HIV & AIDS

The Human Immunodeficiency Virus (HIV) is a retrovirus that targets host immune cells, particulary CD4 T-helper cells, and turns them into viral factories for HIV reproduction. Immune dysfunction characterized by destruction of immune cells, leaving the body open to infection (AIDS = Acquired Immunodeficiency Syndrome) can cause a range of disabilities or death.

Human Immunodeficiency Virus (HIV) adalah retrovirus yang menyerang sel imun tubuh, terutama CD4 T sel pembantu, dan mengubahnya menjadi viral factories untuk memproduksi HIV. Sel imun yang rusak (akibat HIV) akan meninggalkan tubuh, sehingga berpotensi terkena infeksi (AIDS = Acquired Immunodeficiency Syndrome), bahkan dapat menyebabkan kematian.

HIV is transmitted from person to person through infected body fluids. Sexual contact, needle and syringe sharing, contaminated transfusions, and vertical transmission before and during birth or through breast-feeding from infected person.

HIV ditularkan dari orang ke orang melalui cairan tubuh. Hubungan seks, penggunaan bersama jarum dan syringe, transfusi yang terkontaminasi dan transmisi vertikal sebelum dan selama kehamilan, atau ibu yang menyusui anaknya

HIV started its spread before 1970 and evolved into the beginnings of the current pandemic by the latter half of the 1970s. In the late 1970s and early 1980s, there were conditions later attributed to HIV infection called SLIM DISEASE in Zaire, Uganda, and Tanzania. HIV may have affected at least five continents including North and South America, Europe, Africa, and Australia by early 1980s HIV mulai pertama kali menyebar sebelum 1970an dan pertengahan 1970an menjadi pandemic. Di akhir 1970 - awal 1980an HIV (yang dikenal sebagai SLIM DISEASE) menyebar di Zaire, Uganda, &Tanzania. HIV mulai menyebar di lima benua, termasuk Amerika Utara dan Selatan, Eropa,Afrika,dan Australia di awal 1980an.

1986, the name of Human Immunodeficiency Virus (HIV) was adopted. During that time the first anti-HIV treatment, azidothymidine (AZT) was tested. Studies were discontinued early doe to a significant difference in survival noted in the first six months. By the end 2005, there were an estimated 40.3 million people with HIV infection in the world. More than3 million people may have died from complications related to HIV infection. 1986, nama HIV mulai diberikan. Dan pada tahun tersebut treatment anti-HIV azidothymidine (AZT) pertama kali di test. Namun 6 bulan kemudian dihentikan karena ada perbedaan yang menonjol dalam pengujian treatmen tersebut. Di akhir2005, diperkirakan 40.3 juta orang terinfeksi HIV diseluruh dunia. Lebih dari 3juta orang meninggal akibat komplikasi karena infeksi HIV.

Immunity can be classified as: (1) PRIMARY or SECONDARY, according to whether an initial or subsequent contact with the antigen. (2) HUMORAL or CELLULAR, depending on the activities of B cells or T cells respectively. (3) ACTIVE or PASSIVE, depending on whether its acquired through contact with an antigen or provided by a transfer of presensitizes or activated immune cells. Imunitas dapat digolongkan menjadi: (1) PRIMER atau SEKUNDER, menurut kontak pertama atau lanjutan dengan antigen. (2) HUMORAL atau CELLULAR, tergantung dari kepekaan aktivitas sel B atau sel T. (3) AKTIF atau PASIF, tergantung dari apakah kontak dengan antigen atau provided dari transfer sel imun yang aktif.

Activated CD4 cells and several other types of cells, including macrophages (white blood cells) are infected and rendered dysfunctional by HIV. CD4 are manufactured in the bone marrow, and mature in the thymus. CD4+ cells also called T-helper cells, which to help mediate cell recognition events that direct some immune activities to target foreign antigens, promote the differentiation of B cells and cytotoxic T cells and activate macrophages. Sel CD4 yang aktif dan beberapa sel dengan type lain , termasuk makrofagus (sel darah putih) akan terinfeksi dan tidak berfungsi akibat HIV. Sel CD4 di produksi di sumsum tulang dan matang di thymus. Sel CD4+ (sel CD4 yang sudah matang) disebut juga sel T helper, yang membantu sel imun mengatasi antigen asing, mengatur perbedaan sel B dan sel cytotoxic T serta makrofagus yang telah aktif.

HIV live cycle: 1. Free Virus 2. Binding and Fusion : virus binds to cell at two receptor sites 3. Infection : virus penetrates cell contents emptied into cell 4. Reverse Transcriptions : single strands of viral RNA are converted into double stranded DNA by reverse transcriptase enzyme. 5. Integration : viral DNA is combined with the cells own DNA by integrase enzyme. 6. Transcription : when the infected cell divides, the viral DNA is read and long chains of proteins are made. 7. Assembly : sets of viral protein chains come together. 8. Budding : immature virus pushes out of the cell. 9. Immature virus breaks free of infected cell. 10. Maturation : the protein chains in the new viral particle are cut by protease enzyme into individual proteins.

