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HIV Virus HIV stands for Human Immunodeficiency Virus that causes AIDS by attacking white blood cells called CD4 cells that can damage the human immune system that ultimately could not survive the disru tion! although the disease is very mild though" #he virus HIV attacks CD4 cells and turn them into a breeding ground for new HIV virus then destroying it so it can not be used anymore" $hite blood cells are necessary for the immune system"$ithout immunity the body when attacked by the disease then we have no rotector" #he im act is that we can die e% osed to the common cold" &" AIDS AIDS stands for Ac'uired Immune Deficiency Syndrome which is the im act or effects of the hiv virus roliferation in the living body"#he HIV virus needs time to cause the syndrome of AIDS is deadly and very dangerous" AIDS is caused by the weakening or disa earance of the immune system that had been owned since CD4 cells at a lot of white blood cells destroyed by HIV virus" (echanical #ransmission and Distribution of HIV)AIDS Virus ) &lood *%am le+ &lood transfusion! e% osed to hiv , blood on broken skin! skin e% osed to menstrual blood on the wounded! syringes! etc" ) -i'uid Semen! Semen! S erm and semen (en *%am le+ (en having intercourse without a condom or other security! oral se%! etc"" ) Vaginal .luid in $omen *%am le+ $omen having intercourse without a safety net! borrowing se% aids! oral se%! etc"" ) (other/s (ilk 0 milk *%am le+ &aby drinking ation of hiv , female! male artner/s drinking breast milk! and so forth" #he body fluids that contain no HIV virus in eo le with HIV ,+ ) Saliva 0 s it 0 saliva ) Stool 0 dirt 0 tokai 0 cha ters 0 stool ) #ears ) $ater sweat ) 1rine HIV Causes AIDS

#he HIV causes AIDS is as follows+

2" Se%ual transmission #ransmission 3transmission4 of HIV is se%ually occurs when there is contact between the vaginal secretions or fluids reseminal someone with the rectum! genitals! or mucous

membranes of the mouth of her artner" 5ece tive un rotected se%ual intercourse is more risky than un rotected insertive intercourse! anal intercourse and the risk of greater than usual risk se% and oral se%" 6ral se% does not mean no risk because HIV can enter through both insertive and rece tive oral se%" Se%ual violence in general increase the risk of HIV transmission is not generally used as a rotective and often hysical trauma to the vaginal cavity which facilitates the transmission of HIV" Se%ually transmitted diseases increase the risk of HIV transmission because it can cause the disru tion of normal e ithelial tissue as a result of genital ulcers! and also because of the accumulation of HIV)infected cells 3lym hocytes and makrofaga4 in semen and vaginal secretions" 7" Contamination of blood)borne athogens 5outes of transmission is rimarily associated with in8ecting drug users! hemo hiliacs and reci ients of blood transfusions and blood roducts" Sharing and reusing syringes 3syringe4 containing blood contaminated by biological organisms that cause disease 3 athogens4! not only is a ma8or risk for HIV infection! but also he atitis & and he atitis C" Sharing the use of syringes is the cause of one third of all new HIV infections and 9:; of he atitis C infections in <orth America! =eo le/s 5e ublic of China! and *astern *uro e" 5isk of being infected with HIV from a single rick with a needle used HIV)infected eo le sus ected of a ro%imately 2 in 29:" =ost)e% osure ro hyla%is with anti)HIV drugs can further reduce risk" >" =erinatal transmission #ransmission of HIV from mother to child can occur through the womb 3in utero4 during the erinatal eriod! ie the last weeks of regnancy and during labor" If not treated! the rate of transmission from mother to child during regnancy and childbirth is 79;"However! if the mother had access to antiretroviral thera y and gave birth by C)section! the transmission rate is only 2;" A number of factors may influence the risk of infection! es ecially viral load in the mother during delivery 3the higher the viral load! the higher the risk4" &reastfeeding increases the risk of transmission of 4;"

