Patient ask to Mbah Dukun: “Mbah! I have heard many people talk about AIDS, what is it?”
Mbah Dukun Bagong answers:
Acquired Immune Deficiency Syndrome (AIDS) is a collection of symptoms of disease or abbreviation for acquired imune deficiency syndrome caused by Human Immunodeficiency Virus (HIV).
HIV virus can be found in body fluids, especially in blood, semen, vaginal fluids, breast milk. The virus destroys the human immune system and may decrease or loss endurance, so easily affected by infectious diseases.
SYMPTOMS
Patient ask to Mbah Dukun: “May i know it’s Symptoms?”
Mbah Dukun Bagong answers:
A person who has been infected with HIV is likely to pas through three stages of the disease. Not all individuals experience all of the stages.
1. Acute Retroviral Syndrome
Acute retroviral syndrome is a term used describe a group of symtoms that can resemble mononucleosis. Mononucleosis is like a flu-like infection, include fever, fatigue, muscle aches, loss of appetite, upset stomach, weight loss, skin rash, headache, and swollen lymp nodes. These symptoms occur in 50 to 70 % of all men who are HIV positive and in 45 to 90% of all women with the infection. The symptoms develop between one and six weeks after infection and last for two three weeks.
2. Latency Period
After entering a person’s lymph nodes, the virus becomes latent, latency meansthat the virus is still present in the body, but that there are no signs of infection. Therefore, a person may appear to be perfectly healthy even though blood tests show that the virus is present.
HIV infection has an unusually long latency period. It may for 10 years or more. During this period, the virus contnous to reproduce itself in the lymph nodes. As a result, certain abnormal conditions and symptoms may develop. These include the following:
• Persistent Generilzed Lymphadenopathy (PGL). As HIV continues to reroduce, it can cause swelling of the lymph nodus known as persistent generalized lymphadenopathy. Yhe nodus become larger, but are usually not sore or painful. The lymp nodus most comonly affected are those in the neck, jow, groin, and armpits. PGL affects between 50 to 70 % of all patients during latency.
• Constitutional symptoms. Many patients will develop low-grade fevers, fatigue, and general weakness. The virus may also cause a loss of appetite, a decerase in the body’s ability to absorb food, and an increased rate of metabolism, the process by which the body converts food to energy. These changes result in condition called wasting in which a person contunally loses weight and energy.
• Other Symptoms. At any time during the course of HIV infection, the virus may cause problems with organs and tissues throughout the body. A common problem is a yeast infection in the mouth known as thrusd. Ulcers and open sores can also develop in the mouth. The virus can also damage the digestive system. Patients may develop diarrhea or malnutrition as a result. The virus can also destroy cells in the lungs, kidneys, and nervous system. Damage to the nervous system leads to a general loss of strength, loss of reflexes, and feeling of numness or burning sesations in the feet or lower legs.
3. Late-stage AIDS
Late – Stage AIDS is the periode of HIV infection when the virus has become very active and has started to cause massive damage to the immune system. One sign of late-stage AIDS is a sharp decrease in the number of white blood cells known as CD4 lymphocytes. The patient also begins to have more frequent and more serious medical problems, such as infectious disease and cancers. The infections that occur are called opportunistic infections. That term means that foreign bodeis, such as bacteria, have taken advantage of the bodies weakened immune systems.
CD4 celll counts are an important indication of the course of the HIV infection. Doctors use these counts to determine how far the disease has developed and what treatments to use. About 10 percent of those individuals infected with HIV never reach this final stage of disease
AIDS Dementia complex usually occurs late in the progress of AIDS. It is marked by loss of reasoning ability, loss of memory, inability to concentrate, listlessness, and unsteadiness in walking. There are no treatments for this condition.
Patients in late-stage AIDS may develop inflammation of the muscles, especially in the hip area. They may experience pain in their joints similiar to those tha occur with arthritis. Thrush and ulcers in the mouth continue to occur during the late stages of AIDS. Another common condition of this stage is hairy leukoplakia of the tongue. Hairy leukoplakia is characterized by a white area on the tongue that may be flat or slightly raised.
Patients with late-stage AIDS may develop a form of cancer known as Kaposi’s sarcoma (KS). KS is a form of skin cancer characterized by reddish-purple blotches or patches. The disease may also occur in the digestive tract or lungs. KS is one of the most common causes of death in AIDS patients.
