Lessons from Primary HIV Infection

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Lessons from Primary HIV Infection

Slide Presentation
November 8, 2006
Frederick (Rick) Hecht, MD

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Slide 1.

Lessons From Primary HIV Infection

Slide 1.

A Tale of Two Patients

Slide 2.

Donald

Slide 3.

Dick and Donald Compare Notes

Slide 4.

Dick and Donald Compare Notes

Slide 5.

Dick and Donald Compare Notes

Slide 6.

Dick and Donald Compare Notes

Slide 7.

Dick and Donald Compare Notes

Slide 8.

Dick and Donald Want to Know

Slide 9.

Symptomatic Acute HIV

Slide 10.

Options Project Analysis of Acute HIV Symptoms and Viral Load

Slide 11.

Relationship of Number of Symptoms to Initial Viral Load

Slide 12.

Univariate and Multivariate Mixed Model to Predict Set Point Viral Load

Slide 13.

Univariate and Multivariate Mixed Model to Predict Set Point Viral Load

Slide 14.

How Important Is the Viral Load Set Point in Predicting Disease Progression?

Slide 15.

MACS: Progression to AIDS by Viral RNA and CD4 after Seroconversion

Slide 16.

MACS: Progression to AIDS by Viral RNA and CD4 after Seroconversion

Slide 17.

Conclusions

Slide 18.

Why Is Donald's Viral Load Higher?

Slide 19.

HLA Matters: Risk of Progression to AIDS Based on HLA Score in MACS

Slide 20.

HLA Predicts Early Viral Load

Slide 21.

HLA Molecule Presents Antigens to T-cells

Slide 22.

HLA Molecule Binds Specific Peptides Restricted by HLA-Type

Slide 23.

CTL Escape Mutations

Slide 24.

HIV Requires Co-Receptors for Cell Entry

Slide 25.

CCR5 Receptor Genetics and Ligand Copies Predict VL

Slide 26.

Is It All about the Host?

Slide 27.

Transmission Pairs

Slide 28.

Viral Load in Source Predicts

Slide 29.

Summary of Derminants of Viral Load

Slide 30.

Is All about Viral Load?

Slide 31.

Estimated Annual CD4 Cell Count Loss in Untreated HIV-Infected Patients According to Presenting Plasma HIV RNA Level

Slide 32.

Histograms of CD4 Cell Count Change by Categories of Presenting Plasma HIV RNA Level Among All Patients in the Study Cohort

Slide 33.

Predictors of the Rate of Progression to AIDS in MACS

Slide 34.

Predictors of the Rate of Progression to AIDS in MACS

Slide 35.

Predictors of the Rate of Progression to AIDS in MACS

Slide 36.

CD4 T-cell Decline Differs according to T-cell Activation

Slide 37.

Mixed Effects Regression Assessing the Predictors of CD4 T-cell Count Over Time

Slide 38.

Summary of CD4+ T-cell Loss

Slide 39.

Should Dick and Donald be Treated?

Slide 40.

Mass General Acute HIV STI Study

Slide 41.

Mass General Cohort

Slide 42.

Remaining Questions

Slide 43.

Reconstitution of Mucosal CD4+ T cell Depletion?

Slide 44.

AIEDRP Observational Treatment Analysis

Slide 45.

Analysis

Slide 46.

Untreated VS Acute Tx VS Early Tx Viral load

Slide 47.

Viral Load Results

Slide 48.

Viral Load Results

Slide 49.

CD4+ T-cell Results

Slide 50.

CD4+ T-cell Results

Slide 51.

Conclusions

Slide 52.

Viral Load During Treatment Interruption

Slide 53.

IFNy ELISPOT Results

Slide 54.

Gag p24 and p17 Amino Acid Sequence

Slide 55.

Final Conclusion

Slide 56.