HIV/AIDS UPDATE ZUBAIRI DJOERBAN

Estimasi

Terlapor

Rawat Inap

Rawat Jalan

Yang mendapat ART

Prevalensi

Terima kasih Besaran Masalah

o Estimasi di akhir tahun 2009 ada 333.200 odha

o Sekarang yang terdiagnosis < 100.000 odha (,30%)

o Berarti 200.000 + odha belum terdiagnosis

o Belum terdiagnosis berarti tidak mendapat ART

o Tidak mendapat pengobatan ART (anti retro viral therapy)

akan meninggal karena AIDS

o Jadi, kewajiban kita mendiagnosis dan mengobati

INDONESIA

Pusat Layanan HIV

RSUPN Cipto Mangunkusumo

Jumlah kumulatif Pasien yg berobat di poliklinik Pokdi UPT HIV RSCM, Juni 2011

5.414 1 Doktor selesai, 4 Doktor hampir selesai 69 Dokter spesialis (IPD, Anak, Obsgin, Saraf, dll)

3 Post Doctoral

75 Publikasi Penelitian

150+ Sectio Caesaria PMTCT

Layanan HIV di Lembaga Permasyarakatan (Salemba,

Cipinang, Pondok Bambu, Tangerang )

PROFIL UNIT PELAYANAN TERPADU HIV RSCM

Layanan VCT

Layanan Obat

30

49

62 64

89 88 97

92

75

105

87 89 92

99

79

91 98

87

69 78

92

108

95

82

106

0

20

40

60

80

100

120

KUNJUNGAN PASIEN TB HIV DI POLIKLIK POKDI UPT HIV PERIODE MARET 2009 S/D MARET 2011

laki; 1218 laki; 1178

laki; 1494

laki; 1065

laki; 1350 laki; 1378

wnt, 418

Wnt, 403

wnt; 505 wnt; 461 wnt; 454 wanita, 494

0

200

400

600

800

1000

1200

1400

1600

Januari Februari Maret April Mei Juni

Pasien mendapat ARV menurut jenis kelamin Semester I, 2010

Juni juli Agustus Sept Okt Nop Des

1.228 1.115

1.208 1.150 1.131

1.209 LAKI 1,206

459 467 514 476 488 484 PEREMP 495

Odha minum ART menurut menurut jenis

kelamin Bulan Juni sd Des 2011

L P

Juni juli Agustus Sept Okt Nop Des

1.450 1.384

1.498 1.403 1.410

1.477 DEWASA 1,485

237 198 224 223 209 216 ANAK-216

ART menurut Usia

Bulan Juni sd Des 2011

DW AN

-

5.000

10.000

15.000

20.000

25.000

30.000

thn 2008 thn 2009 thn 2010 thn 2011

12.673

20.804

24.719 27.473

Kunjungan pasien di Poli UPT HIV /POKDI

JUMLAH PASIEN BERDASARKAN PEMBAYARAN TH 2011

Tunai, 80.26%

askes, 0,26%

Jamkesmas 2.36%

SKTM, 11.66%

Gakin, 5.46%

Sumber: Laporan Rutin Depkes RI, 2007

HIV cummulative number in Indonesia

2000 2004 1987 2007

HIV INFECTION IN INDONESIA INCREASE RAPIDLY

Jarum sunti narkotika

Seksual

Ibu ke bayi

Transfusi darah

Sarana Kesehatan ?

Terima kasih Penularan

SEL

Limfosit CD4

Sel Dendrit

Makrofag

Limfosit CD8

Natural Killer Cells

Virus HIV ada dimana?

