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Monday, 30 April 2012




HIV infection is a viral infection that progressively destroys white blood cells and causes AIDS (Acquired Immunodeficiency Syndrome). (10) AIDS was first discovered in 1981. (1)
Transmission of HIV infection from mother to child is the main cause of HIV infection in children under 15 years of age. Since HIV became pandemic in the world, an estimated 5.1 million children globally are infected with HIV. Most of these patients infected through transmission from mother to child. Each year an estimated more than 800,000 infants become infected with HIV through transmission from mother to child. And followed by the approximately 610 000 child deaths from the virus. (10)
            In Indonesia, according to the Directorate General of Health Department of PPM and PL recorded 3568 cases of HIV / AIDS at the end of December 2002. There are 20 children with HIV infection who are infected mother. Research conducted Pelita Science Foundation and The Faculty of medicine obstetrics / RSCM during the years 1999-2001 do a check on 558 pregnant women in poor areas in Jakarta, showed as many as 16 people (2.86%) suffering from HIV infection. (10)
Women are contracting HIV infection through heterosexual relations with an infected partner or through the use of drugs, increasing HIV infection in children is due to the result of transmission during the perinatal period (pregnancy, during and after childbirth). Perinatal HIV transmission is a major cause of pediatric AIDS mother - mothers that transmit HIV are usually good and has a number of CD 4 T lymphocytes are normal and do not know if they are infected with HIV. More than 90% of AIDS in children were reported in 1994 occurred because of transmission from mother to child. (10)
 Transmission to the infant can occur during pregnancy, delivery or postnatal through breast milk. The incidence of mother to child transmission is estimated at 20% - 30%. HIV transmission to the fetus if no intervention reported to range between 155-45%. (10)
The risk of transmission in developing countries around 21% - 43%, higher than the risk of transmission in developed countries about 14% -26%. Transmission can occurs during pregnancy, intrapartum, and postpartum. The risk of transmission of most infections occur during labor by 18%, in the content of 6% and 4% after delivery.


Definition and Etiology
HIV infection is a viral infection that progressively destroys white blood cells and causes AIDS (Acquired Immunodeficiency Syndrome). There are two types of the virus that causes AIDS, namely HIV-1 and HIV-2.
HIV-1 is most prevalent in the Western Hemisphere, Europe, Asia and Central Africa, South and East. HIV-1 infects mainly CD4 + T lymphocytes. Emptying of CD4 + lymphocytes causes immunodeficiency. (1), (2) HIV-2 is mainly found in West Africa. (1)
Once infected, a person can look and feel healthy until ten years or more before signs of AIDS appear. However, at this time the blood test can show the presence of HIV. This is referred to as "HIV positive" people who are HIV positive though it looks and feels healthy, can spread it to others. (5)
AIDS is a fatal disease which is an advanced stage of HIV infection. Infection with HIV usually results in damage to the immune system progressively, causing the occurrence of opportunistic infections and certain cancers (especially in adults).
People who suffer from HIV or AIDS called PLWHA (People Living with HIV / AIDS).

