Kamis, 17 November 2011

HIV/AIDS TO CHILDREN

 HIV/AIDS TO CHILDREN

I.1         AIDS/HIV

AIDS (Acquired Immunedeficiency Syndrom) is a set of symptoms or disease that caused by decreasing the human immune system. This disease is caused by HIV (Human Immunedeficiency Virus) that includes retroviridae family. AIDS is final stage of HIV infection (Djoerban and Djauzi, 2009:2861).
The work of  Sunaryati (2011:27) indicates that AIDS is a collection of symptoms and the infection or syndrome that can  result from damage to the immune system. Then, HIV is a virus that weakens the immunity in the human body. People affected by this virus will become vulnerable to opportunistic infections or cancers susceptible.
AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is a disease caused as a result of breeding the HIV virus (Human Immunodeficiency Virus) in the human body, which attacks white blood cells (CD4 cells) that cause damage to the immune system. The loss or reduction in body resistance is easy to make the patient infected with various diseases including even mild            illness. (http://www.infopenyakit.com/2007/12/penyakit-aids.html. Accessed on October 05, 2011)
In short, AIDS is a set of symptoms or syndrome that caused by HIV virus. This virus causes the decrease in the human  immune system.

I.2          The Caused of AIDS

Acquired immunodeficiency syndrome (AIDS) was first recognized in 1981. This disease is caused by human immunodeficiency virus (HIV-1). This virus is an RNA retrovirus of the lentivirus family. HIV-2 causes a disease similar to HIV-1 but less aggressive. (Mandala, et al, 2006:199)
The  HIV virus attacks CD4 cells and makes it a breeding ground of new HIV virus, and then destroying it so it can not be used again. As we all know that white blood cells is necessary for the immune system. Without the body's immune system so when we are attacked by disease, our body is weak and does not attempt to fight outbreaks of disease and consequently we may die even if exposed to influenza or common cold.

I.3          Pathophysiology of AIDS

In the body of PLWHA (people living with HIV / AIDS), viral particles joined with the DNA cells of patients so that once someone is infected with HIV will be infected for life. Of all people infected with HIV, most entered the stage of AIDS in the first 3 years, 50% of patients progress to AIDS after 10 years. Then, after 13 years almost all infected people show symptoms of AIDS and later died. Course of the disease showed a picture of chronic diseases in accordance with the destruction of the immune system is also gradual. (Djoerban and Djauzi, 2009:2863)
When the human body exposed to the HIV virus it is not directly cause or suffer from AIDS but it requires fairly long stage. There are four stage of HIV infection, they are:
a.    Stage 1: window period
At this stage, the HIV virus enters to the body, and forms of HIV antibodies in the blood.  At this early stage, there was no special sign. Patients still looked and felt healthy. In fact, when HIV testing, HIV virus is not detected. This phase is called the window period, which usually lasts between 2 weeks-6 months.
b.    Stage II : HIV-positive (without symptom) about 5-10 years
At this stage, the HIV virus has evolved and spread in the body, and the antibodies formed stronger. However, there are still special signs, and people with HIV still look healthy and feel healthy. At this stage, when carried out laboratory tests, as the HIV virus can be detected by antibodies against this virus has been formed in the body. However, in general, patients still looks healthy and it lasted for 5-10 years, depending on stamina. Average condition to fizzle after 8 years.
c.    Stage III : HIV-positive (with symptom)
At this stage, the immune system is weakened, and the HIV virus has started spreading and getting stronger. Start looking symptoms of opportunistic infections, such as swollen lymph glands throughout the body, constant diarrhea, flu, and other diseases are easy to attack and can not be cured. In general, symptoms last for more than 1 month, depending on stamina.
d.   Stage IV : AIDS
At this stage, the immune system is very weak. This stage is a critical stage, due to various other diseases (opportunistic infections) will be more severe, and complications of other diseases is what killed the patient. (http://doktersehat.com/2010/12/13/penyebab-aids-media-penularan-dan-pengobatan/#ixzz1Mr0kJxN6. Accessed on October 2, 2011)




CHAPTER II      

 DISCUSSION


HIV / AIDS is an infectious disease that is very dangerous. Because until now have not found a drug that can kill this virus. This disease can also cause serious complications in some organs of the body and can cause death. This disease can also be transmitted easily to others, such as through blood, relationship sexual, syringes and even from mother to fetus. This causes people with AIDS also continues to increase every year.