=revention+
Se%ual transmission of HIV can be revented by+ ? abstinence ? monogamous relationshi s between uninfected artners ? non) enetrative se% ? the use of male condoms or female condoms consistently and correctly Another additional ways to avoid infection+ ? If you are an in8ecting drug user! always use new needles or syringes or dis osable needles are ro erly sterili@ed before reuse" ? *nsure that blood and blood roducts through HIV testing and blood safety standards are im lemented"

(a8or Sym toms+

) $eight loss of more than 2:; in 2 month ) Chronic diarrhea lasting more than 2 month ) =rolonged fever for more than 2 month ) Decreased consciousness and neurological disorders ) Dementia 0 HIV ence halo athy

(inor sym toms+

) A cough settled more than 2 month ) Aenerali@ed dermatitis ) #he resence of her es and her es @oster recurrent @ostermultisegmental ) Bandidias oro haryngeal ) Her es sim le% chronic rogressive ) Aenerali@ed lym hadeno athy ) 5ecurrent yeast infections in female genital ) Cytomegalovirus retinitis

Aender and disease manifestations in the oral cavity+

.ungal Infections

Candidiasis+ oral or haryngeal candidiasis is a common fungal infection encountered as an early manifestation of HIV" (ost atients also found in eso hageal candidiasis" Commonly seen when the CD4 count is less than >::0u-" #he s ecies most common cause of candidiasis is Candida albicans ty e of non Albicanswalau un can also be found" #here are four forms that are often found in oral candidiasis are+ erythematosa candidiasis! seudomembranous candidiasis! angular cheilitis! and hi er lasitik or chronic candidiasis 2" *rythematous candidiasis give a reddish lesions! flat! lesions of the dorsal section of the tongue and hard alate or in the area or the soft alate" =atients resent with com laints of burning sensation in the mouth such as eating foods that are salty or s icy" Diagnosis based on hysical e%amination with the re aration of otassium hidroksidamem erlihatkan hy hae of the fungus as a confirmation of the diagnosis

7" =seudomembranous candidiasis gives soft white la'ues on the buccal mucosa! tongue and other oral mucosal surfaces! can be removed! leaving the base reddish or bloody" >" Angular cheilitis is a descri tion such as erythema and cracking in the corners of the mouth" Angular cheilitis may arise with or without candidiasis erythematous or seudomembranous candidiasis" 4" 6r chronic hy er lastic candidiasis give a white la'ue that can not be lifted across the mucosal surface" Human =a illoma Virus+ In some atients with HIV infection! human a illoma virus 3H=V4 causes e ithelial hy er lasia and focal connective tissue! forming an oral warts" In atients infected with HIV! H=V)related oral lesions has a icture a ilomatosa! either stand or remain! and are mainly located in the alate! mucosa bucal! and commisura labialis" #he most common genoty e found in the mouths of atients with HIV infection are 7! C! 22! 2>! 2C! and >7" Surgical removal! with or without intrao erative irrigation with odo hyllum resin! is the referred treatment" Sy hilis+ Although the revalence of sy hilis infection have increased significantly over the ast decade! but is not a common cause of intraoral ulceration! although the HIV infection" #he icture is no different from that observed in healthy eo leD form of chronic ulcers! oor healing! dee ! solitary ulcerD is clinically indistinguishable from tuberculosis! fungal infection! or malignancy" Dark field e%amination may show #re onema" 5eactive lasma reagent 35=54 ositive and histologically found to #re onema allidum is diagnostic" Combination treatment with enicillin! erythromycin! and tetracycline is the choice of treatment! dosage and duration of treatment de ends on the resence or absence of neurosy hilis" <ecrotic stomatitis+ an acute! ainful ulcerations that often about the underlying bone and cause considerable tissue damage" #hese lesions may be a variant of a hthous ulceration! but occurs over a surface area of bone and is associated with severe immune damage" -esions may also occur edentulous area" As the ma8or a tosa ulceration! treatment of systemic corticosteroids or to ical steroids is an o tion for treatment"

