HIV-AIDS Basic Concept

A DULT N URSI N G DEPA RT MEN T

FACULT Y OF N URSI N G
UN I V ERSI TA S I SLA M SULTA N AG UN G
Learning Objectives
• Definition
• Etiology & Risk Factors
• Pathophysiology
• Clinical Manifestation
• HIV Testing
Key facts (WHO, 2019)

• HIV continues to be a major global public health issue, having

claimed almost 33 million lives so far. However, with increasing
access to effective HIV prevention, diagnosis, treatment and care,
including for opportunistic infections, HIV infection has become a
manageable chronic health condition, enabling people living with
HIV to lead long and healthy lives.
• There were an estimated 38.0 million people living with HIV at the
end of 2019.
Definition
• HIV belongs to a group of viruses known as retroviruses. These viruses carry their
genetic material in the form of ribonucleic acid (RNA) rather than deoxyribonucleic
acid (DNA). Infection with HIV occurs when it enters the host CD4 (T) cell and causes
this cell to replicate viral RNA and viral proteins, which in turn invade other CD4 cells
(Smeltzer & Bare, 2010).
• Immunodeficiency results in increased susceptibility to a wide range of infections,
cancers and other diseases that people with healthy immune systems can fight off.
• The most advanced stage of HIV infection is acquired immunodeficiency syndrome
(AIDS), which can take many years to develop if not treated, depending on the
individual. AIDS is defined by the development of certain cancers, infections or other
severe long term clinical manifestations (WHO, 2020).
Etiology
The cause of this infectious disease is the human immunodeficiency virus
(HIV), which can be classified into HIV-1 and HIV-2. HIV-1 is more globally
expanded and virulent. It originated in Central Africa. HIV-2 is much less
virulent and comes from West Africa. Both viruses are related antigenic
ally to immunodeficiency viruses found primarily in primates.

The transmission of HIV depends upon:

• The availability of the infectious agent (HIV) in sufficient quantity
• The viability of the infectious agent (how strong it is)
• The virulence of the infectious agent (how infectious it is)
• The ability of the infectious agent to reach the bloodstream, mucous
membranes, or broken skin of a potential host (the entry for getting
into another person’s body)
Risk factors
Behaviors and conditions that put individuals at greater risk of contracting
HIV include:
• having unprotected anal or vaginal sex;
• having another sexually transmitted infection (STI) such as syphilis, herpes,
chlamydia, gonorrhoea and bacterial vaginosis;
• sharing contaminated needles, syringes and other injecting equipment and
drug solutions when injecting drugs;
• receiving unsafe injections, blood transfusions and tissue transplantation,
and medical procedures that involve unsterile cutting or piercing; and
• experiencing accidental needle stick injuries, including among health
workers
 Pathophysiology
• HIV enters the bloodstream and seeks out T-helper lymphocytes, which are specialized
white blood cells essential to the functioning of the immune system. One of the functions
of these cells is to regulate the immune response in the event of attack from disease-
causing organisms such as bacteria or viruses. When the virus infects the T-helper
lymphocyte, the cell sends signals to other cells, which produce antibodies. This T-helper
lymphocyte cell is also known as the T4 or the CD4 cell.
• HIV infects and destroys the T-helper lymphocytes and damages their ability to signal for
antibody production. When this happens, the immune system eventually becomes
ineffective against any invading pathogen or antigen.
• There are five stages of HIV/AIDS infection:
1. Primary or acute infection
2. The window period ending with seroconversion
3. The asymptomatic period
4. The symptomatic period
5. Full-blown AIDS
Primary or Acute HIV Infection

• Primary or acute HIV infection is the first stage of HIV disease—

typically lasting only a week or two—when the virus first establishes
itself in the body. This is the period of time between first infection
and when the body begins to produce antibodies. The virus is highly
infectious but unfortunately not detectable by any tests. During this
primary infection, patients have no symptoms.
Window Period

• The window period is the period of time between initial infection

with HIV and the point when the body produces detectable
antibodies, which can vary from 2 to 12 weeks. During the window
period a person is infectious, with a high viral load, but still presents
with a negative HIV antibody test. This means the infected person
might get a negative test result while actually having HIV. The point
when the HIV antibody test becomes positive is
called seroconversion. Patients also may remain asymptomatic
during the window period with no clinical manifestations, which
decreases patient motivation for testing.
Asymptomatic Stage