Siklus Hidup HIV : 1. Virus bebas. 2. Mengikat dan Bergabung : virus mengikat pada sel dengan 2 receptor. 3. Masa Menginfeksi : virus menetrasi sel. 4. Transkripsi Balik : dengan enzim transkripsi balik, single strands dari RNA berkonversi menjadi dobel strands DNA. 5. Integrasi : dengan enzim integrase, viral DNA bergabung dengan DNA inang. 6. Transkripsi : saat sel yang terinfeksi membelah, viral DNA diterjemahkan dan rantai protein panjang dibuat. 7. Asembling : set rantai protein viral bergabung. 8. Budding : virus yang belum matang memaksa keluar dari sel. 9. virus yang belum matang bebas dari sel yang terinfeksi 10. Maturation : rantai protein dalam virus baru dipotong oleh enzim protease menjadi individual protein dan virus siap menginfeksi sel lainnya.

Anti-HIV Therapies Antiretroviral medications are used to lower viral load, and the goal is to achieve and maintain an undetectable level of less than 50 copies/mL in serial test. There are 5 classes of antiretroviral medications : fusion inhibitors nucleoside/ nucleotide reverse transcriptase inhibitors non-nucleoside / nucleotide reverse transcriptase inhibitors integrase inhibitors protease inhibitors Terapi Anti-HIV Pengobatan antiretroviral digunakan untuk mengurangi pengisian viral, dan tujuannya untuk mencapai dan menjaga level yang tidak terdeteksi kurang dari 50 kopi/mL. terdapat 5 macam pengobatan antiretroviral : penghalang fusion penghalang transkriptase balik nukleosida /nukleotida penghalang transkriptase balik non nukleosida /nukleotida penghalang integrase penghalang protease

Intervention with macronutrient and micronutrient therapies to support immune function could play an important role in the course of HIV disease. Patients with advanced HIV infection may even consume more kilocalories than other. Patient who lose weight during opportunistic infection may not fully recover their weight or normalize their body composition. Some component of foods or supplements may also have the potential for interaction, so careful monitoring should be established to identify any adverse effects.

Adanya pengaruh dari terapi makronutrisi dan mikronitrisi dapat menyuport fungsi imun untuk melawan HIV. Pasien dengan infeksi HIV disarankan untuk mengkonsumsi kilokalori lebih banyak dari pada yang lain. Pasien yang kehilangan berat badannya selama masa infeksi, mungkin tidak dapat kembali ke berat badan yang semula. Beberapa komponen makanan atau suplemen juga dapat berpotensi dalam interaksi, pengawasan yang teliti dapat mencegah terjadinya efek efek yang kurang baik.

MACRONUTRIENT THERAPY Fluids : additional fluids are recommended in case of dehydration, fluid loses through diarrhea, or sweating, Kcal : Kcal recommended if weight gain is desired. Additional energy may be required to increase metabolic rate Carbohydrate : its recommended based on both energy needs and carbohydrate tolerance Protein : Additional protein is needed in case of inflammation, fever and during pregnancy. Fats : Its recommended are based on energy needs, cardiovascular risk, and inflammatory conditions Cairan berkeringat. Kcal tambahan Karbohidrat dibutuhkan. Protein Lemak : cairan tambahan diberikan dalam kasus dehidrasi, kekurangan cairan karena diare, atau

: Kcal diberikan untuk menambah berat badan, energi diberikan untuk menaikkan metabolisme. : diberikan sesuai dengan jumlah enegi yang
: diberikan dalam kasus inflamasi, demam, & selama kehamilan. : diberikan berdasarkan kebutuhan energi, penderita cardiovaskular,dan kasus inflamasi.

MICRONUTRIENT THERAPY 1. Vitamin A (700-900g / 3000g) recommended for immune function, pregnancy outcomes, and growth and development of children. 2. Riboflavin (1.1-1.3 mg) recommended in case of lactic acidosis. 3. Folic Acid (400 mg/ 1000 mg) recommended in case pregnancy. 1. Vitamin A(700-900g / 3000 g) direkomendasikan untuk fungsi kekebalan tubuh, masa kehamilan, dan tumbuh kembang anak. 2. Riboflavin (1,1-1,3 mg) direkomendasikan dalam kasus lactic acidosis 3. Asam Folat ( 400mg / 1000mg) direkomndasikan pada masa kehamilan.

In addition to individualized outcomes, monitoring and research on the benefits of providing support to prevent malnutrition and improve nutritional status will be important to demonstrate the benefits that nutrition therapy can have in patient living with chronic HIV infection. (Young1997)

Dengan penambahan monitoring, pemanfaatan penelitian terhadap providing support untuk mencegah malnutrisi, dan menaikkan status nutrisi, akan lebih penting dalam terapi nutrisi, sehingga pasien masih dapat bertahan hidup dengan infeksi HIV kronis (Young1997)

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