Com lications of HIV 0 AIDS+

) =neumocystis =neumonia 3=C=4 is rarely found in healthy eo le who have a good body immunity! but generally found in eo le infected with HIV" #he cause of this disease is a fungal =neumocystis 8irovecii" &efore the diagnosis! treatment! and reventive measures are effective routine in $estern countries! the disease is a common immediate cause of death" In develo ing countries! this disease is still the first indications of AIDS in eo le who have not been tested! although these indications generally does not occur unless the CD4 count is less than 7:: er m-" ) #uberculosis 3#&4 infections are uni'ue among other infections associated with HIV! because it can be transmitted to eo le who are healthy 3immunocom etent4 via the

res iratory route 3res iration4" He can be easily treated if identified! may a ear at an early stage of HIV! and can be revented through medication thera y" <evertheless! tuberculosis resistance to various drugs is a otential roblem in this disease" Des ite the emergence of this disease in $estern countries has been reduced due to the use of direct observation and thera y with other recent methods! but it was not the case that occurred in develo ing countries where HIV is most commonly found" In the early stages of HIV infection 3CD4 countE >:: cells er m-4! tuberculosis emerged as a disease of the lungs" At an advanced stage of HIV infection! it often a ears as a systemic disease affecting other arts of the body 3e%tra ulmonary tuberculosis4" ) 6eso hagitis is an inflammation of the gullet 3eso hagus4! the ath of food from the mouth to the stomach" In individuals infected with HIV! this disease occurs due to fungal infection 3fungal candidiasis4 or viral 3her es sim le%)2 or cytomegalovirus4" He also can be caused by mycobacteria! although a rare case" ) Chronic diarrhea that can not be described in HIV infection may occur due to various causes! including bacterial and arasitic infections are common 3such as Salmonella! Shigella! -isteria! Cam ylobacter! and *scherichia coli4! as well as unusual o ortunistic infections and viruses 3such as cry tos oridiosis ! micros oridiosis! (ycobacterium avium com le%! and cytomegalovirus 3C(V4! which is a cause of colitis4" In some cases! diarrhea occurred as a side effect of medications used to treat HIV! or side effects of rimary infection 3 rimary4 from HIV itself" ) <eurological and sychiatric diseases utam! where HIV infection can cause a range of behavioral disorders due to neurological disorders 3neuro sychiatric se'uelae4! which is caused by infection with organisms of the nervous system that has become vulnerable! or as a direct result of the disease itself" ) #o%o lasmosis is a disease caused by a single)celled arasites! called #o%o lasma gondii" #his arasite usually infects the brain and causes acute ence halitis 3#o%o lasma ence halitis4! but it can also infect and cause disease in the eyes and lungs" Cry tococcal meningitis is an infection of the meninges 3membranes covering the brain and s inal cord4 by the fungus Cry tococcus neoformans" It can cause fever! headache! fatigue! nausea! and vomiting" =atients also may e% erience convulsions and confusion! which if left untreated can be deadly" ) Ba osi/s sarcoma is the most common tumor in HIV)infected atients" #he a earance of this tumor in young homose%ual in 2FG2 was one of the first outbreak of AIDS" #he disease is caused by a virus of the subfamily gammaher esvirinae! namely human her es virus)G is also called Ba osi/s sarcoma her es virus 3BSHV4" #his disease often a ears in the skin in the form of ur lish s ots! but can attack other organs! es ecially the mouth! digestive tract! and lungs" ) Cancer lym h high level 3&)cell lym homa4 is a cancer that attacks white blood cells and collects in the lym h nodes! such as &urkitt/s lym homa 3&urkitt/s lym homa4 or the like 3&urkitt/s)like lym homa4! diffuse large &)cell lym homa 3D-&C- 4! and rimary central nervous system lym homa! a ears more fre'uently in atients infected with HIV" #his cancer is often the a ro%imate condition 3 rognosis4 is bad" In some cases! lym homa is the main sign of AIDS" -ym homa is largely caused by the * stein)&arr virus or Ba osi/s sarcoma her es virus"