3.1    How Is The Transmission of HIV to Children

AIDS is an infectious disease. This disease can be transmitted from mother to offspring. HIV transmission to the mother can occur as a result of unsafe sex (bisexual or homosexual), injection drug use with shared needles alternately with HIV, infected through blood and blood products, as well as the use of unsterile medical equipment.
HIV can be transmitted to infants and children through several ways, they are could be from mother to child, transmission through blood, through sexual transmission (sexual abuse in children) (WHO, 2003). HIV transmission from mother to child occurs because women who suffer from HIV / AIDS most of childbearing age (15-44 years) so that there is a risk of transmission of infections that can occur during pregnancy (in vitro). However, the prevalence of HIV transmission from mother to infant is 0.01% to 0.7%. When new mothers infected with HIV and yet there are symptoms of AIDS, infected infants by 20% to 35%. Whereas if the obvious symptoms of AIDS in the mother the possibility of transmission reached 50%.
HIV transmission to infants can also occur during the delivery process via fetomaternal transfusion or contact between skin or mucous membranes of infants with maternal blood or secretions during delivery. The longer of birth process, the greater the risk of transmission, so long labor can be prevented by surgery sectio Caesaria. Other Transmission can also occur during the postpartum period through breast milk. The risk of infants infected through breast milk from mothers positive about 10%. (Kurniawati and Nursalam, 2007:163).

3.2   What are The Complications of AIDS

According to Mandala, et al (2006:204-206) HIV is unique in terms of various organisms and malignancies that occur. Some of them have a relationship with one location, but in terms of a decrease in CD4 cells, the manifestations of disseminated more common. There are several complications that can be caused of AIDS, including:
a.         Skin and Mouth Disease
This disease commonly occurs varies from mild to indicate disseminated infection or life-threatening malignancies. The main skin problem is dermatitis, seborrheic, xeroderma, foliklitis the itch, scabies, tinea, herpes zoster, and papillomavirus infection. While oral or mucocutaneous lesions that often are oral or vaginal candidiasis, ulcers, herpes simplex, and gingivitis.
b.             Gastrointestinal Disease
HIV-related diseases often involve the gastrointestinal tract. Usually a decrease in appetite and weight loss. There are several diseases associated with gastrointestinal, they are:
1.             Esophageal disease
Usually arise with complaints pain on swallowing and dysphagia (can not swallow).
2.             Bowel Disease Smooth
The disease is usually associated with watery diarrhea a lot of volume, abdominal pain, and malabsorption.
3.             Bowel Disease
This disease usually occurs as diarrhea (often bloody) little volume is accompanied by abdominal pain.
c.              Lung Disease
In patients with HIV usually will usually develop lung disease at any given time. Lung disease that often arises is tuberculosis (Tubercullosis). The disease is caused by the Mycobacterium tubercullosis bacterium. HIV patients susceptible to these bacteria because they relate to people with immune system is weak.
d.             Neurologic
HIV directly attacks the nerve cells, resulting in personality changes, motor impairment, weakness, dysphasia, and social isolation. Enselophaty acute, because the therapeutic response, hypoxia, hypoglycemia, electrolyte imbalance, meningitis / encephalitis. With effects: headache, malaise, fever, paralise, and total / partial. In addition, syphilis meningovaskuler cornea cerebral infarction, systemic hypotension, and maranik endocarditis. In addition, HIV attacks can cause death in the brain (neuropathy).

3.3 What Are The Management and Treatment of HIV / AIDS?

HIV / AIDS has yet to be completely cured. However, data for 8 years have shown convincing evidence that treatment with a combination of several anti-HIV medicine (anti-retroviral medicine, abbreviated ARV medicine). This medicine has benefit to lower mortilitas and mordibitas early due to HIV infection. People with HIV / AIDS becomes more healthy so that it can work normally and productively. ARV benefits achieved through the restoration of the immune system by HIV and recovery of patient susceptibility to opportunistic infections.
In general, the management at the patient consists of several types,they are:
a). Treatment to suppress HIV viral replication with antiretroviral medicine (ARVs),
b). Treatment for various infectious diseases and cancer that accompanies HIV infection / AIDS, such as fungi, tuberculosis, hepatitis, toxoplasmosis, Kaposi's sarcoma, lymphoma, cervical cancer
c). Supportive treatment, foods that have a better nutritional value and other supporting treatments such as psychosocial support and the support of religion as well as adequate sleep and the need to maintain cleanliness.
 With the full treatment, mortality can be reduced, better life expectancy and incidence of opportunistic infections can be reduced. (Djorban and Djauzi, 2009: 2865)
In addition, there are several ways for the management and treatment of HIV, they are:
a.              Giving of antiretroviral (ARV)
Antiretroviral medicine given to patients with HIV / AIDS with the aim, as follow:
1.      Stopping HIV replication
2.      Restoring the immune system and reduce the occurrence of opportunistic infections
3.      Improving quality of life
4.      Lowering morbidity and mortality due to HIV infection.
(Nursalam and Kurniawati, 2007:56)
ARV consists of several categories, namely nukleoside reverse transcriptase inhibitors (NRTIs), nucleotide reverse transcriptase inhibitors (NtRTI), non-ukleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PI). Principles of ARV in children and infants is similar to adults. However, provision of antiretroviral medicine in children requires special attention on the dose. For example for the type of ARV Nevirapine was given 2 mg / kg in infants 72 hours after birth with a single dose. (http://aids.about.com/od/medicationfactsheets/a/hivmedsheets.htm.  Accessed on October 28, 2011)
b.      Giving of Nutrition in Children with HIV / AIDS
Nutrition in infants and children with HIV / AIDS is no different with a healthy child. However, protein and calorie intakes should be increased. It is also given multivitamins and antioxidants to maintain body immunity and inhibit viral replication of HIV. The best selected food allergy is low risk and well-cooked to prevent the occurrence of opportunistic infections. Vegetables and fruits should also be well washed and cooked before feeding to the child. While the infant is already infected with HIV should be breastfed exclusively for 4-6 months. Because it is proven to reduced morbidity and mortality due to infections other than HIV. However, if the baby has not proven HIV-positive, mothers should not breastfeed to their babies because can be occur vertical transmission of HIV to the baby especially if the mother's nipples is injury or inflamed. (Nursalam and Kurniawati, 2007:167-168)
c.       Giving sosial support to children with HIV/AIDS
In children who diagnosed with HIV will bring deep emotional trauma for his family. Parents should have to face severe problems in the care of children, giving affection, and so forth so that it can affect the mental growth of children. Parents need time to cope with emotional problems, shock, grief, denial, guilt, anxiety, anger, and various other problems. Thus, the child should be given support, affection, attention, and better monitoring of the parents and the surrounding environment so that children feel more comfortable and feel valued. (Nursalam and Kurniawati, 2007:167-169)