HIV is spread:
• By having sex vaginal, anal, or oral sex unprotected with people who are HIV positive.
• Using shared needles or syringes with an HIV positive person.
• During pregnancy, birth, or breastfeeding, from an infected mother to her baby. (5)
Body fluids of infected people that HIV causes are:
A. Cement
2. Blood
3. Vaginal fluid
4. Mother's Milk (5)
HIV is not transmitted through casual contact or close contact of a sexual nature that are not at work, school or at home.
Has not been reported cases of HIV transmission through coughing or sneezing and people through mosquito bites. Transmission of a physician or dentist who infected to pasennya also very rare.
HIV is a human retrovirus family including sub lentivirinae. Retrovirus containing the inner capsid composed of protein structures referred to in size. Major structural protein, p24, was detected in the serum of patients infected with high loads. (2)
In order for an infection, the virus must enter the cell, in this case the white blood cells called lymphocytes. Virus genetic material inserted into the DNA of infected cells. Inside the cell, the virus proliferate and ultimately destroy the cells and releases new virus particles. The new virus particles then infect other lymphocytes and destroy them. (8)
 The virus attaches to the lymphocytes which have a receptor protein called CD4, which is present in the outer membrane.
Cells that have CD4 receptor is usually called cells or CD4 + T helper lymphocytes.
             Helper T lymphocytes activate and regulate function of other cells of the immune system (such as B lymphocytes, macrophages and cytotoxic T lymphocytes), all of which help to destroy malignant cells and foreign organisms.
HIV infection causes destruction of helper T lymphocytes, resulting in weakness of body systems in protecting themselves against infection and cancer.
A person infected by HIV will lose the helper T lymphocytes through three stages over several months or years:
A. A healthy person has a CD4 lymphocyte count as much as 800-1300 cells / mL blood. In the first few months after being infected with HIV, their number decreased by 40-50%. During these months the patient can transmit HIV to others as many virus particles contained in the blood. Although the body tries to fight the virus, but the body is unable to relieve the infection.
2. After about 6 months, the number of virus particles in the blood reaches a stable level, which is different in each patient. CD4 + cell destruction and disease transmission to others continues.
High levels of viral particles and CD4 + lymphocyte levels are low to help physicians in determining those at higher risk for AIDS.
3. 1-2 years before the onset of AIDS, CD4 + lymphocyte count usually decreases drastically. If the level reaches 200 cells / mL blood, the patient becomes susceptible to infection. (8)
HIV infection also results in impaired function of B lymphocytes (lymphocytes that produce antibodies) and often leads to excessive production of antibodies. These antibodies are mainly directed against HIV and infections experienced by patients, but these antibodies are not much help in fighting a variety of opportunistic infections in AIDS. At the same time, the destruction of CD4 + lymphocytes by the virus leads to reduced ability of the immune system to recognize new target organism and should be attacked.
A. Effect of HIV in pregnant women
Pregnant women who are HIV positive can transmit the virus to the fetus or baby. However, this risk can be minimized. Having children is something every married couple. But if the wife turns containing HIV positive, they should be ready with the possibility of infected infants. In pregnancy, HIV does not cause the disorder 'congenital'. However, there is a tendency risk of pregnancy failure, such as spontaneous abortion, increased. the possibility of spontaneous miscarriage could occur due to other comorbidities, or because the pregnancy has caused HIV journey becomes more progressive, both early and advanced HIV (4)
HIV transmission from mother to fetus is called vertical transmission. But pregnant women with HIV, not 100% pass the virus to her unborn child, therefore, as a result she does not think to immediately terminate the pregnancy. Which, most importantly, the mother should pay attention to diet and regularly during their pregnancy. Another possibility of an infection must be avoided. Because the immune mothers suffering from HIV are very low. When exposed to infection, such as the flu, may be more severe than normal flu. Lots of rest, and avoid disease transmission that is around. (9) In women who are infected with HIV, the virus was found in vaginal fluids of 21%. Maternal disease state is also a consideration because the mother is infected with HIV have a higher risk of death from not breastfeeding.
Risk of HIV-infected women, 2-4 times greater than men. Because:
• The surface of the female genitals is more extensive than those of men. The possibility of infection through semen during intercourse, greater.
• The concentration of HIV in semen is higher than the concentration in vaginal fluid. In fact, spermalah that enter the body of a woman during intercourse.
• Women at risk through anal sex (which should not be done) which damage the anal tissue. Viruspun into the body.
Both men and women alike can be infected with HIV and other STIs, many of whom gave serious consequences and the long term, especially for women for example, inflammatory pelvic disease, tubal pregnancy / ectopic, sterility. (5)
Women at greater risk of contracting STDs because it is more likely than men to get HIV or STDs from one-time sexual exposure. Women may have a difficult asinptomatik STI diagnosed, but increases the risk of HIV. Women often are not on the beneficiaries on sexual negotiation and an object of sexual violence. (5)

The patient may show symptoms of HIV infection within a few years before the occurrence of infection or tumor which is typical for AIDS. Symptoms - symptoms of AIDS from HIV infection itself, as well as opportunistic infections and cancers.