Se%ually #ransmitted Diseases+

#richomoniasis #richomoniasis is a roto@oan infectious disease caused by #richomonas vaginalis! is usually transmitted through se%ual contact and commonly affects the lower urinary tract in women" #richomonas vaginalis shoots eriod is difficult to ascertain! but is estimated to range from > to 7G days" In women often show no com laints or sym toms at all" $hen there are com laints usually a lot of vaginal mucus and smells" Classical vaginal mucus and frothy greenish! usually only found in 2:)>:; sufferer" Vaginal mucus often cause itching and burning of the vulva and surrounding skin" 6ther com laints that may occur is bleeding after se%ual intercourse and bleeding between menstruation" 6n e%amination the atient with sym toms of acute vaginitis! edema and erythema a ear on the labium that feels ain! while at the vulva and u er thigh are sometimes found small abscesses and maceration caused by roteolytic fermen in the body" Chlamydia #y e+ &acterial (odes of #ransmission+ Vaginal and anal" Sym toms+ 1 to H9; of cases in women and 79; of cases in men are asym tomatic" Sym toms may include abnormal genital discharge and burning during urination in both men and women" $omen may also e% erience ain in lower abdomen or ain during intercourse! men may e% erience swelling or ain in the testicles" #reatment+ Infection can be treated with antibiotics" However! it can not undo the damage done rior to treatment" Conse'uences that may occur in eo le who are infected+ In women! if untreated! u to >:; will e% erience elvic inflammatory disease 3=ID4 which in turn can cause ecto ic regnancy! infertility and chronic elvic ain" In men! if untreated! chlamydia can cause e ididymitis! an inflammation of the testes 3where s erm are stored4! which may result in sterility" Infected individuals are at higher risk of contracting HIV if e% osed to the virus"

Aenital Her es 3HSV)74 #y e+ Viral (odes of #ransmission+ Her es is s read through se%ual contact between the skin with body arts that are infected during vaginal intercourse! anal or oral se%" Another strain of the virus!

Her es Sim le% #y e 2 3HSV)24 most commonly s read by nonse%ual contact and usually causes sores on the li s" However! HSV)2 can also be transmitted through oral se% and can cause genital infections" Sym toms+ #he sym toms are usually very mild and may include itching or burningD ain in the legs! buttocks or genital areaD or whitish" &listers or ainful o en sores may also occur! usually in the genital area! buttocks! anus and thighs! although it can also occur in other arts of the body" #he wounds will be healed in a few weeks but may recur" =ossible Conse'uences for the Infected =erson+ =eo le who are infected and have the wound will increase the risk for contracting HIV if e% osed because the sores rovide an entry oint for the HIV virus"

=revention of HIV transmission when an HIV)infected regnant women are at the core of interventions to revent HIV transmission from mother to infant" #he forms of intervention are+ ? maternal and child health services are com rehensiveD ? HIV testing and counseling services are voluntaryD ? =rovision of antiretroviral drugsD ? Counselling on HIV and infant foodD and infant feedingD ? -abor is safe"

An HIV)infected mothers will receive medical thera y as follows+

) &efore the birth of her baby" Antiviral thera y is given to e% ectant mothers in the third trimester can hel revent HIV transmission to their infants"

) At the time of birth" Antiviral treatment can be given to the mother and newborn child to reduce the risk of HIV transmission that can occur during the birth rocess 3because then the baby will be e% osed to the mother/s blood and fluids4! in addition! the mother would be well advised to give formula instead of breast milk to her baby because HIV can be transmitted to infants through breast milk"

) During breastfeeding" &ecause breastfeeding is not recommended for mothers who are infected with HIV! infection is rare in the 1nited States" However! in other laces around the world where infant formulas may not be available! mother and child will be given thera eutic treatment to reduce the risk of HIV transmission in breastfed children"

