LECTURE SERIES“HIV: PENULARAN DAN PENCEGAHAN”
PUSAT PENELITIAN HIV/AIDS
UNIKA ATMA JAYA
Speaker: dr. Alegra Wolter
Myth?
2
• Saya bisa ketularan kalau bergaul / tinggal bareng ODHA ?
• HIV/AIDS adalah penyakit gay dan pemakai narkoba?
• HIV bisa nular lewat gigitan nyamuk?
• HIV = Hukuman mati, ga bisa disembuhkan?
• Ibu hamil positif akan selalu menularkan HIV pada janin
Stages of HIV Infection (WHO)
• Asymptomatic
• Persistent generalized lymphadenopathy (≥ 2) for ≥ 6 months
Stage 1 (Asymptomatic)
• Unexplained weight loss <10 % total BW
• Recurrent respiratory infections (e.g. sinusitis, bronchitis, otitis media, and pharyngitis)
• Dermatological conditions (herpes zoster flares, angular cheilitis, recurrent oral ulcerations, papular pruritic eruptions, seborrhoeic dermatitis, and fungal nail infections)
Stage 2 (Mild)
• Weight loss ≥ 10% of total BW
• Prolonged unexplained diarrhea (≥ 1 month)
• Pulmonary tuberculosis
• Severe systemic bacterial infections (pneumonia, pyelonephritis, empyema, pyomyositis, meningitis, bone and joint infections, and bacteremia).
• Mucocutaneous conditions (recurrent oral candidiasis, oral hairy leukoplakia, and acute necrotizing ulcerative stomatitis, gingivitis, or periodontitis)
Stage 3 (Moderate)
• HIV wasting syndrome
• Pneumocystis pneumonia (PCP)
• Recurrent severe or radiological bacterial pneumonia
• Extrapulmonary tuberculosis
• HIV encephalopathy
• CNS toxoplasmosis
• Chronic (≥1 month) or orolabial herpes simplex infection
• Esophageal candidiasis
• Kaposi’s sarcoma
• Other conditions:
• CMV infections (CMV retinitis or infection of organs other than the liver, spleen or lymph nodes)
• Disseminated fungal infection: extrapulmonary cryptococcosis, disseminated endemic mycoses (e.g., coccidiomycosis, penicilliosis, histoplasmosis), cryptosporidiosis, isosporiasis
• Disseminated non-tuberculous mycobacteria infection,
• Tracheal, bronchial or pulmonary candida infection,
• Visceral herpes simplex infection,
• Acquired HIV-associated rectal fistula,
• Cerebral or B cell non-Hodgkin lymphoma,
• Progressive multifocal leukoencephalopathy (PML)
• HIV-associated cardiomyopathy or nephropathy
Stage 4 (Severe/AIDS)
Special Situations: Mother-to-child transmission
• ARV as soon as possible• with treatment 1% risk, without 15-45% (related to Viral Load)
27
PM
TC
T Pregnancy (30%)
Labor, Delivery (70%) C-section delivery?
Breastfeeding (varied risk <10%)
Still encouraged, espin developing countries
Prevention Strategies
• Condoms, Preventing STDs
• Circumcision
• Anti HIV Drugs: PrEP, PEP, ART Treatment
Medical Strategies
• Sex education, safe sex, abstinence
• Safe needle program
• Advertising and Campaigns
• Public Health Regulation
Social Strategies
31
Circumcision and HIV/STI Prevention
32
• 60% reduced risk of HIV
• Cervical cancer (HPV)
• Herpes simplex virus
(HSV)
• Chlamydia
• Syphilis
• Candidiasis
• Warts
• Dysuria
• Gonorrhea
• Bacterial vaginosis
Partial protection
PrEP (Pre-Exposure Prophylaxis)
• Protection up to 92% (varied, related to adherence)
• Main Target: High Risk Groups (Adults, >35 kg)
• Sexual transmission• HIV-discordant couples, Non-
monogamous, anal sex, without condom, other STD + (6 months), partner of IDU
• IDU• 6 months: using, sharing equipment, on
IDU treatment
36
PrEP Algorithm
37
Routine evaluation
/ 3 months:
• behavioral risk reduction,
• adherence,
• access to condoms,
• pregnancy?
