A.  Background

HIV (Human Immunodeficiency Virus) is a virus that belongs to the family retroviridae that are able to infect lymphocyte cells and induce a decrease in a body’s immune system. Meanwhile, AIDS (Acquired Immune Deficiency Syndrome) itself is defined as a series of symptoms or diseases that are caused by said reduction of bodily immunity due to HIV infection (Djoerban, 2015).

The very first case of AIDS was discovered in the United States in the year 1981 (Fauci, 2018). Meanwhile, AIDS in Indonesia was first officially reported by the Department of Health in 1987 in the Province of Bali (Djoerban, 2015). All across the world, there are 35 million of people who are afflicted by HIV, and 19 million amongst them are unaware of such condition. (UNAIDS, 2014). Within the Asia-Pacific region, 350,000 people are reported to be afflicted with HIV, and around 64% of them are male (UNAIDS, 2013). In the year 2017, there are 48,300 cases of HIV positive in Indonesia, and 9,280 among them has entered the final stage of infection, which is known as AIDS (Kemenkes RI, 2017)

This ailment can be transmitted via bodily fluids. People who are at high risk of being afflicted by this disease are drug users that shares the same syringe, sex worker, recipient of blood donated by an infected person, and babies with mother that are infected by HIV (Fauci, 2018)

The large amount of people suffering from this disease and the large amount of people who are at risk of being exposed solidifies HIV/AIDS as one amongst many infectious diseases that must be continuously studied. HIV diagnostic test, preventative and curative efforts, and educating the general public regarding this illness are vital tasks in order to minimize contagion risk. Even now, the Indonesian government and the rest of world constantly develops effective ways to slow down transmission and improve patient recovery rate by campaigning for the usage of contraceptives and treatment using ARV (Djoerban, 2015)

B.  DEFINITION

Human Immunodeficiency Virus (HIV) is a type of virus that infects white blood cell, thus causing the weakening of a person’s immune system. Acquired Immune Deficiency Syndrome (AIDS) is a series of symptoms that emerged due to the weakening of immune system as caused by HIV infection. (Kemenkes. 2016)

C.  ETIOLOGY

Acquired Immune Deficiency Syndrome (AIDS) is caused by Human Immunodeficiency Virus (HIV). HIV viruses are classified into HIV-1 and HIV-2. HIV-1 are more widespread across the world and is easier to transmit. HIV-1 hailed from Central Africa. HIV-2 weaker than HIV-1 in regards to infectiousness and ease of propagation, and originates from West Africa. Both varieties of viruses are, in regards to antigen, related to immunodeficiency virus that is mainly found in primates. (Valiant and Gulick, 2022)

D. RISK FACTOR

HIV can be transmitted via exchange of various bodily fluids with an infectee, like blood, mother’s milk, seminal fluids, and vaginal discharge. HIV can also be transmitted between a mother to her child during pregnancy and childbirth. It is impossible to be infected by ordinary contacts, such as kissing, hugging, handshaking, or sharing private properties such as food or water (WHO, 2019).

The following are those at risk of HIV infection:

·      Male or female sex workers

·      Users of drugs injected via syringe

·      Men who’s had sexual contact with other men and transgenders

·      Unsafe and risky sexual practices

·      Has been or is currently afflicted by sexually transmitted disease (STD)

·      Has received blood transfusion

·      User of tattoo machine or sharp/medical objects that’s contaminated by HIV

·      Babies from mothers who are afflicted by HIV/AIDS

·      Serodiscordant couples,  where one partner is HIV-positive (PPK, 2017)

 

E.  CLINICAL MANIFESTATION

HIV infection will not immediately show symptoms or any particular complaints.

Patients may arrive with these complaints:

1.    Constant or intermittent fever (temperature higher than 37.5 C) for more than a month.

2.    Constant or intermittent diarrhea for more than a month

3.    Complaints accompanied by a weight loss of more than 10% of base weight.

4.    Other complaints dependent on the accompanying disease.

F. PREVENTION

    General prevention

·      Be in possession of the correct knowledge/awareness

·      Behave in a responsible manner and steer away from AIDS infection risks, such as using drugs or getting intoxicated

·      Avoid stigmatizing and discriminating PLHIV (People Living with HIV/AIDS)

·      Finding out HIV status immediately upon suspecting a risk of infection by voluntarily doing a blood test.

·      ARV medication for HIV infectee that fulfills medication conditions

·      Provide support, care, and medication for PLHIV

     Sexual contact transmission prevention:

·         Those yet to be married: Not engaging in sexual relations

·         Those currently married: Remain faithful to partner

·         Condom usage for risky sexual relations

·         Treatment for sexually transmitted disease (STD) as soon as possible

·         Circumcision for males

     Blood/bodily fluids transmission prevention:

·         Apply general vigilance in all health services, such as:

·         Single use syringe, sterilizing tools, waste management, and staff self-protection

·         Blood screening test for donors/transplant organs

·         Single use syringes for injected drug users

 

Mother to children HIV transmission prevention:

·      Learn the correct knowledge regarding AIDS and reproductive health for teenage girls

·      Counseling and HIV tests for pregnant mothers in widespread epidemic area like in Papua

·      Prevent unplanned pregnancies for women who are aware that they are HIV positive

·      Provide ARV for mothers and babies near and after childbirth

·      Give birth though surgical procedure (Caesarean section), except if the mother has been routinely taking ARV for at least 6 months

·      Consult with healthcare workers regarding breastfeeding their babies

·      Support from family for HIV positive mothers

 

G.    COMPLICATION

HIV complication is when it develops into Acquired Immune Deficiency Syndrome (AIDS). Doctor must be on watch for opportunistic infection and/or low CD4 amount manifesting in HIV positive people.

AIDS happens when lymphocyte count falls within a certain level (under 200 cells per microlitre) and is marked by one or more of these ailments:

§  Tuberculosis (TB)

§  Cytomegalovirus

§  Candidiasis

§  Cryptococcal meningitis

§  Cryptosporidiosis

§  Toxoplasmosis

§  Kaposi's Sarcoma

§  Lymphoma

§  Neurological complications (AIDS dementia complex)

§  Kidney disease 

 

Author          : Alek Gugi Gustaman, SKM

Translator     : Muhammad Faris Hafizhan

Reference:

Justiz Vaillant AA, Gulick PG. HIV Disease Current Practice. [Updated 2022 Sep 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534860/

Panduan Praktik Klinis Bagi Dokter di Fasilitas Kesehatan Primer.2017.PB IDI

WHO HIV update.2019. Global Summary Web, World Health Organization

Djoerban Z, Djauzi S. HIV/AIDS di Indonesia. In: Sudoyo AW, Setiyohadi B, Alwi I,  Simadibrata MK, Setiati S, eds. Buku ajar ilmu penyakit dalam. Ed 6. Jakarta: Pusat  Penerbitan Departemen Ilmu Penyakit Dalam FKUI. 2015.

Fauci AS, Lane HC. Human Immunodeficiency Virus Disease: AIDS and related  disorders. In: Kasper DL, Fauci AS, Longo DL, Braunwald E, Hause SL, Jameson JL.  editors. Harrison’s Principles of Internal Medicine. 20th ed. The United States of America:  McGraw-Hill. 2018.

UNAIDS. The Gap Report. 2014.

UNAIDS. UNAIDS Report in 2013: HIV in Asia and The Pasific. 2013.

Kementrian Kesehatan RI. Laporan Perkembangan HIV/AIDS dan Penyakit Infeksi  Menular Seksual (PIMS) Triwulan IV Tahun 2016. Jakarta: Kementrian Kesehatan RI. 2017.