Symptoms - symptoms:
• Swollen Lymph Nodes
• Weight loss
• intermittent fever
• feeling unwell
• Tired
• Diarrhea is repeated
• Anemia
• Thrush (a fungal infection in the mouth) (8)
Some opportunistic infections and cancers are characteristic of the emergence of AIDS:
A. Thrush.
Excessive growth of the fungus Candida in the mouth, vagina or throat, usually an infection that first emerged.
Recurrent vaginal yeast infections are difficult to treat are often an early symptom of HIV in women. But this kind of infection can also occur in healthy women due to various factors such as birth control pills, antibiotics and hormonal changes.
2. Pneumonia pneumokistik. Because the fungus Pneumocystis carinii pneumonia is an opportunistic infection that often recurs in patients with AIDS.
The infection is often a serious opportunistic infection that first emerged and before they find a way of treatment and prevention, is the most common cause of death in patients with HIV infection
3. Toxoplasmosis.
Chronic infection by Toxoplasma frequent since childhood, but symptoms only occur in a small group of people with AIDS.
If there pengaktivan again, Toxoplasma can cause severe infections, especially in the brain.
4. Tuberculosis.
Tuberculosis in patients with HIV infection, are more common and more deadly.
Mycobacteria other types of Mycobacterium avium, is the cause of the onset of fever, weight loss and diarrhea in people with advanced stages of tuberculosis. Tuberculosis can be treated and prevented with anti-tuberculosis drugs are commonly used.
5. Gastrointestinal infections. Gastrointestinal infections by the parasite Cryptosporidium is commonly found in people with AIDS. These parasites may be obtained from food or water contaminated. Symptoms include severe diarrhea, abdominal pain and weight loss.
6. Progressive multifocal Leukoensefalopati. Progressive multifocal Leukoensefalopati is a viral infection in the brain that can affect the function of neurological patients. Initial symptom is usually a loss of strength of arm or leg and loss of coordination or balance.
In a few days or weeks, patients are not able to walk and stand and usually a few months later the patient will die.
7. Infection by cytomegalovirus. Repeat infections tend to occur at an advanced stage and often strike the retina of the eye, causing blindness.
Treatment with anti-viral drugs to control cytomegalovirus.
8. Kaposi's sarcoma. Kaposi's sarcoma is a tumor that is not painful, red to purple, a prominent spots on the skin.
These tumors are particularly common in homosexual men.
9. Cancer.
Can also occur lymph node cancer (lymphoma) which first appeared in the brain or internal organs. Women with AIDS is likely to develop cervical cancer. Homosexual men are also susceptible to cancer of the rectum. (8)
B. Effect of HIV on Fetus and Newborn
The process of estimating the medical world or the transmission of HIV infection has been going on since the baby in the womb, namely through the placenta. However, the greatest risk of transmission occurs during labor and after childbirth. This is because the virus thrives in the area barkembang Vagina. During birth the baby has a close contact with the vagina as the path is born. Blood ejected during labor would be about the baby's body. "If there are injuries in infants, the virus (from mother's blood can enter through the wound). After delivery the baby was still infected with HIV. Through breast milk. (1) (2) (3) (9) For the mothers with HIV are advised not to give milk, because the HIV virus is also present in breast milk (3), to reduce the risk of transmission from mother to child if safe alternatives are available, accessible, and acceptable.
Not easy to make sure babies are born infected with HIV or not. Only be known after 18-month-old child. (9) Infants who are infected can not be recognized clinically until a severe illness or chronic problems to arise. Common symptoms that often occur in children are diarrhea is prolonged, often experience fever, infection or old, to grow the fungus in the mouth, the more body lean and continuous weight loss.
Early clinical signs can be mild and include diarrhea that long (> 1 month), oral kanidiasis protracted, lymphadenopathy, hepatomegaly, or a decrease in growth rate. Recurrent otitis media is often a mild clinical signs. At the next level of severity, the patient may present with severe life-threatening infections, including pneumonia or septicemia. Chronic sinusitis in babies can be a major sign of immune dysfunction merupkan. (2)
Acute clinical signs caused by virulent organisms in patients limfopeni HIV-infected CD4 + 1 is referred to as opportunistic infections "determinants of AIDS". The most frequent opportunistic infections were pneumonia and lethal P. Carini (PPC). Clinical signs of severe respiratory imfeksi with cough, tachypnea, dyspnea, and hypoxemia with blood gas pointing towards the alveolar capillary blockade (eg inflammatory processes interstisil). Rontenogram chest showed diffuse bilateral pneumonitis with dafragma flat. Diagnosis confirmed by bronchoscopy and bronchoalveolar washings with staining for cysts and trofozoit. Lactate levels are also rising. (2)
Infants and children are infected most often suffer Hipergammaglobulinemia (> 1.750 g / L) with high levels of anti-HIV-1 antibody. Anemia can also occur (<8g/dL), neutropenia (<1000/mm3) and thrombocytopenia (<100.000/mm3). (2)

