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Spach/HIV/Acute HIV/PP

HIV: Acute (Primary) Infection David H. Spach, MD Medical Director, Northwest AIDS Education and Training Center Associate Professor of Medicine,Division of Infectious Diseases University of Washington, Seattle. Spach/HIV/Acute HIV/PP. Acute (Primary) HIV. Spach/HIV/Acute HIV/PP.

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Spach/HIV/Acute HIV/PP

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  1. HIV: Acute (Primary) InfectionDavid H. Spach, MDMedical Director, Northwest AIDS Education and Training CenterAssociate Professor of Medicine,Division of Infectious DiseasesUniversity of Washington, Seattle Spach/HIV/Acute HIV/PP

  2. Acute (Primary) HIV Spach/HIV/Acute HIV/PP

  3. Spach/HIV/Acute HIV/PP

  4. Case History • A 27-year-old man presents with a 48 hour history of fever, lymphadenopathy, severe fatigue, and rash. He had high risk sexual activity with 2 other men 7 days ago. He has no known prior medical problems. Spach/HIV/Acute HIV/PP

  5. Acute (Primary) HIV HIV Antibodies HIV RNA Acute HIV “Set Point” 3 months 6 months Spach/HIV/Acute HIV/PP

  6. Acute HIVEarly Events in Transmucosal Infection From: Kahn J, Walker BD.N Engl J Med 1998;339:33-9. Spach/HIV/Acute HIV/PP

  7. Case History: Question • A diagnosis of acute (primary) HIV is suspected. Which of the following best supports this diagnosis? 1) A negative HIV antibody test and HIV RNA 1,0002) A negative HIV antibody test and HIV RNA 200,000 3) A positive HIV antibody test and HIV RNA of 2,0004) A positive HIV antibody test and HIV RNA of 50,000 Spach/HIV/Acute HIV/PP

  8. HIV: Manifestations of Primary Infection From: Vanhems P. AIDS 2000;14:375. Spach/HIV/Acute HIV/PP

  9. Acute (Primary) HIV HIV Antibodies HIV RNA “Set Point” 3 months 6 months Spach/HIV/Acute HIV/PP

  10. Plasma HIV RNA Levels Acute HIV “Set Point” 6 months Spach/HIV/Acute HIV/PP

  11. HIV Infection: Natural History Acute HIV Infection Year 1 Spach/HIV/Acute HIV/PP

  12. Risk of Progression to AIDS: HIV RNA & CD4 HIV RNA Level (bDNA) From: Mellors J et al. Science 1996;272:1167-70. Spach/HIV/Acute HIV/PP

  13. Immune Response to Acute HIV Infection Acute HIV Weak CTL Rapid Progression Moderate CTL Moderate Progression Strong CTL Slow Progression 6 months From: Walker BD. Nature 2000;407:313-4. Spach/HIV/Acute HIV/PP

  14. HIV Primary Infection Isolates N = 108 PatientsNewly HIV-Infected Phenotypic Data: 10-fold Resistance From: Little SJ. JAMA 1999;282:1142-9. Little SJ. 8th Conf Retrovirus. Abstract 756 Spach/HIV/Acute HIV/PP

  15. HIV Primary Infection Isolates N = 141 Patients Phenotypic Data From: Little SJ. JAMA 1999;282:1142-9. Spach/HIV/Acute HIV/PP

  16. HIV Primary Infection Isolates N = 80 Patients Genotypic Data From: Boden D. JAMA 1999;282:1135-1141. Spach/HIV/Acute HIV/PP

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