Definition of HIV/AIDS
AIDS is severing disease signed by cellular
immunity damage that is caused by retrovirus (HIV) or fatal disease where the patient
needs intensive care during the disease process. According to Mansjoer, AIDS
(Acquired Immunodeficiency Syndrome) is a group of symptoms that is caused by
immune deficiency progressively and the main cause of this disease is HIV
(Human Immunodeficiency Virus).
HIV infection progressively destroy white blood cells, it will make immune system is collapse. This circumstance will lead to opportunistic infection and certain cancer (especially in adults). HIV in children usually are usually caused by mother transmission through placenta. It may from breast milk infect the baby.
Etiology
The main cause
of AIDS is HIV, this is a virus that is from retrovirus group, this virus
usually attacks human immune system. This disease can be transmitted through
sexual transmission, blood contamination, and perinatal transmission. Risk
factors for HIV infection to children and babies are bisexual parents,
unhealthy sexual behavior, intravenous drug abuse, blood transfusions.
HIV Transmissions from Mother to Baby
The HIV
transmission from mother to baby can be many ways:
Antepartum (during pregnancy)
Mother with
positive HIV will transmit that virus to the baby. This transmission usually
called vertical transmission. This transmission can be through placenta
(intra-uterine) where the baby exposed with mother blood.
Intra-partum (during delivery)
The baby can be
infected by HIV through blood and vaginal mucosa, this infected mucosa can be
infected the baby through lung tract or digestive system that may be swallowed
by the baby.
Mother body fluid exposure
Infected mother
can be found viruses in vagina fluid about 21%, and it can be sucked by the
baby. The birth passage is influenced by HIV level in vagina fluid, birth way,
cervix ulcer or vagina ulcer, wound in vagina wall, amnion infection, premature
childbirth, electrode use for the fetus, vacuum or forceps, episiotomy, and CD4
level. Fetal membrane rupture for 4 hours before delivery will increase the
antepartum transmission.
Breast Milk Transmission
Post-delivery transmission
usually occurs through breast milk. Breast milk content is HIV in massive
number. Other factors that can contribute HIV infection are from breast
infection or breast wound, baby mouth ulcer, premature, and baby immune system.
So, the breast milk transmission is the most risky transmission from mother to
the baby.
Pathophysiology
In detail, HIV
infect lymphocyte with CD4 antigen, which this antigen works as a vital receptor.
This subset lymphocyte –lymphocyte helper that maintains immune responds- is
like an alarm that will give an alert to other immune cells to fight the HIV.
HIV infection mechanism causes CD4 cells decrease. This CD4 is a vital respond
for immune system, and this mechanism is unknown in detail, it may be direct
CD4 infection, apoptosis induction through viral antigen, cells destruction,
and lymphocyte precursor dysfunction in lymph. HIV can infect other cells,
those are monocyte, monocyte infection is different with CD4 infection, and
this infection cannot be cells death. Infected monocyte can fight as latten
virus reservoir but it cannot be inducted. It also can bring viruses to organs,
especially brain. Hybrid experiment shows virus nucleates acid in bowel cells,
glomerular epithelium, and arthralgia. In fetus tissue, the most consistent
viruses are in the brain, liver, and lung. Pathology of HIV involve many
organs, although this is so hard to determine whether damage is caused by local
virus infection, other infection, or autoimmune.
HIV infection
usually has no sign and symptoms, although “incubation period” or interval before
infection of HIV. Generally, the infection in perinatal is much more slower
than adult HIV infection. During this phase, immune regulation disturbance
usually appear, especially B cells function; hypergamaglobulinemia with
nonfunctional antibody production is more common in children than adult with
HIV infection. Inability in responding toward antigen with immunoglobulin
influence the baby without antigen exposure before, so the protection for bacterial
infection will be low. Lymphocyte CD4 depletion is next result and perhaps it
has no relation with symptomatic status.
Babies and
children with HIV infection usually have normal lymphocyte level, and 15%
pediatric AIDS patient maybe has a normal CD4 and CD8 lymphocyte. The risk of encephalopathy
in children is increase based on HIV infection.
Sign and Symptoms
HIV infection
sign and symptoms in children is varieties, it may asymptomatic to sever
disease called AIDS. AIDS in children is about more than 80% from vertical
transmission. 50% AIDS in children is under one year old and 82% is under 3
years old. There is HIV infection in baby that is caused by vertical
transmission, in this condition the baby maybe does not have AIDS sign and
symptoms until 10 years old.
Sign and
symptoms usually appear because of microorganism infection in children
environment. So, this sign and symptoms is not specific. The sign and symptoms
that may appear are growth disturbance, low body weight, anemia, fever, lymphadenopathy,
and hepatosplenomegaly.