JARINGAN

Kelenjar getah bening

SSP: makrofag, glia,

cairan liquor

Saluran Genito urinaria:

limfosit T dan makrofag di

semen dan epitel ginjal

Justin Stebbing et al : NEJM 350;18, 29

April 2004

BASOFIL

EOSINOFIL

BATANG

SEGMEN

LIMFOSIT: T (CD4, CD8 dll), LIMFOSIT B

MONOSIT

Terima kasih LEUKOSIT

Perjalanan Penyakit

Infeksi HIV seringkali tanpa gejala 2-7 tahun

Secara bertahap kondisi makin lemah

Kekebalan turun sesuai dg berkurangnya CD4

Mudah terserang berbagai penyakit: jamur candida,

toxoplasma, crypto, cytomegalovirus, kanker Kaposi,

tbc dll

Satu kali infeksi, infeksi seumur hidup

Tanpa ART, semua meninggal

Tanpa Gejala 2-7 tahun

Tahap lanjut:

Panas lama

Batuk Sesak

Diare

Berat badan turun

Sariawan

Kejang

Kesadaran menurun dll

Terima kasih Gejala

Primary HIV Infection

Asymptomatic

Acute retroviral syndrome

Clinical Stage 1

Asymptomatic

Persistent generalized lymphadenopathy

Clinical Stage 2

Moderate unexplained weight loss (

Clinical Stage 3

Unexplained severe weight loss (>10% of presumed or measured body weight)

Unexplained chronic diarrhea for >1 month

Unexplained persistent fever for >1 month (>37.6C, intermittent or constant)

Persistent oral candidiasis (thrush), Oral hairy leukoplakia, Pulmonary tuberculosis (current)

Severe presumed bacterial infections (e.g., pneumonia, empyema, pyomyositis, bone or joint infection, meningitis, bacteremia), Acute necrotizing ulcerative stomatitis, gingivitis, or periodontitis

Unexplained anemia (hemoglobin

Clinical Stage 4

HIV wasting syndrome, as defined by the CDC (see Table 1,

above), Pneumocystis pneumonia, Recurrent severe bacterial pneumonia, Chronic herpes simplex infection (orolabial, genital, or anorectal site for >1 month or visceral herpes at any site), Esophageal candidiasis (or candidiasis of trachea, bronchi, or lungs)

Extrapulmonary tuberculosis, Kaposi sarcoma, Cytomegalovirus infection (retinitis or infection of other organs), Central nervous system toxoplasmosis, HIV encephalopathy, Cryptococcosis, extrapulmonary (including meningitis), Disseminated nontuberculosis mycobacteria infection, Progressive multifocal leukoencephalopathy, Candida of the trachea, bronchi, or lungs, Chronic cryptosporidiosis (with diarrhea)

Clinical Stage 4 (LANJUTAN)

Chronic isosporiasis

Disseminated mycosis (e.g., histoplasmosis, coccidioidomycosis, penicilliosis)

Recurrent nontyphoidal Salmonella bacteremia

Lymphoma (cerebral or B-cell non-Hodgkin)

Invasive cervical carcinoma

Atypical disseminated leishmaniasis

Symptomatic HIV-associated nephropathy

Symptomatic HIV-associated cardiomyopathy

Reactivation of American trypanosomiasis (meningoencephalitis or myocarditis)

Terima kasih Infeksi Oportunistik

Data di RSCM Jakarta

Opportunistic Infection

Percentage (%)

Candidiasis oral 50

Pulmonary TB 37

Pneumonia 16.5

Extra pulmonary TB 13.8

Toxoplasma encephalitis 12.1

Chronic Diarrhea 11.2

Seborrheic dermatitis. 5.3

CMV retinitis 3.4

Candidiasis esophageal 3.3

Persistent Fever 3.2

Herpes zoster 3.2

EPP 1.6

Wasting syndrome 1.2

Herpes simplex 0.6

Cryptococcal Meningitis 0.4

ITP 0.2

Toxocariasis 0.1

PCP 0

Pattern of opportunistic

infections of newly

diagnosed HIV-infected

patients in Cipto

Mangunkusumo hospital

2008-2009

Karjadi TH, Yunihastuti E , Pramundita R,

Aziza S, Lie S, Imran D, et al. Presented

at 2010 PDPAI Clinical Research Meeting

Hepatitis coinfection in HIV patients

67,9

11,7 5,9

0

10

20

30

40

50

60

70

80

anti-HCV + HBsAg + anti-HCV andHBsAg +

Percentage of coinfection

Pokdicare Database, 2004-2009 N=4551 HIV patients

Missing value= 938

Age = median 28 (16-77)

