A. DEFINITION
AIDS (Acquired Immune Deficiency Syndrome) is a disease caused as a result of the reproduction of the HIV virus (Human Immunodeficiency Virus) in the human body, in which the virus attacks the white blood cells (CD4 cells) that cause damage to the immune system. The loss or reduction in body resistance makes the patient very easily infected by various diseases including mild illness.
The HIV virus attacks the white cells and makes it a breeding ground for viruses. White blood cells are necessary for the immune system. Without the immune system when our bodies are attacked by the disease, body is weak and unable to fight the disease that comes and consequently we may die even if exposed to influenza or the common cold.
When the human body is exposed to the HIV virus does not directly cause disease or AIDS, but it takes a long time even years for HIV to cause AIDS or HIV positive are deadly.
HIV, the virus that causes AIDS, can be transmitted from an infected mother to her baby. Without treatment, approximately 30 percent of infants of HIV-infected mothers become infected as well. Mothers with high viral loads are more likely to transmit HIV to their babies. However, no viral load is low enough to be considered "safe". Infection can occur at any time during pregnancy, but usually happens just before or during labor. The baby is more likely to be infected if the delivery takes longer. During childbirth, newborns exposed to the mother's blood. Drinking milk from infected mother can also infect the baby. HIV-positive mothers should not breast-feed their babies. To reduce the risk of infection when the father is HIV-positive, a lot of couples using sperm washing and artificial insemination.
B. Transmission of HIV / AIDS from mother to infant
HIV is found in body fluids, and most commonly found in blood, semen and vaginal fluids. In other body fluids can also be found, such as breast milk and saliva, but the amount is very small.
Some 75-85% of virus infection occurs through sexual intercourse (5-10% of them through homosexual relations), 5-10% due to contaminated syringes (especially injecting drug users are used interchangeably), 3-5% may occur through contaminated blood transfusions.
HIV infection is mostly (over 80%) affects the productive age group (15-50 years), especially men, but the proportion of female patients tended to increase.
Infections in infants and children 90% occur from HIV + mothers. about 25-35% of infants born to HIV-infected mothers will be infected with the virus through infection occurred during pregnancy, childbirth and breastfeeding.
With antiretroviral treatment in the last trimester pregnant women, the risk of transmission can be reduced to 8%.
HIV-positive mothers can reduce the risk of the baby contracting with:
1. Antiretroviral drugs (ARVs)
The risk of transmission is very low when antiretroviral therapy (ART) use. Transmission rate is only 1 percent when mothers on ART. This figure is approximately 4 percent when mothers taking AZT during week six months post pregnancy and infant zidovudine given during the first six lives.
However, if the mother did not use drugs before his labor, there are two ways you can halve this transmission. AZT and 3TC used during labor and for the mother and baby for a week after birth. One dose of nevirapine during labor, and one dose for the baby 2a € "3 days after birth. Combining nevirapine and zidovudine during labor reduces the transmission to only 2 percent. However, resistance to nevirapine can develop in up to 20 percent of women taking the tablets when they are pregnant. This reduces the efficacy of ART used later by the mother. This resistance can also be spread to the baby when breastfeeding. However, short-term therapy is more affordable in developing countries.
2. Keeping it brief time parturition
The longer the process of birth, the greater the risk of transmission. If the mother is taking zidovudine and had a viral load below 1000, the risk is almost zero. Mothers with high viral load can reduce surgical risk by using Fault.
3. Avoiding breastfeeding
About 14 percent of infants infected with HIV through infected breast milk. This risk can be avoided if the infant is given breast milk substitutes (PASI, or formula).
However, if replacement feeding is not given correctly, another risk to the baby is intense. If the formula can not dilarut with clean water, or cost issues causing the amount was not enough formula, breastfed babies better. The worst was a mixture of milk and PASI. Perhaps the most suitable way for most women in Indonesia are exclusively breastfeeding (not interfering with PASI) during the first 3-4 months, then replaced with a formula exclusively (not mixed with milk).
C. INFECTIONS IN BABY
When tested for HIV, the majority of babies born to HIV-positive mothers showed positive results. This means no antibodies to HIV in their blood. But babies receive antibodies from their mothers, in order to protect his immune system so fully formed. So a positive test result early in life does not mean the baby is infected.
If babies are infected, the immune system will make antibodies against HIV, and HIV testing will continue to show positive results. If the baby is not infected, the mother's antibodies will disappear and the test became negative after about 6-12 months.
Another test, similar to the viral load test can be used to determine whether the baby is infected, usually a few weeks after birth. These tests, which look for antibodies and not the virus, currently only available in Jakarta, and the price is quite expensive.
D. MATERNAL
New research shows that HIV-positive women who are pregnant do not get any sicker than non-pregnant. This means that being pregnant does not affect the health of HIV-positive women.
However, short-term therapy to prevent transmission to the baby is not the best choice for the health of the mother. HAART is the standard treatment. If a pregnant woman takes medications only during labor, the possibility of the virus in the body will become resistant to the drug. This can cause problems for the future treatment.
A pregnant woman should consider all of the possible problems related to ART:
- Do not use both ddI with d4T in treatment was due to a combination of lactic acidosis can lead to a high rate.
- Do not use efavirenz or indinavir during pregnancy.
- If the CD4 count over 250, do not start using nevirapine.
- Some doctors suggest that women stop treatment during the first trimester of pregnancy.