The symptoms
that has relation with HIV infection are opportunistic infection; germ, parasites,
fungi, or protozoa. Because of immunodeficiency condition in children,
especially cellular immunity, so the children will be easy to get sick if they
are exposed to those microorganisms in long period, and tend to recurrently.
Those diseases are mouth ulcer that can spread to esophagus, lung inflammation
caused by pneumocystis carinii, lung inflammation caused by atipic mycobacterium,
or brain toxoplasmosis. If the children are attacked by mycobacterium
tuberculosis, this disease will lead to lung and brain damage. Not only those
symptoms, but also recurrent diarrhea.
Other sign and
symptoms are pneumonia interstitial lymphocytic, it is lung disturbance with
clinical manifestation; hypoxia, hard to breath, clubbing finger, and lymphadenopathy.
In radiology manifestation may appear bilateral reticulonoduler infiltrate,
sometime with adenopathy in hilus and mediastinum.
The most
dangerous clinical manifestation is chronic encephalopathy that lead to growth
and development delay (intellectual and motoric ability), so it will be mental
retardation. Encephalopathy can be a primer manifestation of HIV infection. The
brain becomes atrophy with ventricle enlargement and calcification. HIV antigen
can be found in central nervous system or cerebrospinal fluid.
Diagnosis Test
HIV diagnosis
test are Elisa. Latex agglutination and western blot. ELISA test and latex
agglutination is to identify HIV infection, to rise this HIV infection must do western
blot. Other tests are with HIV antigen, antigen P24 test (polymerase chain
reaction) or PCR. If the test is in the skin, so antibody detection can be done
(usually for baby with HIV positive mother)
In brief,
diagnosis test for HIV are:
1.
HIV infection diagnosis: ELISA, western blot,
P24 antigen test, HIV culture
2.
Immune system detection: LED, CD4 lymphocyte,
CD4and CD8 ratio, macroglobulin B2 serum, immunoglobulin level.
Diagnosis
Early HIV
infection diagnosis is wanted, but early detection for risky baby is much more
important. If the pregnant mother is identified, so the opportunity to prevent
and cure with antiviral is better. Otherwise, HIV test and counseling must be
routine activity to care pregnancy.
1.
Breast Feeding Consumption
If the babies
that exposed with HIV infection from breast feeding, they will have high risk
for HIV infection during breast feeding. Even virology test show negative result
for HIV infection, HIV infection still can occur. Virology test is recommended
to do after the babies have no more breast feeding for 6 weeks. If the babies
age are 9 to 18 month during breast feeding termination, antibody test can be
done before virology test, because antibody test is much more chepper. If the
antibody test is positive, then virology test must be done to make it sure,
although the babies’ antibody production is unknown.
2. Babies with HIV infection
clinical manifestation
If virology
test cannot be done, the babies under 12 month old that exposed HIV and showed
HIV clinical manifestation must do virology test. Positive result in every
stadium is 100% positive HIV.
3. Asymptomatic HIV Exposure
12 years old
babies usually have no maternal antibody. Positive antibody test is indicated
positive HIV infection (94.5% cerorevertion in 12 months of age; 96% specific)
and it must retest in 18 months old.
4. Babies Under 18 month old
Laboratory definitive
diagnosis in babies under 18 months old can only ensure with virology test. Positive
result defines HIV infection. If virology access is limited, WHO (World Health
Organization) suggest to do virology in 6 to 8 weeks where the babies infected
in uterus or intra partum.
Virology test
which is done in 48 hours can identify the baby in uterus, but the sensitivity
is 48%. If this test is done 4 weeks, so the sensitivity will rise 98%.
Positive side
of virology test in every age is clear HIV infection. Even though, it need to
retest for other different blood sample. Babies with positive virology test
must check the anti HIV antibody in over 18 months old.
5. Over 18 months
old Babies
Definitive diagnosis for HIV infection can use adult antibody test. Positive
result must follow national standard algorithm.
Complication
1. Mouth Ulcer
Mouth ulcer may caused by candida, herpes simplex, sarcoma kaposi , oral
HPV, gingivitis, periodontitis Human Immunodeficiency Virus (HIV), oral leucoplaque,
nutrition, loss of body weight, fatigue, and deformity. Oral candida is
signed by with white plaque in the mouth membrane. If this mouth ulcer does not
treat well, oral candida will continue to esophagus and stomach ulcer. The mouth
ulcers sign and symptoms are pain in swallowing, and sternum pain (retrosternal
pain).
2.
Neurology
a.
