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A. Basic Concepts of HIV/AIDS Theory

1. Definition of HIV/AIDS

Human Immunodeficiency Virus (HIV) is a virus that causes AIDS which belongs to the retrovirus group.
Someone who is infected HIV, will experience lifelong infection. Most people with HIV / AIDS (PLWHA)
remain asymptomatic (without signs and symptoms of a disease) for a long time. However, they can
actually infect other people. Most people with HIV will die within a few years after the first signs of AIDS
appear if no services and therapy are provided (Ministry of Health, 2012).

2. Pathogenic HIV/AIDS

The main mechanism of HIV infection begins after the virus enters the host's body, HIV attacks white
blood cells (Th lymphocytes) which are the body's source of immunity to ward off various infectious
diseases. By entering the Th Lymphocyte the virus forces the Th Lymphocyte to multiply itself thus
causing the death of the Th Lymphocyte. Death of Th Lymphocytes makes the body's immune system
decrease, so that the immune system decreases, thereby creating infection from outside (either other
viruses, bacteria, fungi or parasites) so that this causes death in people with HIV/AIDS.

3. Clinical Manifestations

Patients infected with HIV can be grouped into 4 groups, namely:

1. Asymptomatic patients without symptoms that occur during the incubation period which lasts
from 7 months to 7 years

2. Persistent generalized lymphadenopathy (PGL) with symptoms of lymphadenopathy general

3. AIDS Related Complex (ARC) with symptoms of fatigue, fever, and immune system disorders

4. Full blown AIDS is the final phase of AIDS with severe clinical symptoms in the form of chronic
diarrhea, interstitial pneumonitis, hepatomegaly, splenomegaly, and oral candidiasis caused by
opportunistic infections and neoplasia such as Kaposi's sarcoma. The patient eventually died due
to complications of secondary infection.

4. Clinical Diagnosis and Laboratory Examination

Common methods for establishing a diagnosis of HIV include:

a. ELISA (Enzyme-Linked ImmunosSorbent Assay)

The sensitivity is high that is equal to 98.1-100%. Usually this test gives a positive result 2-3 months after
infection.

b. Western blot
The specifications are high, namely 99.6-100%. The examination is quite difficult, expensive, and takes
about 24 hours.

c. PCR ( Polymerase Chain Reaction ) This test is used to:

1) HIV test in infants, because antimaternal substances are still present in infants which can hinder
serological examination.

2) Establish infection status of seronegative individuals in high-risk groups

3) Test in the high group before seroconversion occurs.

4) Confirmatory test for HIV-2, because ELISA has low sensitivity for HIV-2 (Widoyono 2011).

7. Symptoms of AIDS

According to (Noviana Nadarsyah 2013) symptoms of people infected with HIV to AIDS can be seen from
2 symptoms, namely Major Symptoms (common) and Minor Symptoms (not common):

1) Major Symptoms

a) Weight loss of more than 10% in one month

b) Chronic diarrhea that lasts more than 1 month

c) Prolonged fever for more than 1 month

d) Decreased consciousness and neurological disorders

e) Dementia / HIV encephalopathy

2) Minor Symptoms

a) Cough persists for more than 1 month

b) Generalized dermatitis
c) The presence of multisegmental herpes zoster and recurrent herpes zoster

d) Oropharyngeal candidiasis

e) Chronic progressive herpes simplex

f) Generalized lymphadenopathy

g) Recurrent fungal infections of the female genitalia

h) Cytomegalovirus retinal

8. Mode of Transmission

Human immunodeficiency virus (HIV) can enter the body in three ways, namely through (1) sexual
intercourse, (2) the use of needles that are not sterile or contaminated with HIV, and (3) transmission of
HIV from an HIV-infected mother to the fetus in her womb. known as Mother to Child Transmission of
HIV (PPIA) (Ministry of Health of the Republic of Indonesia 2012).

9. Prevention of HIV/AIDS

1) Prevention of transmission through sexual intercourse The main cause of HIV transmission is
through sexual intercourse, so prevention needs to be focused on sexual intercourse. In order to avoid
contracting HIV, a person must have safe sexual behavior by not changing partners. If one partner is
already infected with HIV, then during sexual intercourse must use a condom to prevent it from
transmitting it to their partner.

2) Prevention of blood-borne transmission, namely by ensuring that the blood used for transfusion is
not contaminated with HIV, that syringes and other tools that can injure the skin are not used
interchangeably, clean tools such as needles, razors, piercing tools, and so on. others by heating or
disinfection solutions (Noviana Nadarsyah 2013).