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Tropism
The term viral tropism refers to
which cell types HIV infects.
HIV can infect a variety of
immune cells such as CD4+ T
cells, macrophage,and
microglia cells.
HIV Entry to macrophages and
CD4+ T cells is mediated
through interaction of the virion
envelope glycoprotein (gp120)
with the CD molecule on the
target cells and also with
chemokine coreceptors.
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Replication cycle
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Folliculitis
The most prevalent dermatologic
disorder in patient with HIV infection
and is seen in 20 % of patient.
It is more common in patien with CD
4+ Tcell Count< 200 cell/l.
One form of folliculitis, eosinophilic
pustular folliculitis, is a rare
dermatologic condition that is seen
with increased frequency in patient
with HIV infection .
Chronic pruritic, edematous papule
distributed over the face,neck,and
upper trunk.
Respon poorly to antibacterials.
Respons to combination of
ultraviolet-B light therapy,highpotency topical steroid,and non 13
sedating antihistamines.
Staphylococcal infection
can occur as abscesse
Staphylococus aureus is the most
skin and systemic bacterial
pathogen in HIV-infected patients.
Around 50%chronic
staphylococcus nasal carriage.
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Prurigo nodularis
Pruritus is common symptom in
patients with HIV infection and can
lead to prurigo nodularis.
More frequently seen in patients with
CD4+ cell counts below 50/l
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Psoriasis
Although they are not reported to be
increased in frequency,may be particularly severe when they occur in
patient with HIV infection.
Individual infected with HIV do have
increased prevalence of arthritis
associated with psoriasis.
can have unusual presentation
((inverse psoriasi )
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Varicella-zoster
Scattered facial verrucous lesion
of ACV-resistant VZV.
In HIV, Vzv can be the cause of
varicella, even in adults,and can
cause manifestation more severe.
Chronic verrucous or vegetative
nodules can develop.
Herpes zoster in young, sexually
active adults is one of the common
presenting feature of HIV .
Multi-dermatomal herpes zoster is
often seen ( widespread
dissemination).
Post-herpetic neuralgia is more
common.
Dermatomal vesiculo-pustular lesion,
preceded by localized itching,
tenderness,or burning painthe
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hallmark.
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Molluscum
contangiosum(MC)
Diffuse skin eruption due to MC may be
seen in patient with advanced HIV
infection.
Lesions tend to be more numerous and
may be nodular ( so-called giant
molluscum if 1 cm or more ) and
disfiguring .
Treatment option :cryoterapy, electro
dessicasi, gentle curettage,topical
trtinoin,and superficial chemical peeling.
Respon well to effective antiretroviral
therapy .
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Mosaic warts
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Mycobacterial infections
Skin mycobacterial infection in
HIV patient are caused primarily
by Mycobacterium tuberculosis.
Skin manifestation : papulonecrotic lesion, papulo pustular
lesion, nodules, plaque,
abscesses, ecthyma and ulcer.
Scrofuloderma is also not
uncommon.
papulo-pustular lesions of
disseminated tuberculosis.
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Drug eruption
Drug reaction producing full-body
erythema.CD 4+ cell counts< 50l.
Skin of patient with HIV infection is
often a target organ for drug
reaction.
Patient may have particularly
severe cutaneous reaction,
including erythoderma and stevensjohnson syndrome.
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Photosensitive
Photodermatitis of the face andvee
Patient with HIV infection are often
of the neck
quite photosensitive and burn easily
following exposure to sunlight or as a
side effect of radiation therapy .
HIV infection itself is photosensitizing,
and patient with low CD4 +cell count
may receiving photo sensitizing drugs
Such as trimethoprim/sulfamethoxa
zole.
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Perioral dermatitis
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Bacillary angiomatosis(BA)
Characteristic exophytic angiomatous
nodules of BA with and without surrounding cellulitic.
Bartonella henselae and B.quintana
As solitary or multiple vascular lesion
that clinically resemble Kaposis
sarcoma.
Involvement of the liver, spleen, lymph
nodes, bone, lung and central nervous
system.
BA HIV-infected patients withCD4 >
100 cells/l.
Typical :dermal vascular proliferastion,
with plump endothelial cell lining the
vessels.
Erythromycin,500po qid 8 weeks.
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Sifilis
Generalized rashed can develop in
patiens with secondary syphilis,
including the macular and papular
variants.