HIV encephalopathy or it called AIDS complex
(AIDS dementia complex), the sign and symptoms of this complication are headache,
memory lost, hard to concentration, progressive confusion, psychomotor delay, apathies,
and ataxia. Next stadium are global cognitive disturbance, verbal respond
delay, affect disturbances, spastic paraphrases hyper flexi, hallucinations,
tremor, incotenencia, and death.
b. Meningitis Cryptococcus
is signed by fever, headache, malaise, neck rigidness, nausea and vomit, mental
status changes, and seizure. The diagnosis for this complication is
cerebrospinal fluid check.
3. Gastrointestinal
a. Wasting syndrome, the
diagnosis criteria are body weight is loss about 10%, chronic diarrhea more
than 30 days, chronic fatigue, and unexplainable fever.
b. Diarrhea is caused by
bacteria and virus, fast normal flora grow, lymphoma, and sarcoma Kaposi, this
sign and symptoms are loss body weight, anorexia, fever, malabsorption, and
dehydration.
c. Hepatitis is caused by
bacteria, virus, lymphoma, sarcoma Kaposi, illegal drugs, alcoholic. The sign
and symptoms are anorexia, nausea and vomit, abdomen pain, icteric, and arthritis
fever. To know complete information about hepatitis, you may click here.
d. Anorectal disease is
caused by abscess and fistula, perianal ulcers and inflammation with inflammation
sign such as pain in rectum, irritation, and diarrhea.
4. Respiration
Pneumocystis carinii with shallow respiration (dyspnea), cough, chest pain,
hypoxia, fatigue, and fever from opportunistic infection that may caused by
mycobacterium intracellular (MAI), cytomegalovirus, influenza virus,
pneumococcus, and strongyloides.
5. Dermatology
Skin lesion, herpes virus (simplex and zoster), dermatitis xerosis,
muscle reaction, scabies lesion, and decubitus with pain, irritation, burn,
secondary infection and sepsis signs and symptoms. Opportunistic infection such
as herpes zoster and herpes simplex will be signed by vesicle and broken skin
integrity. Mollusca contangiousum is virus infection that is signed by plaque
form with deformity. Dermatitis sosreica have diffuse lesion, skin integrity
break in AIDS patient’s face.
6. Sensory
Acute external otitis or internal otitis, loss of hearing related to
myelopathy, meningitis, cytomegalovirus and drugs reaction.
Treatment
Caring
Children nursing care are maintain enough nutrition, healthy lifestyle can
prevent the infection, care the opportunistic infection or other infections
include tumor or cancer. Limit the HIV replication with antivirus drugs such as
dideosinuxleotid (azidomitidin (AZT) that can limit RT enzyme by DNA virus
integration, psychosocial need to pay attention, have a consultation with HIV
transmission.
Medical Treatment
Medical treatment include
prophylaxis drugs prescription to prevent opportunistic infection with high
level of morbidity and mortality. Wide researches had been done and show
that cotrimosaxole prescription is
recommended to HIV patient under 1 years old or patients with CD4 level is under
15%, so that pneumonia infection caused by pneumocystis jiroveci can be
prevented. Isoniazid prescription (INH) is as TBC prophylaxis, but INH for TBC prevention is
still in controversial, it can
prevent TBC with right diagnosis method. But in another case, such as in TBC endemic,
TBC is a natural disease. Right diagnosis need to do to
determine whether need medication or not.
Another prophylaxis drug is
nystatin preparat as anticandida, pirimetamin for toxoplasma, sulfate preparat
for malaria, and other drug that must be prescribed for patient’s clinical
condition.
The important treatment
for HIV infection is ARV or antiretroviral. A research about ARV drug is very
fast, although there is no ability to eradicate virus in DNA provirus in CD4
memory dormant stadium. HIV and AIDS treatment use 3 antiviruses, with virus
molecular where no human homolog. The first drug had been found in 1990 is
Azido thymidine (AZT) , AZT is deoxytimidine nucleoside analog that work in
reverse transcriptase blockage. If this drug used alone, it can decrease HIV RNA
plasm for many months or years. HIV disease is not influenced by AZT
prescription because in long period HIV virus will evolve and form drugs
resistance mutant.
Prevention
HIV from mother to baby can be prevented:
During pregnancy
Antiretroviral drugs
during pregnancy for low vital load so that viruses in the blood and body fluid
is not effective to transmit to the fetus.
During Childbirth
Antivirus prescription
(Nevirapine) during childbirth and it is better if the childbirth with suctio
caesaria because it can prevent risk of HIV transmission 80%.
After Childbirth
Complete information about
HIV transmission through breast feeding need to inform.
No comments:
Post a Comment