Detection of HIV-1 antibody is highly sensitive and specific. However, maternal IgG in infants tranplasenta obscure use of antibody screening to diagnosis except in older children and adolescents. Maternal IgG has a half-life of 20-28 days and at most babies infected with HIV -1 humoral response develops at the age of 4-6 months. After 6 months, the antibody can be detected by the assay imunosorbent. (1), (2) The number of CD4 + less than 200U / L can also be a diagnosis for AIDS (1).
Direct detection of viral protein or nucleic acid is less sensitive but very specific. If available, the direct detection or confirmation of diagnosis is recommended untukm. The most sensitive test is a PCR to detect nucleic acid sequence and direct virus isolation (culture) from the peripheral blood. (2) (3) The sensitivity of PCR and virus isolation will increase sharply when performed on a 1-week-old infant who is not breastfed. At 1-month-old infant sensitivity of PCR and viral culture bias can reach 90% even more. (3) Assay of protein p-24 is less sensitive but fast and easily available, especially in countries without facilities for PCR testing and viral culture. To confirm the diagnosis, the positive results of two blood samples with one or a combination of tests (PCR, culture or p-24 test). (3)
Anti-retroviral drugs for pregnant women chosen that can serve to prevent transmission from mother to child. Drugs that proved effective included ZDV (Zidovudin), ZDV/3TC (Lamivudine), and NVP (Nevirapine). (6) empirically ZDV, a drug with high efficacy and safe for both mother and fetus. Therefore, if at all possible, the first-line choice for pregnant women including ZDV. (1) (2) (6) The combination of ZDV/3TC is the first choice for pregnant women, with a dose of ZDV, 100mg, 5 times a day, (1) begins at the age of 14-34 mg of pregnancy and continued during pregnancy. (1) Anti- retroviral drugs for pregnant women should be continued during labor, usually fixed using a combination of therapies. (a) (6) NFV (nelfinavir) is well tolerated by pregnant women and is the drug of first choice from the class of protease inhibitors (protease inhibitor) to pregnant women. 2x1250mg doses per day resulted in drug levels in blood are sufficient. (6)
Women in the first trimester of pregnancy may consider delaying therapy until the age of 10-12 weeks of pregnancy because of potential teratogenic effects of ART (anti retroviral). ART is usually non-emergency needs. But if the woman is severely ill people living with HIV, which is given as early as possible therapeutic benefits greater than the theoretical risk for fetusnya, especially if therapy is initiated with medications that have been reported empirically for the safety of pregnancy (such as ZDV, 3TC, NVP or NFV). (6)
Prevention of Opportunistic Infections
We can provide Hepatitis B vaccination, influenza and pneumonia. If CD4 + under 200/uL, prophylaxis for P carinii pneumonia is recommended for granted, namely sulfamethoxazole-trimethoprim DS (1 tablet daily) or Pentamidine aerosol. (1)
Prevention of HIV transmission to infants
Prevention of transmission could be giving antiretroviral (ART), delivery by SC (Sectio cesarian), and delayed initiation of breastfeeding. (1) With Anti-retroviral therapy typically uses a combination (ZDV/3TC) (1). According to the study, anti-retroviral drugs should be given at 14 weeks of pregnancy. However, other studies merekomondasikan to 8 weeks of pregnancy. With Anti-retroviral, the possibility of transmission can be reduced approximately 8-15 percent. (9)
 Process a cesarean delivery / was thought to reduce the risk of transmission. In the process the baby is not 'direct contact' with the birth canal (vagina). Nor is there any chance that the baby was injured due to the tools of labor. Even if the mother is taking medication according to Anti-retroviral and by cesarean delivery, the likelihood of HIV transmission can be reduced to 1%.
Given the expensive C-section and can not reach people in remote areas, a doctor will 'eradicate' HIV from the birth canal. Prior vaginal delivery is a nesting spot virus, cleaned with antiseptic, every 6 or 8 hours. (1) (3) (9)
PLWHA are women should avoid breastfeeding to reduce the risk of transmission from mother to child if safe alternatives are available, accessible, and acceptable. But the alternative of safe breast milk substitutes are often not available in some countries of limited resources. In such conditions, it is recommended to be exclusively breastfed during the first 6 months of infant life. Women who need ART and are breastfeeding should continue ARTnya regimen. But the efficacy of antiretroviral therapy to prevent postnatal transmission through breast milk is unknown. (6)