• After the acute stage of HIV infection, people infected with HIV continue to
look and feel completely well for long periods, sometimes for many years.
During this time, the virus is replicating and slowly destroying the immune
system. This asymptomatic stage is sometimes referred to as clinical
latency. This means that, although a person looks and feels healthy, they
can infect other people through any body fluid contact such as unprotected
anal, vaginal, or oral sex or through needle sharing.
• The virus can also be passed from an infected woman to her baby during
pregnancy, birth, or breastfeeding when she is unaware of being HIV
positive. Unless the infected person is given antiretroviral therapy, the onset
of AIDS occurs an average of 10 years after being infected with HIV.
Symptomatic Stage

• The symptomatic stage occurs when clinical manifestations appear,

including nausea, vomiting, cold and flu-like symptoms, weight loss,
malaise, and general infections. Because these symptoms occur with
many other illnesses, patients don’t recognize them as unique to HIV
infection and often do not get screened, tested, diagnosed, or
treated. Clinical symptoms appear as the body’s immune system can
no longer respond effectively to other pathogens because the HIV has
taken over the CD4 lymphocytes.
Full-blown AIDS

• Autoimmune deficiency syndrome (AIDS) is always caused by HIV,

but HIV is not always in the full state of AIDS. Only after the HIV has
completely infected the CD4 cells and used their metabolism and
multiplication ability is the body’s immune system incapacitated.
AIDS is diagnosed when the CD4 count is less than 200 compared
with the normal range of 1,000 T cells in healthy people. Primary tests
for diagnosing HIV and AIDS include a positive ELISA test, viral load
test, or Western Blot Test.
• The AIDS Stadium consist of 4 Stages
 AIDS Stadium 1: Tanpa Gejala
• Tidak ada penurunan berat badan
• Tanpa gejala atau hanya:
Limfadenopati
Generalisata Persisten

DD:
1. Limfadenitis
2. TB Kelenjar
3. AIDS stadium 1
4. Limfoma Maligna

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Stadium 2: Sakit Ringan

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PPE (Palpular Pruritic Eruption)
DERMATITIS SEBOROIK = INFEKSI KULIT

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18
Jamur di lidah
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 • Batuk >2 minggu
• Keringat Malam hari
• Berat Badan Turun

Stadium 3: TB Paru: Infiltrat di tengah

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Stadium 4: Sakit Berat (AIDS)

-Sindroma Wasting (HIV) : kurus kering

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Stadium 4: Wasting sindrom
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Clinical Manifestation
• The symptoms of HIV vary depending on the stage of infection. Though
people living with HIV tend to be most infectious in the first few months
after being infected, many are unaware of their status until the later
stages. In the first few weeks after initial infection people may experience
no symptoms or an influenza-like illness including fever, headache, rash or
sore throat.
• As the infection progressively weakens the immune system, they can
develop other signs and symptoms, such as swollen lymph nodes, weight
loss, fever, diarrhoea and cough. Without treatment, they could also
develop severe illnesses such as tuberculosis (TB), cryptococcal
meningitis, severe bacterial infections, and cancers such as lymphomas
and Kaposi's sarcoma.
HIV Testing

1. Rapid point-of-care tests can deliver preliminary results in around

20 minutes. These may require a blood drop from your finger, an oral
swab from your gums, or a sample of urine. Of these, the preferred
method is the blood-based combination HIV antigen/antibody (Ag/Ab)
test
2. Standard point-of-care tests are lab-based tests that detect HIV
antibodies only. Also known as the HIV ELISA, the test requires a blood
draw. The results are usually returned within five to 10 working days.
The test is less commonly used today and has been largely replaced by
the combination HIV Ag/Ab test.
• Rapid at-home tests are saliva-based antibody tests that can be
purchased online or at many retail drugstores. While less accurate
than a point-of-care test, the test offers privacy and can deliver
results in around 20 minutes
• Home collection kits can also be purchased online. This antibody test
requires a drop of blood placed on a test card, which you then send to
a lab via express mail. You can then receive the results either by
phone or online as early as one business day after your sample is
delivered
• Nucleic acid tests (NAT) are blood-based tests that detect HIV RNA.
While expensive, the NAT can detect HIV earlier than other forms of
testing and may be appropriate if you have had a recent high-risk
exposure or are experiencing acute symptoms of early infection. The
NAT is also used to screen donated blood or test newborns suspected
of having HIV. Results are usually returned within a couple of days.