Post on 28-Feb-2018
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HIV / AIDSIN PEDIATRIC
Department of Pediatrics
Medical Faculty University of NorthSumatera
H. Adam Malik Hospital 1
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Introduction HIV : Human immunodefciency Virus AIDS : Acquired Immune Defciency
Syndrome is a collection osymptoms and inections in humansresulting rom the specifc damage to theimmune system/ defciency cellular
immune caused by HIV inection
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haracteri!ed :" reduction o the Helper #"lymphocytes " opportunistic inections and
" de$elopment o malignant neoplasms %irst case :&'(&) *SA adult
homose+sual
In the ,orld) - ()... death e$ery day & person e$ery &.
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Immunologic maniestation :
" Helper # 0 " Ig1 and IgA
" 2atural +iller cell 0 " 3acrophag : s+in test Anergi" #uberculin
" 3umps " Candida albicans
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4pidemiology
&'(5 oles+e) rubinstein andamman : AIDS in children in *SA Higher HIV inection in the
,orld : Arica especially Aricasub"sahara 67.8 population9
&'(( : southeast Asia " #hailandfrst report AIDS in children
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orld epidemiology HIV / AIDS untilDesember ;..< #otal 7.=5..=...
>&< year ;=5..=...2e, case : 7='..=...
>&< year ?..=...Dead caused by AIDS : 5=&..=...>&< year :
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Near 1.800 baby born HIV !" / #ay
De$e%o&'n( )o*n+ry , HIV +ran-'-'on r'-
+o )'%# 25 40 .
Co&reen-'$e &re$en+'$e +ran-'--'on , 10
Ine)+'on ,
n-ae -e7
ID In+ra $ena Dr*( -er "
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HIV 6@9 baby
HIV 6@9 mother : ;< " 7.8 HIV 6@9baby
De$elopment country : >
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National Epidemioloy H!"#A!DS $%&&'(
B- C=
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ES3 K ;..5 ";..< (
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13DEVELOPMENT OF HIV VIRUSDEVELOPMENT OF HIV VIRUS
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Helper ) $redHelper ) $red
colour( invaded *ycolour( invaded *ymany H!" virusesmany H!" viruses
$*lue colour($*lue colour(
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#ransmissionSeQual#ransusion
ID*Verticaltransmission
reasteedingFthers
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Incubation periode Adult : 3 month-antibody anti HIV (window periode)
Clinical manifestation : immediately - many years later
< year! "iremia can detected early life - year
#purtinistic infection : clinical manifestation in $
mo life
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linical maniestation Asymptomatic AIDS 3icroorganisme inection rom
en$ironment %ailure ti thri$e) ,eight loss) anemia)
reccurent e$er) limphadenopaty) and
hepatosplenomegaly Fportunistic inection
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AIDS defning illness
%ailure to thri$erolonged diare
rolonged e$erFral candidiasisulmonary tuberculosisneumonia
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Gaboratory eQamination 3any place in Indonesia
: linical maniestation and serologic 6@9: arents suspected HIV 6@9
Some place: linical maniestation and serologic 6@9 %&'
C*
a+arta: linical maniestation: Serologic) D7 and E E2A
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Screening
Abandoned babies/street childrenabies o mother ,ith high ris+ beha$iour6drug addicts/prostitutes/multiple seQ
partner/single"teenage or underage9abies o HIV positi$e motherSeQually abused children O children ,ithseQually transmitted disease
hildren recei$ing regular bloodtransusion/blood products e=g #halasemia
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o o, up sc e u e or n an s o n ec e
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o o, up sc e u e or n an s o n ec emother
+epeat as soon aspossi*le
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Mother H!" ,ve
P-+ of a*y at % /eeks $%01 ml venous*lood in
ED)A *ottle(% /eekly follo/ up /ith F- until ' /eeks start P-P prophyla2is at ' /eeks till H!"
