HIV paper

CHAPTER I
INTRODUCTION

A. Background
In 2000, an increase in the spread of the HIV epidemic is real through commercial sex worker, but there is a new phenomenon of the spread of HIV / AIDS through drug users too late. 2002, HIV has spread to households. So far more than 6.5 million women in Indonesia so vulnerable population infected with HIV. More than 30% of them gave birth to infants infected with HIV. In 2015, is expected to occur on the transmission of 38 500 children who were born and were infected with HI

To 2006 estimated 4360 children affected by HIV and half of them died. Currently an estimated 2320 children affected by HIV.
Most women take care of families and children in addition to taking care of yourself, so that health problems in women will affect the entire family. Women with HIV / AIDS must gain the support and care that includes counseling memaai about the disease, care, treatment, and prevention of transmission to children and their families.
Maternal transmission of HIV to be a result of unsafe sex, drug injection by the number of turns along with HIV, infected through blood and blood products, use of unsterile medical equipment and tools to incise the skin. The cause of HIV infection in women in a sequence of the biggest is the use of illegal drugs by injection of 51%, 34% of heterosexual women, 8% blood transfusion, and unknown in 70%.
HIV transmission to infants and children bus from mother to child, transmission through blood, through sexual transmission (sexual abuse in children). Transmission from mother to child occurs because women who suffer from HIV / AIDS vast majority (85%) of childbearing age (15-44 years), so there is a risk of bias infection occurs during pregnancy. Prevalence of transmission from mother to infant dalah 0.01% to 0.7%. When new mothers infected with HIV and no symptoms of AIDS, the possibility of infected infants by 20% to 35%, while the obvious symptoms of AIDS in women likely to reach 50%.
AIDS transmission rate can be reduced from 25% - 30% to less than 2% (reduced by> 90%) if we are using antiretoviris drugs (ARVs) in the last Trismester pregnancy, during labor and birth and babies were treated for 6 weeks postpartum and not breastfeeding. Rules / resiman that there has not been very effective in developing countries.

B. Research Objectives
A. To find definitions of HIV / AIDS
2. To find out the cause of HIV / AIDS
3. To know the spread of HIV / AIDS
4. To find HIV / AIDS
5. To find out the handling of HIV / AIDS

C. Benefits of Research
It is hoped that the readers know and understand about the meaning, cause, transmission, prevention and treatment of HIV / AIDS.

D. Problem formulation
How can prevention and treatment of HIV / AIDS

E. Methods of Writing
This paper was prepared using literature






CHAPTER II
DISCUSSION

A. Definition
HIV (Human Immunodeficliency Virus) / decrease in viral immunity in humans is a very small germ called a virus, which can not be seen by humans.
AIDS (Aquired Immune Deficiensy Syndrome) is a collection of symptoms due to decreased immune system that occurs because a person infected with the virus Human Immunodeficliency Virus (HIV). People who are infected with this virus can not cope with the invasion of other infectious diseases because the body system continues to decline drastically.

B. Etiology
AIDS is caused by a virus called HIV. If someone exposed to HIV infection, the virus will attack the immune system that is part of our body tasked to fight the infection.
Gallo (National Institutes of Health, USA) found HTL virus III (Human T lymphotropic virus), which also is the cause of AIDS.
In 1986 from Africa found another virus that can also cause AIDS called HIV-2 and HIV-1 in contrast to the genetic and antigenic.