HIV =athogenesis
2" HIV Infection Iourney ty ical untreated HIV infection! timed around a decade"Covers the stages of rimary infection! the virus s read to lym hoid organs! clinical latency! increased e% ression of HIV! clinical disease and death" #he duration between rimary infection with the disease rogresimen8adi average about 2: years" In untreated cases! death usually occurs within 7 years after clinical onset" After rimary infection! there is a eriod of 4)22 days between infection and viremia beginning mucosaD viremia can be detected for G)27 weeks" #he virus s read widely throughout the body during this eriod! and infect lym hoid organs" A similar acute mononucleosis syndrome occurs in many atients 39:)H9;4 >)C weeks after rimary infection" At this stage there dro in the number of circulating CD4 # cells is significantly" Immune res onse to HIV occurs in about 2 week to > months after infection! lasma viremia decreased! and CD4 levels increase" &ut the immune res onse is unable to com letely rule out infection and cell)HIV)infected cells ersist in the lym h nodes" Clinically latent eriod can last for 2: years" During the eriod of viral re lication to occur a lot" It is estimated that about 2: billion HIV aryikel harinya"waktu roduced and destroyed every art of virus in lasma is about C hours! and the viral life cycle 3from the time of infection to the cells during the roduction of new offs ring that infect the ne%t cell4)rat average 7"C days" CD4 , # lym hocytes! ma8or targets res onsible for virus roduction seems to have a very high reversal rate" $hen infected in a roductive! half)life of CD4 , # lym hocytes was 2"C days" &ecause of the ra id roliferation of this virus and an error rate of reverse transcri tion of HIV)related! it is estimated that every nucleotide of the HIV genome may be mutated in the daily limit" *ventually the atient will suffer diseases of constitutional and clinical disease are a arent! such as o ortunistic infections and neo lasms" Higher levels of virus can be detected dive further stages of infection" HIV is found in atients with advanced disease! usually much more virulent and cyto athic than the strains of the virus found in early infection" 6ften ergesaran of HIV)2 monocyte)tro ic and macro hage)tro ic 3()tro ic4 a variant of lym hocyte)tro ic 3#)tro ic4 accom anies the rogression to AIDS" #5*A#(*<# #here is no cure for HIV 0 AIDS! but many drugs can be used in combination to control the virus" *ach class of anti)HIV drugs block the virus in different ways" It/s best to combine at least three drugs from two different classes to avoid creating a strain of HIV that are resistant to single drug" Classes of anti)HIV include+ <on)nucleoside inhibitors of reverse transcri tase 3<<5#I4 <<5#I off" A rotein that HIV needs to make co ies of itself" *%am les include efaviren@ 3Sustiva4! etravirine 3Intelence4 and nevira ine 3Viramune4" <ucleoside reverse transcri tase inhibitors 3<5#Is4" <5#Is are the wrong version of the building blocks that HIV needs to make co ies of itself" *%am les include Abacavir 3Jiagen4! and drug combination emtricitabine and tenofovir 3#ruvada4 and lamivudine and @idovudine 3Combivir4" =rotease inhibitors 3=I4" =I disable rotease! another rotein that HIV needs to make co ies of itself" *%am les include ata@anavir 35eyata@4! darunavir 3=re@ista4! fosam renavir 3-e%iva4 and ritonavir 3<orvir4"

*ntry or fusion inhibitor" #hese drugs block HIV entry into CD4 cells" *%am les include enfuvirtide 3.u@eon4 and maraviroc 3Sel@entry4" Integrase inhibitors" 5altegravir 3Isentress4 is working with disabled integrase! a rotein that HIV uses to insert genetic material into the CD4 cell"

#he first stage+ HIV HIV infection begins with the entry and followed the occurrence of serologic changes when antibodies to the virus changed from negative to ositive" S an of time since HIV enters the body until the test becomes ositive antibodies against HIV)called window eriod" -ong window eriod is between 2)> months! and some have lasted u to C months" #he second stage+ asym tomatic 3without sym toms4 Asym tomatic means that in the organs of the body terd at HIV but show no sym toms" #his situation can last an average of 9)2: years" &ody fluids that are a arently healthy eo le living with HIV are able to transmit HIV to others" #he third stage+ -ym h gland enlargement #his hase is characteri@ed by enlargement of lym h glands and flatten ermanently 3 ersistent generali@ed lym hadeno athy4! not only a ears in one lace and lasted more than a month" Stage four+ AIDS #his situation is accom anied barmacam ) variety of diseases! among other constitutional disease! neurological disease and secondary infections"