HIV/AIDS

By: Tia Amestiasih

 History

Probably arose in central Africa

before 1931
Believed to be a monkey virus
mutated to affect humans
First cases reported 1980s in
male homosexuals
 In 1995, the number 1 cause of death
for ages 25 44 in U.S.
Heterosexual transmission is
increasing in the U.S. and is the most
common route of transmission
outside of the U.S.
Greater than 50% of cases are
women
 Introduction
US (2015) 1.2 million person are infected
with HIV 50.000 new cases every year

Indonesia (2013)
DKI Jakarta (32.782); Jawa Timur (19.249);
Papua (16.051), Jawa Barat (13.507), Bali
(9.637).
2015 papua (19.202)
 Introduction
HIV is a cytopathic retrovirus tht attacks
the CD4 T-lymphocytes in the immune
system
AIDS is defined as a CD4 count <200/l
CD4 <14%
Or the precence of an AIDS-defining
illness
 2-4 years during wich CD4 T-cells are
continully destroyed and regenerated, and
viral replication continues clinical latency
Immune control ineffctive, and the CD4
count falls leading to increased
suspectibility to OI
Risk factors for HIV acquisition

Sexual activity
Injection drug use
Blood transfution
Pregnancy
Intrapartum
Occupational exposure
 AIDS-defining illness

Pneumocystis jiroveci pneumonia (PCP)

Mycobacterium tuberculosis (TB)
Toxoplasmosis
Esophageal candidiasis
Disseminated Mycobacterium avium
complex (dMAC)
Cytomegalovirus (CMV)
Among others
 CD4 < 200 PCP
CD4 < 100 histoplasmosis
CD4 < 50 dMAC and CMV retinitis
 Clinical presentation
Fever
Respiration complaints
Neurologic complaints headache,
painless, visual loss
Gastrointestinal complaints acute
diarrhea, pancreatitis, difficulty swallowing
 Primary survey

Airway
Breathing
Circulation
Disability
Exposure
 Secondary survey
Physical examination
Vital sign
General appearance dehydration, hair
loss,
Head and neck visual acuity, oral
examination, lymphadenopathy
Cardiovacular murmur?
Neurologic
Skin
 Diagnostic studies
Complete blood count
Absolute lymphocyte count total white
blood cells count
- ALC <1.000/l predict CD4 count
<200/l
- ALC >2.000/l -------------------------
>200/l

Chemistry
- Glucose level, electrolytes, renal function
Liver profile, liase, lactate dehydrogenase
(LDH)
- in patients with abdominal pain and jaundice
- Lactate dehydrogenase is also useful in patients
with suspected PCP Elevation >200 IU/l
Blood culture
Urine
- UTI
Stool
Blood gas
Immaging
Chest X-ray for all HIV-positive patents
with PCP or fever without a source
Head computed tomography (CT) scan
all patient with neurologic symtoms
Brain magnetic resonance imaging (MRI)
Abdominal CT scan
 Treatment in ED
Fever
CD4 >500/l do not need antimicrobial
therapy
CD4 <200/l should be treated with
broad-spectrum anibiotic coverage
piperacillin-tabozatam+aminoglycoside
 Treatment in ED
Pulmonary complaint
PCP patient should be treated with
trimethoprim-sulfamethoxazole
 Treatment in ED

CNS complaints
Toxoplasosis and mass
Neurosurgery&Steroid (dexa 10 mg iv)
Cryptococcal meningitis amphotericin
B iv
 Treatment in ED
GI compaints
- Candidial esophagitis oral fluconazole
 Disposition
Admission
Fever without a source, CD4 <500/l
Any ill appearing or dehydrated patient
All ps wit pulmonary infc
Ps with abnormal CT scan
SEMOGA BERMANFAAT