C. Signs and Symptoms
A. AIDS
AIDS is an advanced manifestation of HIV. During the stage of an individual may feel healthy and do not suspect that their patients with the disease. In later stages, the individual's immune system can no longer deal with opportunistic infections and they continue to suffer from minor and major body Karen is able to provide services.
Infection rates in infants approximately 1 in 6 babies. In early infection, did not show specific symptoms. But a few weeks later the parents who are infected with HIV will develop mild illness such as flu daily and diarrhea. AIDS sufferers outwardly healthy. At 3-4 years the patient does not show typical symptoms. After 5-6 years to begin to arise recurrent diarrhea, sudden weight loss, frequent canker sores in the mouth and swelling of lymph node area. If described without medical treatment, the symptoms of PMS would be fatal.
2. HIV
HIV infection provides a non-specific clinical picture with a wide spectrum, ranging from asymptomatic infection (asimtomatif) at an early stage to severe symptoms at a more advanced stage. Slow course of the disease and the symptoms of AIDS on average 10 years after emerging infections, even longer.
Factors that influence the development of HIV into AIDS is not known clearly. HIV infection is estimated that over - over and exposure to other infections affect the progression towards AIDS. The reduced cell count below 200/ml CDA showed developmental worsening. Bad state is also indicated by the increase in B2 micro-globulin and also increased I9A.
The course of HIV infection clinics have found some of the classifications are:
a. Acute infection: CD4: 750-1000
Symptoms of Acute infections usually occur sedudah incubation period of 1-3 months. The symptoms are generally such as influenza, fever, arthralgia, anereksia, malaise, skin symptoms (rash, urtikarta), neurological symptoms (pain to, retrobulber pain, cognitive impairment danapektif), gas trointestinal disturbances (nausea, diarrhea). In this phase of the disease is highly contagious because of viremia. The above symptoms are the body's reaction to the insertion of Unis that lasts approximately 1-2 weeks.
b. Asymptomatic Chronic Infection: CD4> 500/ml
After the acute infection passes it over the years and then, generally about 5 years, the state of the patient looked well, though in fact there is a slow virus replication in the body. Some patients have swollen glands lomfe thorough, called lymph denopatio (LEP), although this is not something that is not affected for prognostic and survival. We have already started to decline in CD4 cell counts to guide people with reduced immunity, but still at the level of 500/ml.
c. Symptomatic Chronic Infection
This phase began on average after five years of HIV infection. Various symptoms of mild or more severe disease occurs in this phase, depending on the level of immunity pemderita.
1). Immunity decline are: CD4 200-500
At the beginning of this sub-phase of the diseases that arise over such minor reactivation of herpes zoster or herpes simplex. However it can be cured or just a regular treatment. Malignancies can also occur in a further phase of this sub-phase and can progress to the next sub-phase, so-called AIDS-Related (ARC).
2). Reduction in weight Immunity: CD4 <200
In this sub-phase of this serious opportunistic infection that is often threatening. Malignancies arising in the sub-phase is also present, although often at an earlier phase. Viremia occurred for the second time and it has been said already in the body loses its resistance.



Signs and Symptoms of AIDS
A. AIDS is suspected in adults when there are at least two major symptoms and one minor symptom and not the causes of immunosuppression such as cancer, severe malnutrition or the use of corticosteroids for long.
a. Major symptoms
1). Weight loss of more than 10%
2). Chronic diarrhea of ​​more than one month
3). Fever of more than one month
b. Minor symptoms
1). Cough for more than a month
2). Dermatitis common preuritik
3). Herpes zoster recurrens
4). Kandidias oropharynx
5). Generalized lymphadenopathy
6). Disseminated herpes simplex with chronic progressive
2. Suspected of AIDS in children. If there are symptoms palinh least two major and two minor symptoms, and there is no reason - other causes of immunosuppression such as cancer, severe malnutrition, corticosteroid use old or other etiologies.
a. Major symptoms
1). Weight loss or a slow and abnormal pertmbuhan
2). Chronic diarrhea of ​​more than 1 month
3). Fever over dari1bulan
b. Minor symptoms
1). Generalized lymphadenopathy
2). Oro-pharyngeal candidiasis
3). General recurrent infections
4). Cough parsisten
5). Dermatitis


D. HIV / AIDS in Women
HIV / AIDS in women is different because:
A. Women are more easily infected with HIV than in men. Men enter the semen into the vagina, where the liquid is tidk will settle for a long time. When the semen contains HIV virus then it will easily fit into a woman's body through the vagina and cervix, especially if there are cuts or ulcers on the section.
2. Women often become infected at younger ages than men. This is because young women and girls usually are hard to resist unwanted sexual tidk or unsafe.
3. Women receive more blood transfusions than men because of the birth.
4. More rapid progression to AIDS after HIV infection in women. Malnutrition and lead to women of childbearing age are less able to fight disease.
5. Women often unfairly questioned as the ringleader spread of AIDS, but in fact he also has a responsibility equal to men.
6. HIV-infected pregnant women will pass it on to the fetus.
7. Women usually a nurse a sick family member with AIDS, although they too are sick.