3.4   Prevention of Transmission of HIV / AIDS to children

Before prevention of HIV transmission to children, the first performed prevention of HIV transmission is to women because the child can also be through the mother. Prevention of HIV transmission in women primary performed by that included changes in sexual behavior by applying the principles of ABC, they are Abstinence (not having sex), Be Faithful (Faithful to your partner) and Condom (use a condom if doing forced sexual intercourse with a partner). Women are also advised not to use medicine remedy espedially with the use of intravenous drug needles are borne alternately, and incise the skin and the use of tools and sharp objects interchangeably with others (such as piercing, tattooing, shaving razor, etc.). Health workers need to apply the universal precautions and use of blood and blood products to Patients free of HIV.
According to the WHO (2003), plans four strategies to prevent HIV transmission from mothers to infants and children, they are:
a.              Preventing HIV-infected women
b.              If women are already infected by AIDS, it is must be prevented of pregnant.
c.               If the woman is pregnant do prevention in order do not contagious in infants and children
d.             If the mother and child has been infected by HIV, it should be given support and care.
HIV transmission from mother to baby can be prevented through four ways, starting during pregnancy, childbirth, and after birth, they are:
1.             The mother use of antiretrovirals during pregnancy
2.             The mother use of antiretrovirals during labor and newborns
3.              Obstetric handling during delivery
4.              Treatment during lactation.
Delivery method chosen by sectio caesaria since proven to reduce the risk of HIV transmission from mothers to infants up to 80%. (When accompanied by the use of selective cesarean antiretroviral therapy, the risk of transmission can be reduced until 87% (Nursalam and Kurniawati, 2007:165).

CHAPTER III   

CONCLUSIONS AND SUGGESTION


III.1    CONCLUSION

After reading and understanding the papers written above, it can be concluded that:
AIDS is a disease that is very dangerous. AIDS is a syndrome or disease caused by Human Immunodeficiency Virus (HIV) that attacks the white blood cells (CD4 cells) and cause the decline in the human immune system. When a person is infected with HIV it takes several years to get to the stage of AIDS. This disease can also be transmitted to anyone, even from mother to baby. If not properly treated and untreated, the disease can cause some complications on the organ - specific organs including the skin, mouth, gastrointestinal, pulmonary and neurology.
The management of patients with HIV / AIDS should be done well. The provision of antiretrovirals can be used to prevent viral replication and to restore the immune system. Children with AIDS should also be given more nutrition and social support. HIV/AIDS transmission from mothers to infants and children can be prevented by administering anti-HIV in the mother during pregnancy, childbirth, and after the baby is born. Gave birth to a baby through Caesaria sectio method and does not give exclusive breastfeeding in infants can also prevent transmission.

III.2    SUGGESTION

To prevent the occurrance of HIV/AIDS to children and transmission of HIV there are some way, namely:
Ø   Abstaining from sex
Ø   Being loyal to the couple and not changing partners
Ø   Not using drugs
Ø   Avoiding pregnancy if you have been infected with HIV
Ø   Keeping the child, not to contracting HIV because children are the future generation
Ø   Conducting delivery by sectio Caesaria method and does not give milk to babies.


Calles, R.R.2000. Pathophysiology of the Human Immunodeficiency Virus.
Djoerban, Zubairi and Djauzi Samsuridjal. 2009. Ilmu Penyakit Dalam. Jakarta: Interna Publishing.
Kedaulatan Rakyat, July 17, 2011.
Mandala, et al. 2006. Penyakit Infeksi. Jakarta: Erlangga.
Nursalam dan Ninuk Dian Kurniawati. 2007. Asuhan Keperawatan pada Pasien Terinfeksi HIV/AIDS. Jakarta: Salemba Medika.
Stewart G. 1997. Managing HIV. Sydney: MJA Published.
Sunaryati, Septi Sinta. 2011. 14 Penyakit Paling Sering Menyerang dan Sangat Mematikan. Jakarta:Flashbooks.

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