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  • HIV/ AIDS and Related Diseases

    Dr. Musofa Rusli, Sp.PD Div. of Tropical Infectious Disease, Dept. of Internal Medicine

    Faculty of Medicine Universitas Airlangga

    Master Class Lecture

  • Lecture Contents Background Epidemiology Transmission Natural history

    Clinical features of HIV Diseases that define HIV infection Clinical stadium

    Opportunistic infections Viral infections Fungal infections Parasitic infections Bacterial infections

    Immune Reconstitution Inflammatory Syndrome Other diseases related to HIV infection Malignancy Common co-infections

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  • HIV/ AIDS Global Epidemy (Approximate numbers in 2012)

    34.000.000 in the world

    180.000 in Indonesia

    3.500 in Jawa Timur

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  • Discovery of HIV/ AIDS

    Kluster kasus Kaposis sarcoma dan PCP pada orang gay di AS (1981)

    Nama awal:

    Limfadenopati

    KS dengan infeksi oportunistik

    GRID (gay-related immune deficiency)

    4H (Haitians, homosexual, hemophiliacs and heroin users) disease

    US CDC: AIDS (1982)

  • Clinical Manifestation of AIDS prior to ARV Era

  • Co-discoverer of HIV Luc Montagnier*

    Institute of Pasteur France Robert Gallo

    National Cancer Institute USA

    LAV HTLV-III

    Francoise Barre-Sinoussi* Institute of Pasteur France

    *Awarded Nobel Prize 2008

  • 1985: AIDS is caused by HIV 1988: World AIDS Day (December 1)

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    HIV Replication Cycle

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    HIV Initial Infection and Dissemination

  • Induction of HIV-specific immune responses, beginning with CD8 + T cells and following

    with antibodies that provide incomplete control of viremia

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    HIV Initial Infection and Dissemination

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  • The stages and natural history of HIV infection

    HIV-1 infection is divided into stages primary infection with seroconversion clinical latency early symptomatic disease AIDS.

    The mode of acquisition: heterosexual transmission, MSM Risk factors for transmission include high plasma HIV viral load and presence of ulcerative genital sexually transmitted diseases. During the period of asymptomatic infection, patients generally have no findings on physical examination except for lymphadenopathy. Despite the lack of symptoms, high rates of HIV replication and CD4 T cell destruction may be occurring.

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  • HIV Natural History

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  • Conditions that define an AIDS diagnosis P. carinii pneumonia 42.6 percent

    Esophageal candidiasis - 15.0 percent

    Wasting 10.7 percent

    Kaposi's sarcoma 10.7 percent

    Disseminated M. avium infection 4.8 percent

    Tuberculosis 4.5 percent

    Cytomegalovirus disease 3.7 percent

    HIV-associated dementia 3.6 percent

    Recurrent bacterial pneumonia 3.0 percent

    Toxoplasmosis 2.6 percent

    Immunoblastic lymphoma - 1.9 percent

    Chronic cryptosporidiosis - 1.5 percent

    Burkitt lymphoma - 1.5 percent

    Disseminated histoplasmosis - 1.0 percent

    Invasive cervical cancer - 0.9 percent

    Chronic Herpes simplex 0.5 percent 11/7/2013

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  • Lymphadenopathy

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  • ACUTE EXANTHEM OF HIV INFECTION

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  • Opportunistic Infections

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  • Pneumocystis jirovecii Pneumonia

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  • CYTOMEGALOVIRUS INFECTIONS

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  • HERPES SIMPLEX VIRUS INFECTIONS

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  • Human papillomavirus

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  • VARICELLA-ZOSTER VIRUS INFECTIONS

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  • PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY

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  • CANDIDIASIS

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  • CRYPTOCOCCOSIS

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  • ASPERGILLOSIS

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  • Nontuberculous Mycobacterial Infections

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  • TOXOPLASMOSIS

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  • Tuberculosis in HIV

    HIV infection is a potent risk factor for the development of active tuberculosis (TB).

    This may result from: high risk of reactivation of latent Mycobacterium

    tuberculosis infection;

    increased risk of exposure to TB;

    greater risk of infection with M. tuberculosis following exposure to an infectious source;

    progression of M. tuberculosis infection to primary active TB.

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  • SKIN INFECTIONS

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  • Eosinophilic folliculitis

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  • Kaposis Sarcoma

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  • Non-Hodgkins Lymphoma

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  • The Burden of HIV,HBV and HCV Worldwide

    Estimated number in million.

    350

    175

    40

    12 4

    1

    0,5

    HBV HCV

    HIV

  • Worldwide prevalence of hepatitis and HIV

    Infection Worldwide U.S.

    HIV 31 million 860,000

    Hepatitis B (chronic) 300 million 1 million

    Hepatitis C (chronic) 170 million 4 million

  • Epidemiology

    About 400,000 HIV/HCV + in U.S.

    overall 30-50% of HIV+ are co-infected

    Prevalence of HCV in HIV+ individuals:

    approx. 90% in IVDU

    60-85% in hemophiliacs

    4-8% in HIV+ MSM

    HIV/HCV Coinfection

  • Almost all HIV positive IDU are HCV coinfected

    HIV/HCV100% (n=117) Iran

    HIV/HCV 98% (n=131)Vietnam

    HIV/HCV 99.3% (n=138) China

    HIV/HCV 99% (n=131) Chiang Mai

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  • Certain principles underlie the decision to use prophylaxis

    the incidence and prevalence of specific infections in HIV-infected individuals the potential severity of disease in terms of morbidity and mortality the level of immunosuppression at which each disease is likely to occur the feasibility and efficacy of preventive measures, and in particular their impact on quality of life and survival the potential for emergen