E. Transmission / spread of HIV / AIDS
HIV live dicairan body such as blood, semen and fluids from people infected with HIV. The virus becomes scattered when the body fluids enter another person's body. HIV is spread by way of bias:
A. Unsafe sexual relationship with a person infected with the virus.
2. Needles and syringes are sterile tidk, or other sharp objects piercing or cutting the skin.
3. Blood transfusion, if the blood has not been checked for free from HIV.
4. HIV infected pregnant women transmit to the baby during pregnancy, childbirth and breastfeeding.
5. Infected blood into the incisions or open wounds of others.
HIV can be transmitted from mother to baby in three ways, namely in the uterus (through-the placenta) during birth or through breast milk. In the breast-fed infants is approximately half of the transmission occurs when about childbirth, breastfeeding mothers and a third through a small part in the uterus. Infected infants are not breastfed, about two-thirds of transmission occurs during or close to delivery and a third in the uterus.
A. Gestation
Pregnancy can be dangerous for women with HIV or AIDS during labor and delivery. Mothers will often experience the following problems:
a. Miscarriage
b. Fever, infection and declining health.
c. Serious infections after giving birth, which is difficult for the patient and possibly threatening the mother.
2. Give birth
After delivery the genital equipment wash 2 times a day with soap and clean water that are protected from infection.
3. Breastfeeding
HIV infection is sometimes transmitted to infants through breast milk (ASI). Is not yet known with certainty the frequency of events like this or why it only occurs in some infants but not in certain other babies. In milk there is more HIV virus in mothers who had an infection and mothers who had been showing signs of AIDS.
After 6 months, when babies become stronger and larger, the danger of diarrhea and infections get better. Breast milk can be replaced with another and provide additional food. In this way the baby will get the benefits of breastfeeding with a lower risk for contracting HIV

F. Prevention of HIV / AIDS
Prevention of HIV / AIDS can be done by:
A. Always faithful to each other and with their partners
2. Learn to use safe sexual relations, namely the relationship which prevents the entry of germs that may be inherent in the male semen into the female body parts
3. Avoid perforation of the ear, tattoo, needle tujuk / make incisions / holes in the skin of the body by means of unwashed
4. Avoid blood transfusions except for emergencies
5. Do not borrow from each other razors or toothbrushes
6. Do not touch someone else's blood / open wound without protection (Maxwell, 2000)

G. Handling
A. General Handling
a. After HIV diagnosis, treatment is done to slow the rate of viral replication. Various kinds of drugs prescribed to achieve this goal and various combinations of drugs continue to study. To find a drug cure.
b. These treatments are of course have side effects, however, they were really able to slow the spread of HIV in the body.
c. Treatment of infections appertunistik depends on specific substances that may infect patients, medication with high doses of anti-biotic and anti-viral drugs are often given routinely to prevent infection in order not to spread and become more severe

2. Special Handling
a. Done since antenatal screening and testing is done at the request of the patient where the risk of STDs after the counseling process and its relationship with HIV, is concerned deems it necessary checks.
b. Encourage the availability of serologic tests
c. Specific counseling for people infected with HIV, especially those with pregnancy berkiatan da risks faced
d. For high-risk group but negative test results do counseling for preventive measures (use of condoms)
e. Provide nutrition with high nutritional value, overcome opportunistic infections
f. Perform therapy (AZT as soon as possible, especially when konsentrsi virus (30000-50000) RNA copies / Ml or if CD4 decreases drastically
g. Management of labor in accordance with the consideration of the conditions encountered (pervaginanm or perabdominam, consider the principles of infection prevention).

Recommendations of ART
to reduce perinatal transmission
Situation
gestation
Recommendation

A. Pregnant HIV-infected antiretroviral naive prior


2. Pregnant HIV-positive people who are getting ART and pregnancy

3. HIV-positive pregnant at the time of delivery came and had not received ART

4. If the children of mothers with HIV came after childbirth, while the mother has not received ART during pregnancy / intrapartum
A. Pregnant HIV-positive individuals underwent clinical, immunologic, and virologic standart.pertimbangan ART initiation and research with people with HIV who are not pregnant with consideration of effects on pregnancy.
Recommended a three-part AZT regimen after the first trimester without memendang ibu.regimen combination hiv levels recommended in people with HIV clinical status, immunological, and viroogisnya weight or HIV levels of more than 1000 copies / mL.jika people with HIV come in the first trimester of pregnancy, giving AZT can delay until the age of 10-12 weeks gestation.
2. If after the first trimester of pregnancy is unknown, but previous ART forwarded, preferably by including terimester ZDV.jika known at first pregnancy, people with HIV were given counseling about the benefits and risks of antiretroviral therapy in HIV-positive people choose to stop pertama.jika trimester zidovudine during the first trimester, all drugs should be discontinued for then given a stimulant after the first trimester to prevent resisitensi obat.tanpa considering the previous regimen, AZT is recommended to be administered during the intrapartum and
3. There are several regimens are recommended:
A. Nevirapindosis single dose at birth and infant tunggalpada at age 48 hours
2. AZT and 3TC orally at birth, followed by AZT/3TC in ayi for a week
3. Intravenous zidovudine intrapartum zidovudine in infants followed for 6 weeks
4. Two doses of AZT in combination with intravenous neviraprin during labor followed by zidovudine in infants for 6 weeks
Immediately after delivery, HIV-positive individuals undergo such levels of CD4 and HIV to determine whether the treatment will be continued