statusresolved $-otrimo2a3ole 41& m#m%#day
)MP
iven once daily on 5 alternate days/eekly
P-+ ,ve P-+ ,ve
+epeat H!" P-+ at '/eeks of ae
,ve 6ve
!nfected +epeat H!" P-+ *et/een 76' months of ae
P-P prophyla2is up to 4%months $or for life if develop
P-P or lo/ -D7 for ae(A+) and follo/ up
Non !nfected
Stop -otrimo2a3ole
5 month F#U until 48 months
Ensure that the *a*y9s H!" !:status is
neative *y 48 months
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3anagementFpportunistic inection : treatmentounseling : parents and / or amily
about nutrition) hygiene) ollo, upAEV indication 6 time R 9AEV : controlling
sychosocial support
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Frist line regimen :
AZT + 3TC + NVP/ EFV
d4T + 3TC + NVP/EFV
ABC + 3TC + NVP/ EFV
2525
Antiretroviral
2 NRTI + 1 NNRTI2 NRTI + 1 NNRTI
Second line regimen :
ABC +ddl +PI !PV/r "#"$ NFV%"#"$S&V/r 'il" BB (2) *g
Pedoman Nasional Terapi Antiretroviral. Departemen Kesehatan Republik IndonesiaDirektorat Jendral Pemberantasan Penakit !enular dan Penehatan "ingkungan#$%%&
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A;) ;idovudine
5)- "#r Sa?uinavir#ritonavir
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RNARNA
ReverseReverse
transcriptasetranscriptase
ProteaseProtease
DNADNA
NucleusNucleus
Protease
inhiitorsReverse transcriptase inhiitors!
NRTI "nucleosi#es$ nucleoti#es%
NNRTI
EntryInhibitors:
Fusion, CD4, CCR5
CXCR4
Tar(e+- o HIV Tera&y
HIV
Integrase
Inhibitors
CD4! TCe%%
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3## Inter$entionpattern
PMTCT (Prevention o Mother HIV toChild Transmission)
re$ent mother / candidate rom HIV in=I HIV 6@9) pre$ent unplanningpregnancy
re$ent transmission 6 AEV) S) AEVbaby) no breasteeding 9are and support
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re$entionDeli$ery O Inant 2ursing
All equipment used during deli$ery should be cleaned O sterilised
ord blood sample collected using a syringe Oneedle
2ursery1lo$es must be ,orn#hermometer must be o indi$idual use O suctioncatheter should be o single useDisposable diapersashed o the contact ,ith body secretionAll sharp according to the ministry o healthguidelines
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ircumcision lo,er the incidence o HIV C.8 accordingto HF= 3illions o people in the ,orld could be sa$ed
rom HIV by this method=
arber O circumcision equipments must be cleaned beoreused
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3illennium De$elopment 1oals 63D19
;D NT= ;ENA;@ATAN SE>A;@AT
>A;@ATNBA 2015
DI TANDATAN
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3D1 T
TAN ,
;E;@ERANTAS =E;IS=INAN =E>APARAN;ENCAPAI PENDIDI=AN DASAR NT= SE;A
;END?R?N< =ESETARAAN ENDER
PE;@ERDABAAN PERE;PAN
;ENRN=AN ANAINNBA;ENA;IN =E@ER>AN
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%FE #H4 %IES# #I34 HIV IS E4FE#4D I2%FE #H4 %IES# #I34 HIV IS E4FE#4D I224S44U &'(5 I2 *2I#4D S#A#4S F%24S44U &'(5 I2 *2I#4D S#A#4S F%
A34EIA AS A 3S#4EIF*S DIS4AS4A34EIA AS A 3S#4EIF*S DIS4AS4
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EF"$Efaviren3(0N"P$Nevirapine(
A- $A*acavir(0 ddl$Didanosine(0 5)-$"#r$Sa?uinavir#ritonavir(0+)" r +itonavir
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3
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EA#A"EA#A GH FA# 1DI3AUA2 42D4EI#A HIVW &. *#IE FA# #DD:" 5 3AA3 AEV ;Q/hr
" 4241AHA2 ;Q/hr
" A2#I A3*E 5Q/hr" A2#IIE4#IU ;"5Q/hr
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39TERAPI METHADOE !AAT II TER!EDIA DI R! ADAM MA"I#