HIV/AIDS

drg.Ivan Arie Wahyudi, M. Kes., Ph.D

INTRODUCTION
AIDS first recognized 1981
HIV RNA retrovirus discovered 1983
2nd leading cause of disease burden worldwide
Leading cause of death in Africa
Approx 1 million people currently diagnosed in
America
The first case that was found at Bali Indonesia,
on April 1987. It was reported that one
foreigner was indicated HIV.

TRANSMISSION OF HIV

Blood, semen, breast milk, saliva

Sexual, parenteral, vertical
Risk of contracting infection dependent on
Viral load

Integrity of the exposed site

Type of body fluid

Volume of body fluid

WHAT ABOUT THESE ACTIVITIES?

TRANSMISSION OF HIV

Risk after a single exposure

>90% blood or blood products

14% vertical

0.5-1% injection drug use

0.2-0.5% genital mucous membrane

<0.1% non-genital mucous membrane

THE VIRUS
Glycoproteins (gp 120, gp41)
2 copies of ssRNA, viral enzymes
Attachment with gp 120 to CD4 receptor
Fusion mediated by gp 41
Inside cell RNA transcribed to DNA by RT
DNA incorporated into cell genome
DNA is copied and translated to viral enzymes,
proteases
New infectious virus buds from host cell to
repeat process

VIRUS STRUCTURE

VIRUS ENTRY

MECHANISM OF REPLICATION

THE STAGES OF HIV IN HUMAN BODY

STAGE 1 : PRIMARY HIV INFECTION

70-80% symptomatic, 3-12 weeks after
exposure
Fever (short flu-like illness), rash, cervical
lymphadenopathy, aseptic meningitis,
encephalitis, myelitis, polyneuritis
Surge in viral RNA copies to >1 million
Fall in CD4 count to 300-400. Normally range?
Seroconversion???

SEROCONVERSION

3-12 weeks, median 8 weeks

Level of viral load post seroconversion correlates with
risk of progression of disease
Differential for this syndrome: CMV, Strep
pharyngitis, toxoplasmosis, secondary syphilis

STAGE 2 : CLINICALLY ASYMPTOMATIC

STAGE

Antibody tests will show a positive result

This stage lasts for an average of 10 years
Remain well with no evidence of HIV disease except for
generalized lymphadenopathy
Fall of CD4 count by about 50-150 cells per year

STAGE 3 : SYMPTOMATIC HIV

INFECTION

The lymph nodes and tissues become damaged or

'burnt out' because of the years of activity
Chronic weight loss/ rapid weight loss
Frequent fever that lost of several week without
explanation
Diarrhea
Mild candida infections/ white spot in the mouth
and throat
Recurrent herpes infections
Pelvic inflammatory disease
Extreme weakness of fatigue
A cough that wont go away

STAGE 4 : PROGRESSION FROM HIV TO

AIDS

CD4 <200

Pneumocystis pneumonia
Esophageal Candidiasis

Mucocutaneous herpes simplex

Miliary/extrapulmonary TB
Cryptosporidium

HIV-associated wasting
Peripheral neuropathy

DIAGNOSIS

Antibody test, ELISA

Western blot
HIV RNA viral load

SKIN AND ORAL DISEASE

Seborrheic dermatitis
Xeroderma
Itchy folliculitis
Scabies
Tinea
Herpes zoster
Papillomavirus
Oral and vaginal candidiasis
Oral hairy leukoplakia
Aphthous ulcers
Herpes simplex
Gingivitis
Kaposis sarcoma
Molluscum contagiosum
Bacillary angiomatosis

MANAGEMENT

Treatment recommended when symptomatic or CD4

count below 200
Earlier if high viral load, rapidly falling CD4 count,
hepatitis C co-infection

ANTIRETROVIRALS

Nucleoside reverse transcriptase inhibitors

Non-nucleoside reverse transcriptase inhibitors
Protease inhibitors
Fusion inhibitors
R5/X4 inhibitors

DRUG TARGETS

Table Oral Lesions Associated with HIV

Adapted with permission from Greenspan D, Greenspan JS. Oral manifestations of HIV infection.
AIDS Clin Care 1997;9:29-33.

Fungal

Candidiasis
Pseudomembranous
Erythematous
Angular cheilitis
Histoplasmosis
Cryptococcosis

Viral

Herpes simplex
Herpes zoster
Human papillomavirus lesions
Cytomegalovirus ulcers
Hairy leukoplakia

Bacterial

Linear gingival erythema

Necrotizing ulcerative
periodontitis
Mycobacterium avium complex
Bacillary angiomatosis

Neoplastic

Kaposi's sarcoma
Non-Hodgkin's lymphoma

Other

Recurrent aphthous ulcers

Immune thrombocytopenic

Pseudomembranous candidiasis. Creamy white

patches on erythematous mucosa

Pseudomembranous candidiasis. Creamy white patches on erythematous

mucosa.

Erythematous candidiasis appearing

as red plaques on the palate

Erythematous candidiasis appearing as red plaques on the palate.

Hairy leukoplakia appearing as corrugations

on the lateral margin of the tongue

Hairy leukoplakia appearing as corrugations on the lateral

margin of the tongue.

More extensive hairy leukoplakia appearing

as corrugations and plaques on the lateral margin
of the tongue

More extensive hairy leukoplakia appearing as corrugations and

plaques on the lateral margin of the tongue.

Necrotizing periodontal disease showing localized

destruction of the gingival tissue

Necrotizing periodontal disease showing localized destruction of the

gingival tissue.

Kaposi's sarcoma occurring in the gingiva

Kaposi's sarcoma occurring in the gingiva.

TERIMAKASIH