4. AZT syrup is given to infants for 6 weeks, beginning as soon as possible within 6-12 hours after kelahiran.beberapa doctor may choose a combination of zidovudine with other antiretroviral therapy, especially if the mother is known to be resistant to this regimen AZT.namun unknown efficacy and dosage for children is not fully known .
Immediately after delivery, HIV-positive individuals undergo such levels of CD4 and HIV to determine whether the treatment will undergo diagnostic dilanjutkan.bayi early so treatment can be given as soon as possible if you were HIV positive.


LABOR MANAGEMENT IN PREGNANT WOMEN WITH HIV
To reduce the risk of HIV transmission occurs mainly during intrapartum, some researchers tried to compare the transmission of HIV yag undergoing Caesarean section with vaginal deliveries. Delivery by Caesarean sesio thought to reduce infant exposure to fluids that contain HIV serkovaginal. When HIV-infected women choose Caesarean section delivery, the risk of getting low at below 1%.

Recommend ways to reduce labor HIV transmission from mother to child
How
Labor
Recommendation

A. Pregnant HIV-positive people who come to the pregnancy over 36 weeks, yet mendapatART, and is awaiting the results of HIV levels and CD4 * yng estimated before delivery.

2. Pregnant HIV-positive people who come in early pregnancy, was received combination antiretroviral therapy and HIV levels remained above 1000 copies / mL at week 36 of pregnancy

3. HIV-infected pregnant rightly combination ART, and HIV levels undetectable by week 36 of pregnancy


4. Pregnant HIV-positive people who have effectively planned Caesarean section, but come in early labor or after rupture of membranes

A. There are several regimens that should be discussed clearly. HIV-positive should receive antiretroviral therapy PACTG 076 regimen. HIV counseling conducted on Caesarean section to reduce the risk of transmission and the risk of postoperative complications, anesthesia and other operating risks to her.
If it is decided Caesarean section, Caesarean is planned in week 38 of pregnancy. During the caesarean, people with HIV receive intravenous AZT starting 3 hours before, and infants received AZT syrup for 6 weeks. Decisions will continue AZTsetelah birth or not depends on the govern
iksaan virus levels of CD4 *
2. ART regimens used to go on. People with HIV should receive counseling that HIV levels will probably not go down to about 1000 copies / mL ssebelum labor, so it is recommended to perform Caesarean section. Similarly, the risk of complications of caesarean binding, such as postpartum infection, anesthesia and surgery. Caesarean section was decided Jia, seksioo planned in week 38 of pregnancy. During the caesarean, HIV-infected intravenous mendapatAZT starting at least 3 jamsebelumnya. Another Arat DAPT continued before and after childbirth. Infants received AZT syrup for 6 weeks.
3. HIV-infected women currently receive combination antiretroviral therapy, and undetectable levels of HIV may be less than 2%, even at vaginal delivery. The selection of mode of delivery should memeperimbangkan advantage caesarean risk of complications.
4. AZT administered intravenously immediately. If the rapid progress of labor, people with HIV is offered to undergo a vaginal delivery. If Ervik minimal dilatation and suspected to be a long labor, intravenous zidovudine can be selected and perform Caesarean section or pitosin to memepercepat persalianan. If odhadiputuskan to undergo a vaginal delivery, the electrode head, invasive monitors and other assistive devices should be avoided. Baby should receive AZT syrup for 6 weeks.

CHAPTER III
CLOSING

A. Conclusion
HIV is a very small germ, called the virus that can not be seen by humans. AIDS is a disease that develops later, after a person infected with HIV, the AIDS virus. HIV transmission in women occurs through injection drug use 51%. Hetero women seksusal 34%, 8% and blood transfusion is unknown as much as 7%. While HIV infection in infants and children can be through vertical (mother to baby), blood, through sexual transmission (sexual abuse in children), and the use of unsterile medical devices. Common symptoms found in infants with infection. HIV is a disorder of growth and development, oral diasis conditions, chronic diarrhea. HIV transmission from mother to baby can be prevented through a four-way started during pregnancy, during delivery and after birth (Nurs, 2007)

B. Suggestion
It is hoped the reader to better understand what the cause, treatment and the signs and symptoms of HIV / AIDS to prevent further infection.