An adult (> 12 years) are considered AIDS when the HIV test shows positive by checking the appropriate strategy to get at least two major symptoms associated with a minor symptoms, and symptoms are not caused by other conditions unrelated to HIV infection:
Major symptoms:
1. Body weight decreased by more than 10% in one month
2. Chronic diarrhea lasting more than 1 month
3. Prolonged fever for more than a month
4. Impairment of consciousness and neurological disorders
5. Dementia / HIV encelopathy
Minor symptoms:
1. Cough settled more than 1 month
2. Generalized dermatitis
3. The existence of multisegmental herpes zooster and recurrent herpes zooster
4. Oropharyngeal candidiasis
5. Herpes simplex chronic progressive
6. Generalized lymphadenopathy
7. Recurring fungal infection in a woman's genitals
8. Cytomegalovirus retinitis
If not available HIV testing facilities so, if there is one of the signs / symptoms below, are reported as AIDS cases, although without laboratory examination:
1. Kaposi's sarcoma
2. Life-threatening pneumonia and recurrent
PATOPHYSIOLOGY
Patient ask to Mbah Dukun : "Mbah! Would you tell me how can HIV make AIDS?
Mbah Dukun Bagong answers :
HIV infection begins with viral attachment to cells that have CD4 molecules as the main receptor of T lymphocytes, monocytes, macrophages and other dendritic cells. Gp120 which is a surface receptor the virus will bind to CD4. then interact with gp120 will koreseptor embedded in cell membranes and exposed to the peptide of Gp41 and start going fusion between viral and cell membranes. After fusion, the internal virion core is released into the cytoplasm as a complex ribonucleoprotein. Have HIV reverse transcriptase enzyme that will convert viral RNA into DNA. This DNA will enter the host cell nucleus to mRNA to subsequently entered into a translation with structural proteins to form protein, mRNA will produce all viral proteins. Genomic RNA and viral proteins will form the virus particle, which will be attached to the outside of the cell. Through the process of budding at the cell surface, virions would be issued in a state of host cells mature.
Soon after HIV infection, virus-free or partially located within the CD4 T cells that are infected will reach the regional lymph glands and stimulates cellular and humoral immunity among other ways to recruit lymphocytes-lymphocytes. But this collection of lymphocyte-lymphocyte exactly cause CD4 + T cells will be more and more infected. Monocytes and lymphocytes are infected with the virus will spread throughout the body, HIV can also enter the brain via infected monocytes or through endothelial cells.
A few days after HIV infection will occur limfopenia due to a decrease in blood CD4 T. During this initial period of free virus and viral protein p24 can be detected in high levels in the blood and the number of HIV-infected CD4 + T cells increased. In this phase the virus replicates rapidly with little control of the immune response. Then after 2-4 weeks will be a dramatic increase in the total number of lymphocytes caused by the increase in the number of CD8 T cells (cytotoxic cells), which is part of an immune response against viruses. The existence of cytotoxic T cells is a sign of neutralizing antibody stimulation. Antibodies will be formed after the second or third week but sometimes up to several months. Decline in free virus and infected T-cell lysis caused by HIV-infected cells by CD8 T Activated CD8 cells in HIV-infected individuals also produce several soluble cytokines that can inhibit viral replication in CD4 T cells without causing cell lysis. After that the CD4 count will be returned to original levels prior to HIV infection. During the acute phase showed the majority of cases of acute viral symptoms in general, which include fever, lethargy, myalgia, and headache, and symptoms such as pharyngitis, lymphadenopathy and rash.
After the acute phase of infection, a state of asymptomatic for several years despite declining CD4 slowly. Amount of virus in blood and peripheral cells can be detected is low. The decrease in blood CD4 count average of 65 cells / ml every year. Showed damage to the immune system but not latent and can still be improved, especially in limphonodules. Decrease in the number of CD4 T cells during HIV infection may directly affect some reactions immunologic played by CD4 T cells as hypersensitivity slow type, lymphocyte transformation of young cells, and cytotoxic T lymphocyte cell activity. The emergence of HIV strains are more pathogenic and replicate faster on the host was a major factor in controlling the ability of the immune system. It also said that the number and function of cytotoxic T cells will decrease if the number of CD4 cells drops to <200/ml. Because these cells play a role in controlling virus-infected cells and clean the virus at an early stage so that the proposed loss of cell activity is having an impact in increasing the number of viruses. Another possibility is because there is no mutation of the viruses that are not recognized by cytotoxic T cells. The average time from HIV infection to AIDS is 8-10 years.