E. HOW TO TRANSMISSION HIV / AIDS
- Primarily through unsafe sex (without a condom) with a partner who has been infected, either through vaginal, oral, or anal (Anus).
- Using needles used in people infected with the HIV virus.
- Receiving a blood transfusion infected with the HIV virus.
- Pregnant women infected with the HIV virus will be transmitted to the baby.
F. SIGNS AND SYMPTOMS OF DISEASE AIDS
A person who is exposed to the HIV virus in the early onset generally do not provide the typical signs and symptoms, the patient is only experiencing a fever for 3 to 6 weeks depending on the immune system to make contact when the HIV virus. Once conditions improve, people affected by the HIV virus will remain healthy in a few years and slowly declining kekebelan body / weak to fall ill with recurrent bouts of fever. One way to get certainty is to undergo HIV antibody test especially if someone was already doing activities that risk HIV virus.
The signs and symptoms seen in patients with diseases such as AIDS are as follows:
- Respiratory Tract. Patients experiencing shortness of breath, stop breathing for a moment, coughing, chest pain and fever stricken bleak other viral infections (pneumonia). Not infrequently diagnosed in the early stages of HIV disease AIDS suspected tuberculosis.
- Gastrointestinal. Patients with AIDS show signs and symptoms such as loss of appetite, nausea and vomiting, often experiencing fungal diseases of the oral cavity and esophagus, as well as having a chronic diarhea.
- Body weight. Patients experiencing also called wasting syndrome, body weight loss of up to 10% below normal due to disturbances in protein and energy systems in the body as it is known as malnutrition as well as impaired absorption / absorption of food in the digestive system resulting in chronic diarhea, conditions tired and weak underpowered.
- System Persyarafan. Interference with the central persyarafan resulting in less memory, headaches, difficulty concentrating, often looked confused and slow response limbs. At the end persyarafan system (Peripheral) will cause pain and tingling in the hands and feet, which is less tendon reflexes, always had low blood pressure monitor and Impotence.
- System Integument (skin Networks). Patients having an attack of chickenpox virus (herpes simplex) or carar fire (herpes zoster) and various skin diseases that cause pain in the skin tissue. Others are experiencing hair tissue infections of the skin (Folliculities), dry skin mottled (outer layer of the skin cracks) as well as eczema or psoriasis.
- Urinary tract and Reproduction in women. Patients often experience vaginal fungal disease, it is a sign of early HIV infection. Injury to the urinary tract, and compared disease syphillis Men the more numerous women who suffer from smallpox. Other people with AIDS are women likely to have inflammation cavity (bone) known as pelvic term 'pelvic inflammatory disease (PID)' and having irregular periods (abnormal).
G. HOW TO PREVENTION HIV - AIDS
Five basic ways to prevent HIV-AIDS penluaran namely:
- No pre-marital sex or oral sex free either vaginal, anal sex with an terinfekasi
- Mutually faithful, only to have sex with a legitimate partner.
- The use of condoms can reduce but not eliminate completely the risk of contracting HIV / AIDS.
- Reject drug use, particularly injecting drug.
- Do not use needles.
- Avoid sexual contact until the completion of antibiotic treatment.
- Suggest also our sexual partners to be checked in order to prevent further infection and prevent transmission
- Women prostitutes to always check themselves regularly, so if the infection can be quickly treated properly
- Control of sexually transmitted diseases is to improve the safety of sex contacts by using prevention efforts.
H. HANDLING AND TREATMENT OF AIDS
In spite of many countries continue to researchnya in addressing HIV AIDS, but until now there is no cure AIDS including serum or vaccine that can cure people of the HIV virus causes AIDS. The purpose of the provision of drugs in patients with AIDS is to help improve the immune system, improve the quality of life for the They were known to the HIV virus in an effort to reduce the number of births and deaths.
Antibiotics are the treatment for gonorrhea. Sexual partners should be examined and treated as soon as possible when the diagnosis of gonorrhea. This applies to sexual partners in the last 2 months, or sexual partners during the last 2 months when there is no sexual activity. Many antibiotics that are safe and effective for treating gonorrhea, N.gonorrhoeae eradicate, to stop the chain of transmission, reduce symptoms, and reduce the possibility of residual symptoms.
The main choice is penicillin + probenecid. Antibiotics can be used to treat gonorrhea, among others:
1. Amoxicillin 2 g + probenecid 1 g, peroral
2. 2-3 grams Ampicillin + probenecid 1 g. Peroral
3. Azithromycin 2 grams, peroral
4. Cefotaxime 500 mg, intramuscular injection
5. Ciprofloxacin 500 mg, peroral
6. Ofloxacin 400 mg, peroral
7. Spectinomisin 2 grams, intramuscular injections
These drugs are given in a single dose.
Treatment of Pregnant / lactating
In pregnant women can not be given drugs known as quinolones and tetracyclines. Recommended is the provision of drugs known as cephalosporins (Ceftriaxone 250 mg IM as a single dose). If a pregnant woman is allergic to penicillin or cephalosporins should be not be tolerated Spektinomisin 2 g IM as a single dose. In pregnant women may also be given Amoxicillin 2 g or 3 g oral probenecid 1 g orally added as a single dose given at insulating N. gonorrhoeae were sensitive to penicillin. Amoxicillin fatherly recommended treatment if accompanied by infection C. Trachomatis.