Papular > maccular form.
Incidence of the Jarisch Herxheimer
reaction is 95 % in patient with
seropositive primary syphilis or
secondary .
Papular lesions are typically on
the face, flexural fold ,and trunk.
Annular lesion > seen on the faces
of black ,can resembles sarcoidosis
or tinea.
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Fungal infection
Manifestation can be very extensive
and have unusual morphologies.
In advanced HIVCentral clearing
may be absent and patients can
have widespread dermatophytosis.
Fungal nail infection most
commonly presents as distal
subungual onychomycosis.
Trichophyton rubrum is the most
frequently encountered fungal
pathogen.
Systemic antifungal : itraconazole,
terbinafine,use of antifungal shampoo.
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Erythema nodosum
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Epidemiology
38.6 million people now
living with the diseases
world wide.
As of january 2006,the
joint United Nations
Programme On
HIV/AIDS(NAIDS) and
WHOAIDS has killed
more than 25 million
people.
In 2005AIDS claimed
an estimated 2,4-3,3
million lives,of which more
than 570.000 were
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children.
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Transmission
Three main transmission routes for HIV :
Sexual route : genito-genital
genito-anal
genito-oral
Blood or blood product route.
Mother-to child transmission ( MTCT). without
treatment transmission rate is 25 %.Where drug
treatment and cesarian section are available, can be
reduced to 1 % .Breast feeding also a risk of infection for
the baby .
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Blood Transfusion
Childbirth
Needle-sharing injection
drug use
Receptive anal intercourse
Percutanous needle stick
Receptive penile-vaginal
intercourse
Insertive anal intercourse
Insertive penile-vaginal
intercourse
Receptive oral intercourse
Insertive oral intercourse
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Manifestasi klinis
Tahap pertama : Infeksi akut.
akut.
6 minggu pertama setelah paparan HIV dapat berupa
demam, rasa letih,nyeri otot dan sendi, nyeri telan, dan
pembesaran kelenjar getah bening .
Tahap kedua
: Asimtomatis.
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Stadium klinis II
1.Penurunan berat badan,tetapi < 10 % dari berat badan
sebelumnya.
2.Manifestasi mukokutaneus minor (dermatitis seborrohoic
prurigo,infeksi jamur pada kuku,ulserasi mukosa oral
berulang,cheilitis angularis.
3.Herpes zoster,dlam 5 tahun terakhir
4.Infeksi berulang pada saluran pernapasan atas ( mis:
sinusitis bakterial ).
Dengan atau penampilan /aktivitas fisik skala II:simtomatis,
aktivitas normal.
Stadium klinis IV
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2.
3.
4.
5.
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Diagnosis
WHO disease staging system for HIV infection and
disease :
Stage I : HIV disease is asymtomatic and no categorized
as AIDS.
Stage II : Includes minor mucocutaneous manifestation and
recurrent upper respiratory tract infections.
StageIII : Includes unexplained chronic diarrhea for longer
than a month ,severe bacterial infections and
pulmonary tuberculosis.
StageIV:Includes toxoplasmosis of the brain,candidiasis of
the esophagus, trachea,bronchi or lung and
Kaposis sarcoma;these disease are indicators 77
of
AIDS .
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Management
Strategi penatalaksanaan dan pengendalian progresivitas
HIV ke AIDS dilakukan melalui :
1.Terapi antiretroviral
2.Terapi infeksi oportunistik serta malignansi
3.Dukungan nutrisi berbasis makronutrient dan
mikronutrien.
4.Konseling terhadap penderita maupun keluarga ,dan
5.Membudayakan pola hidup sehat
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ANTIRETROVIRAL THERAPY
Combination antirertoviral therapy ( ART), or higly
active antiretroviral therapy ( HAART), is the
cornerstone of management of patient with HIV
infection .
HAART consists of three or more drugs.The most
common combination given to those beginning treatment
consists of two NRTIs combined with either an NNRTI or
a boosted protease inhibitor.
Exp :Zidovudin (AZT) : 1x 500-600 mg
Lamivudin (3TC ) : 2x 150 mg
Nevirapin 1x 200mg for 14 days,then 2x 200mg.
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Prevention
Promoting condom use
Promotion of marriage
Promotion of monogamy
Promotion of morality
Abstinence outside marriage
Screening of blood transfusion
Needles, use clean ones( not to share needles)
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