• STI?
PEP (Post Exposure Prophylaxis)
• 72 HOURS after exposure• Talk to your health care provider or an emergency room doctor about PEP
right away.
• Special conditions:• High risk sexual encounter, exposed? (e.g. condom broke, no protection,
sexually assaulted)
• Shared needles and works to prepare drugs (for example, cotton, cookers, water)
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Evaluation 3 mo, 6 mo
Who should get tested?
• Regardless of risk, 15-65 yo *unless refuses
• <15, >65 yo, screening for high risk• MSM• IDU
• Unprotected anal, vaginal intercourse• Partner with High risk behaviors• History of STI• Sex workers
• Other: pregnancy
40
Undetectable Viral Load• HIV cannot be detected in standard diagnostic test (<50 copies/mL)
• No chance of passing HIV.
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March 28, 2019, from https://www.schulich.uwo.ca/about/news/2017/december/world_aids_day_top_5_myths_about_hivaids.html
• Kementrian Kesehatan Republik Indonesia. (2019). Laporan Perkembangan HIV AIDS dan Infeksi Menular Seksual (IMS) Triwulan IV Tahun 2018.
• Joint United Nations, & Programme on HIV/AIDS. (2018). UNAIDS data 2018, 376. https://doi.org/978-92-9173-945-
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• Terms, Definitions, and Calculations | Surveillance Overview | Statistics Center | HIV/AIDS | CDC. (n.d.). Retrieved February 2, 2019, from https://www.cdc.gov/hiv/statistics/surveillance/terms.html
• Weinberg, J. L., & Kovarik, C. L. (2010). The WHO Clinical Staging System for HIV/AIDS. Virtual Mentor, 12(3), 202–206. https://doi.org/10.1001/virtualmentor.2010.12.3.cprl1-1003
• Prinsip Penularan HIV – ODHA Berhak Sehat. (n.d.). Retrieved March 27, 2019, from https://www.odhaberhaksehat.org/2012/hiv-hanya-bisa-menular-jika-baca-artikel-ini/
• Myths about HIV and AIDS | AVERT. (n.d.). Retrieved March 27, 2019, from https://www.avert.org/hiv-transmission-prevention/myths
• Patel, P., Borkowf, C. B., Brooks, J. T., Lasry, A., Lansky, A., & Mermin, J. (2014). Estimating per-act HIV transmission risk. AIDS, 28(10), 1509–1519. https://doi.org/10.1097/QAD.0000000000000298
• Wilton, J. Putting a number on it: The risk from an exposure to HIV. Retrieved March 27, 2019, from https://www.catie.ca/en/pif/summer-2012/putting-number-it-risk-exposure-hiv
• HIV and Family Planning - POZ. (n.d.). Retrieved March 27, 2019, from https://www.poz.com/basics/hiv-basics/hiv-family-planning45
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27, 2019, from https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/24/71/preventing-mother-to-child-transmission-of-hiv-after-birth
• World Health Organization PMTCT guidelines | AVERT. (n.d.). Retrieved March 27, 2019, from https://www.avert.org/infographics/world-health-organization-pmtct-guidelines
• Myths about HIV and AIDS | AVERT. (n.d.). Retrieved March 27, 2019, from https://www.avert.org/hiv-transmission-prevention/myths
• Szabo, R., & Short, R. V. (2000). How does male circumcision protect against HIV infection? BMJ (Clinical Research Ed.), 320(7249), 1592–1594. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10845974
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• UNAIDS. (n.d.). Undetectable = untransmittable public health and HIV viral load suppression UNAIDS explainer. Retrieved from http://www.unaids.org/sites/default/files/media_asset/undetectable-untransmittable_en.pdf 46
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