In 2023, the cases of Human Immunodeficiency Virus (HIV) in Indonesia increased. According to data from the Ministry of Health, the transmission of cases is dominated by housewives, accounting for 35%. One of the contributing factors is the low knowledge about prevention and the effects of the disease, as well as having a partner with risky sexual behavior.

It is important to note that HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immune Deficiency Syndrome) are two different conditions. HIV is a virus that damages the immune system by infecting and destroying CD4 cells. The more CD4 cells are destroyed, the weaker the immune system becomes, making it susceptible to various diseases. Untreated HIV infection will progress to a serious condition called AIDS, which is the final stage of HIV infection and at this stage, the body's ability to fight infections is completely lost, potentially leading to death.

The incubation period, which is the time from infection to the appearance of the first symptoms in HIV-infected patients, is difficult to determine. Research suggests that the average incubation period is 5-10 years and varies widely, ranging from 6 months to more than 10 years. Even though there are no symptoms, the infected individual can still be a source of transmission. Approximately 30-50% of those infected with HIV will experience acute infection symptoms similar to mononucleosis, including fever, sore throat, cough, myalgia, night sweats, and complaints of pain when swallowing, nausea, vomiting, and diarrhea. At this stage, the patient is highly infectious even though HIV antibody tests may still be negative. The first stage is the acute infection stage, which occurs in the first few months after someone is infected with HIV. During this stage, the immune system of the infected person forms antibodies to fight the HIV virus, and this is followed by the asymptomatic chronic phase (stage two), which can last for several years, and some patients do not experience any symptoms during this stage. During this phase, there may be slow replication in certain cells and latency in others, but it is clear that HIV activity continues. If late latent stage infection is left untreated, it will progress HIV to the third stage, which is AIDS. When a patient reaches this stage, the immune system is severely damaged, making the patient more susceptible to other infections.

Regarding diagnosis, there are one or more symptoms of the disease that are indicative of AIDS, including:

• Unexplained weight loss, more than 10%

• Night sweats.

• White patches on the tongue, mouth, genitals, and anus.

• Purple spots on the skin that do not disappear.

• Fever lasting more than 1 month (continuous or intermittent)

• Chronic diarrhea for more than 1 month.

• Nervous system disorders, such as difficulty concentrating or memory loss.

• Fungal infections in the mouth, throat, or vagina.

• Easy bruising or bleeding for no reason.

• Irritability and depression.

• Rash or spots on the skin.

• Shortness of breath.

• Consistent weakness.

• Cough for more than 1 month

• Generalized lymphadenopathy

• Oropharyngeal candidiasis

• Recurrent herpes zoster

and laboratory tests (HIV testing) as evidence of HIV infection.

HIV transmission is known to occur through:

• From an HIV-infected mother to her baby during pregnancy, childbirth, or breastfeeding.
• Sexual intercourse with a person infected with HIV.
• Blood transfusion or other blood products (contaminated with HIV virus).
• Sharing needles contaminated with HIV, such as syringes, piercing tools, tattoo equipment.

However, HIV is not transmitted through:

• Living with a person infected with HIV.
• Physical contact, hugging, and shaking hands with a person infected with HIV.
• Sharing eating and drinking utensils, clothing, and toilets with a person infected with HIV.
• Saliva.
• Mosquito/Insect bites.
• Swimming with a person infected with HIV.

HIV transmission prevention can be done through ABCDE:

• A: Abstinence – Abstaining from sex or refraining from risky sexual intercourse, especially for those who are not yet married.

• B: Be faithful – Being faithful to one's partner.

• C: Condom – Preventing HIV transmission through sexual intercourse by using condoms.

• D: No Drugs – Avoiding drug use and refraining from sharing non-sterile needles.

• E: Education – Providing accurate education and information about HIV, including at local healthcare facilities.

Sources:

• Parwati T, Bakta M, Purwadi N, Suta negara D. AIDS case report. Indonesian Medical Journal 1988.

• Arjatmo Tjokronegoro, Hendra Utama. Internal Medicine Textbook Third Edition, FKUI, Jakarta, 1996.

Author: Lely Nurhayati, MD (Medical Laboratory Service Doctor at PRAMITA Clinic, Surabaya Mulyosari branch)