Anti Retroviral therapy

Infeksi Oportunistik

Transfusi, Infus, Antibiotika, anti jamur

Pengobatan Kecanduan

Dukungan psikologik

Dukungan sosial

Terima kasih Pengobatan

Terima kasih Pencegahan

Efektifitas Upaya pencegahan penularan HIV

1. Upaya Biomedik

Anti Retro Viral: 92-96%

PMTCT: mendekati 100%

Sunat, Sirkumsisi: 65%

Gel Tenofovir Intravaginal 39%

Kondom

Pengobatan penyakit menular seksual

2. Upaya Struktural

Ekonomi, Budaya, Pendidikan, Hukum, Gender

HAM

3. Perubahan Perilaku, Positive Prevention

Segera mengobati odha dg ART/ARV

mengurangi angka penularan 92-96%

Deborah Donell dkk, Lancet 12 Juni 2010,

Heterosexual HIV-1 transmission after initiation

of ART: a prospective cohort analysis.

Odha yang minum ARV akan mengurangi penularan

ke pasangan heterokseksualnya sebanyak 92%

Treatment is Prevention.

Terima kasih Bukti Hasil Penelitian 2010

The New York Times - February 23, 2007 :

Circumcision's Anti-AIDS Effect Found Greater

Than First Thought. Donald G. Mcneil Jr.

That decision, announced on Dec. 13, 2008, made

headlines around the world and led the two largest

funds for fighting AIDS to say they would consider

paying for circumcisions in high-risk countries. But

the final data from the trials, to be published today

in the British medical journal The Lancet, suggest

that circumcision reduces a man's risk by as

much as 65 %

+ +

ART Lini Pertama

Zidovudine

Stavudine*

Tenofovir

Lamivudine/

Emtricitabine

Nevirapine

Efavirenz

* Digunakan selama 6 bulan pertama hingga keadaan umum membaik

Dengan pemantauan efek samping

Penelitian HPTN 052, 0leh pemerintah Amerika. Dimulai

2005. 1.763 pasangan, 97% hetero seksual

PenelitianAmerika, Botswana, Brazil, India, Kenya,

Malawi n di n Amerika, Botswana, Brazil, India, Kenya,

Malawi, Africa Selatan, Thailand, dan Zimbabwe.

2 Kelompok, (I) segera ARV setelah diketahui terinfeksi

HIV, kelompok (II) ARV ketika CD4 sudah turun < 250

sel/mm3

Terima kasih Bukti Hasil Penelitian Terbaru 2011

Hasil Penelitian: Hanya 1 orang yang tertular HIV

untuk pasangan odha yang segera diobati setelah

diketahui terinfeksi.

Sedangkan pd kelompok II yang mulai ARV ketika

CD4 < 250 penularan HIV terjadi pd 27 orang

ARV segera setelah diagnosis mengurangi

penularan 96%

Treatment is Prevention

Hari AIDS Sedunia 1 Desember 2011

(1) Zero new HIV infections,

(2) Zero discrimination

(3) Zero AIDS-related deaths.

Terima kasih Getting to Zero

Target 15 juta tes HIV

penduduk Afrika telah

tercapai

88% yang tes HIV telah

mendapat penjelasan

hasilnya, dan

ditemukan 2.200.000

orang yang positif HIV

(18%).

5 million people in ART, what do you have to say

about the 10 million people who are still waiting?

JULIO MONTANER (2010 Vienna: Head of International

AIDS Society and Chair of International AIDS Conference) :

I think it is a crime. It is a crime. We cannot wait. People

infected with HIV who have a medical indication to be on

treatment, they are dying because they are not being

treated.

Not only they are dying, their families are suffering. They are

also weakening our economies

People who are not treated are more likely,

dramatically more likely to transmit infection.

We have to stop this.

This is nonsense. We have to stop it. We

have got to stop it now.

Makin banyak odha di indonesia

Kemajuan pesat pengobatan, obat gratis

AIDS sudah ada obatnya

Minum ARV, mencegah kematian

Minum ARV, jarang sakit

Mengobati lebih dini lebih baik

Mengobati lebih dini mencegah penularan HIV

96%

Kesimpulan

Terima kasih