficiency Syndrome (AIDS)

AIDS is the final and most serious stage of HIV infection. Because HIV has
severely damaged the immune system the body cannot fight off opportunistic
infections. (Opportunistic infections are infection and infections related cancers that
occur more frequently or more severe in people with weakened immune systems than
in people with healthy immune systems.) People with HIV diagnosed with AIDS if
have fewer than 200 cells/mm3 CD4 count or if having opportunistic infections. After
an AIDS diagnosis a persons viral load can be high and they can easily transmit HIV
to others. Without treatment people with AIDS usually live 3 years 8.
2.6 Pathogenesis

Gambar Pathogenesis HIV9

The HIV life cycle is complex, its duration and outcome dependent on target cell type and
cell activation. In the early stages HIV gains access to the cell but does not inflict immediate lethal
damage but the entry process stimulates signaling sequences within the cell to facilitate viral
replication. Two molecules within the HIV envelope the external glycoprotein (gp120) and the
transmembrane protein (gp41) form spikes on the surface of the virus. During the invasion process
gp120 first attaches to the cell membrane by binding to the CD4 receptor. Interactions between
viruses and chemokine co-reseptors (such as CCR5 CXCR4) cause irreversible conformational
changes. The actual fusion occurs within minutes of pore formation releasing the viral core into
the cytoplasm. After the core disassembles the viral genome is transcribed into DNA by viral
reverse transcriptase. Because reverse transcriptase is error-prone and has no proofreading activity
various viral variants can be generated during this process. The DNA will go into the nucleus and
integrate with the hosts DNA to form what is called the provirus. A provirus can be latent or
continue to form RNA. The resulting RNA is used to make viral proteins that are released from
the plasma membrane and grow into new viruses10.

2.7 Evaluation
The 5 basic components that have been agreed upon regarding HIV testing (informed
consent, confidentiality, counseling, correct test results, connections to care, treatment and
prevention services). HIV diagnostic tests include 2 testing methods: serological testing with
antibodies and antigen test, and virological testing with qualitative HIV DNA testing and
quantitative HIV RNA testing11.
Patients diagnosed with HIV or serious medical problems should have a complete blood
count to evaluate for leukopenia or thrombocytopenia. Differences in complete blood counts can
help estimate a patients CD4 count. A CD4 count may be normal if the white blood cell and
lymphocyte counts are within normal limits. If the absolute lymphocyte count is below 950
cells/mm3 the patients CD4 count may be below 200 cells/mL which is sufficient for
immunosuppression and risk of opportunistic infections7.
2.8 Treatment
Guiding principle of HIV infection: Monitoring both periodic and regular HIV-RNA
plasma and CD4 count to determine the progress of HIV infection and treatment of antiretroviral
therapies, therapeutic decisions must be individually based on the amount of RNA HIV and CD4
count, combination antiretroviral therapies aimed to supress HIV so that HIV infection's progress
can be inhibited, each antiretroviral in combination therapy should be treated with an optimal dose
and schedule. Antiretroviral therapy is recommended for all HIV- infected individuals with
symptoms or the CD4 count less than 350 per mikroliter or HIV-RNA plasma number is 55,000
per microliters or without viewing CD4 count.
Prevention of viral proliferation using strong ARV agents provides good results treatment
of HIV infection. The drugs used consist of three groups, namely nucleosides and non-nucleoside
reverse transcriptase inhibitors and protease inhibitors
Reverse Transcriptase Inhibitors : HIV reverse transcriptase inhibitors include two classes
of antiretroviral drugs: nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside
reverse transcriptase inhibitors (NNRTIs). Mechanistically there is a fundamental difference
between NRTIs and NRTIs. Elongated HIV DNA causes chain termination while NNRTIs bind
directly to the HIV reverse transcriptase enzyme and inhibit the enzymes function.
Nucleoside Reverse Transcriptase Inhibitors: NRTIs require intracellular phosphorylation
to achieve an active state. Once in the triphosphorylated state NRTIs copy human nucleotides and
can be exchanged by reverse transcriptase. Unlike human nucleotides NRTI drugs do not have a
3-hydroxyl group and it is not possible to add additional nucleotides to the NRTI drug hence the
name chain terminator.
Non-nucleoside reverse transcriptase inhibitors. NNRTIs bind to a hydrophobic pocket
near the p66 subunit near the polymerase active site. Binding of NNRTIs causes hyperextension
of the thumb region of reverse transcriptase which leads to conformational changes in this
polymerase domain that inhibit DNA polymerization a critical step in HIV reverse transcription.
The NNRTI hydrophobic binding pocket region mainly encompasses amino acids. codons 98 to
108 and 179 to 190.
Protease inhibitors : HIV protease inhibitor (red pentagon) binds to the active site of HIV
protease and inhibits protease processing of Gag and Gag-Pol polyproteins. HIV protease inhibitor
HIV protease inhibitors are structurally complex molecules that bind to the active site of HIV
protease and inhibit the activity of the protease enzyme. HIV protease inhibitors interfere with the
normal processing of the Gag and Gag-Pol polyproteins, causing the normal maturation process to
stop, thereby preventing the infection of new cells. Protease inhibitors have no effect on cells
already infected with HIV (those with proviral DNA mixed with host DNA) 12.

2. 9 Prevention
HIV prevention strategies based on transmission routes. Sexually transmitted risk
behaviors programs including promotion of condoms, reproductive health education in schools,
counseling and HIV tests, HIV screening and treatment, antiretroviral therapy. For blood
transmission could be with adverse effects reduction using napza injections, blood management
security, infection control at hospitals, post exposure profilaksis. Mother to child transmission can
be prevented by providing HIV and sexually transmitted infection tests to all pregnant women.
ARV treatment is recommended for pregnant women living with HIV, and recommended not to
breastfeed change to formula milk6,13.
2.10 Prognosis
The prognosis depends on the patients current condition and treatment. So far treatment is
to prolong life span, and the treatment is not a defitive therapy, so the prognosis is generally dubia
ad malam6.
 CHAPTER III

CONCLUSION

Human Immunodeficiency Virus (HIV) is a virus that attacks cells that play a role in the
immune system and making a person more susceptible to infections and other diseases. HIV can
cause AIDS, AIDS is an advanced HIV infection that occurs when the bodys immune system is
severely damaged by the virus. To diagnosed HIV several examination should be carried out. ARV
is the important treatment for HIV/AIDS. The prognosis depends on patient current condition and
treatment and commonly the prognosis is dubia ad malam.
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