Patient ask to Mbah Dukun : "Can HIV transmitted?and how?
Mbah Dukun Bagong answers :
Yes it can transmitted so everybody can infected. HIV spread by mucosal secret, breast feeding, sperm or blood. So it can transmitted by sexual contact, pregnancy and breast feeding, transfusion, accident needle among health care. Remember! Saliva isn't media to spread HIV because it needs 1 gallon saliva to transmit HIV. so don't worry to kiss your partner.
TREATMENT
Patient ask to Mbah Dukun : "Can Patient with AIDS be cured?
Mbah Dukun Bagong answers :
The main approach is to improve the provision of antiretroviral immunity. Current ARV regimens recommended by WHO is a combination of three antiretroviral drugs. There are several regimens that are used, with the advantages and disadvantages of each. First-line drug combinations commonly used in Indonesia is a combination Zidovudin (ZDZ), Lamivudin (3TC), with Nevirapin (NVP). Three classes of antiretroviral drugs (ARVs) are as follows:
A. Reverse transcriprase nucleoside inhibitors (NRTIs)
NRTI class of zidovudine (AZT), didanosine (DDL), zalcitabine (ddC), stavudin (d4T), lamivudine (3TC), abacavir (ABC), tenofavir (TDF) and emtricitabine (FTC). NRTIs work by phosphorylation interseluler to form and join triphosphate inhibits further DNA chain elongation of RNA viruses. Each specific drug similar to nucleosides. CNS penetration in both NRTI and zidovudine in AIDS dementia looks useful. This class of drugs primarily eliminated through the kidneys and does not interact with other drugs through the cytochrome P-450.
B. Non-nucleoside reverse Trancriptase inhibitors (NNRTIs)
NNRTI class of nevirapine (NVP), delaviridine (DLV) and efavirenz (EFV). NNRTIs inhibit the enzyme reverse transcriptase through a bond with the enzyme activity. Drugs do not require intracellular activation and was not active against HIV-2. This drug may inhibit or induce cytochrome P-450 activity in the liver that interact with other drugs through the cytochrome P-450. These drugs require attention when combined with other antiretrovirals.
C. Protease Inhibitor (PI)
PI Group of saquinavir (SQV), indinavir (IDV), ritonavir (RTV), nelvinafir (NFV), amprenavir (APV), lopinafir / Kaletra (LPV / r) and atazanafir (ATV). This drug works to prevent the release of post-translational polypeptides into functional viral proteins. This medicine is given in combination 2NRTI can control viral replication in tissue and plasma as well as improve the immune system. PIs inhibit the cytochrome P-450, increases the potential for many drug interactions. Some drugs that interact with the protease inhibitor ritonavir is especially rifampin, midazolam, simvastatin, and certain antihistamines.
D.Stimulation of Blood Cell Production
Many AIDS patients have very low levels of white and red blood cells. People with low red blood cell counts often suffer from anemia a condition that causes weakness, exhaustion, and generally poor health. People with low white blood cell counts are unable to fight off infections. To protect AIDS patients against these conditions, drugs may be given to stimulate the production of both red and white blood cells.
E. Alternative Treatment
For many years, doctors were able to offer AIDS patients little assistance in treating their disease. As a result, patients became very interested in alternative forms of treatment. Among those treatments were a variety of Chinese and Western herbal medicines and specialized diets designed to strengthen the immune system. Patients also tried nonphysical methods, such as visualization. In visualization, a person tries to imagine what a virus looks like and what kind of battle is going on in his or her body. By this method, the person believes that he or she may have some control over that battle.
Patients have tried a variety of pain control techniques as well. These have included hydrotherapy (the use of water baths and treatments), acupuncture (a Chinese therapy technique where fine needles puncture the body), meditation, and chiropractic (therapy that involves manipulation of the spine).
F. Very Important
You have treatment all diseases in Patient HIV with AIDS example : Chronic Diarrhoea, Candidasis, Tuberculosis and other chronic diseases. They cause bad condition of patient
ADVICE FROM MBAH DUKUN
Don't ignore Patient with AIDS. Don't be afraid with them. Don't be afraid to infected HIV. They should be afraid about you. They are afraid if you infect them. If they infected disease from you, their life will be threatened. Because, their immune is so weak
References
1. http://www.faqs.org/health/Sick-V1/AIDS-Treatment.html