• HIV infection is caused by the virus HIV-1 or HIV-2. It can be transmitted from mother to baby.
• Transmission of HIV can be in many ways, the most important is through bodily fluids. The most common is through sexual intercourse.
• Transmission of HIV virus in infants can occur during pregnancy, childbirth and after childbirth.
• HIV infection will be severe when it develops into AIDS, dangerous for both mother and baby. Because it will lower the immune system, leaving it vulnerable to various diseases and opportunistic infections.
• Therapy for the treatment of HIV infection and AIDS could be using a variety of anti-retroviral drugs such as Zidovudin and others.
• Provision of vaccinations such as Hepatitis B and the other is recommended for infants, especially to prevent opportunistic infections.
• Prevention by using ART, SC or by delaying breastfeeding, should be performed on pregnant or who have become infected with HIV.
• The current treatment of surgery for people with HIV / AIDS require special handling.
• Better screening for HIV in couples getting married, even though these tests are expensive and taboo thing to do.
• Prevention of HIV infection should be done to prevent infection in infants, with no contact with people with HIV / AIDS can be having sexual intercourse, blood transfusion, exchange of syringes and other costs associated with patient body fluids.
• Women who suffer from HIV should use ART to prevent transmission to her baby.
• There is also counseling in women with HIV / AIDS on the dangers of HIV / AIDS on themselves and their babies.
• People with HIV / AIDS should not stay away and isolate us, because HIV infection / AIDS is not transmitted through social contact.
• Management of HIV / AIDS infection in pregnancy and after delivery and the approach requires the cooperation of various parties as well as possible.
• With medical management, obstetric and pediatric well is expected to reduce maternal mortality and infant against HIV / AIDS.
• When performing surgery on people with HIV / AIDS by using a standard glass eyes and meetings. Double surgical gloves and blunt suture needles yng (blunt)



1. Cunningham F.G.; Obstetri Williams. 21st edition. Chapter 57, “Sexually Transmitted Diseases.”
2. Nelson Ilmu Kesehatan Anak Vol. 2. edisi 15 (cetakan 1 2000) : oleh Behrman, Kliegman, Arvin.
3. Catherine Peckham, M.D. and Diana Gibb, M.D. “Mother to child transmission of the human immunodeficiency virus”. www.nejm.org.
4. HIV berpengaruh terhadap kesuburan. www. Suara Merdeka.com.
5. Mempelajari pencegahan HIV dan isu - isu perubahan perilaku. www. Certi.org.
6. Tata laksana ODHA wanita. www.aids-rspiss.com.
7. Komisi penanggulangan AIDS. “Terapi HIV/AIDS semakin memberi harapan”.  www.aids-rspiss.com dan www.aidsI ndonesia.or.id 
8. Infeksi HIV. www.medicastore.com
9. “AIDS dan kehamilan”. Tabloid Ibu dan Anak. 
10. www.PDPERSI.co.id
11.   De Jong  , buku A jar Bedah, jakarta

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