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Update on Early and Acute HIV Infection
Slide Presentation
December, 2009
Frederick M. Hecht, MD

Click on slide thumbnails to view full-size image.

Slide 1.
Update on Early and Acute HIV Infection
Slide 1.
Where do we stand in treatment of acute/early HIV?
Slide 2.
Memory CD4+ T-cell are rapidly depleted in acute SIV
Slide 3.
Treatment of acute SIV restores GALT CD4+ T-cells
Slide 4.
Restoration of Mucosal CD4+ T cell in acute HIV is not so clear
Slide 5.
AIEDRP Observational Treatment Analysis
Slide 6.
Analysis
Slide 7.
Untreated vs Acute Tx vs Early Tx Viral load
Slide 8.
CD4 T-cell count Untreated vs Acute TX vs Early Tx
Slide 9.
Lack of clear support for Acute Tx benefit from ACTG 371 Trial
Slide 10.
Risk of Death Associated with Deferral of Antiretroviral Therapy, According to CD4+ Count at Baseline, with Adjustment for HIV RNA Level, Age, and Sex
Slide 11.
What is the median time from infection to CD4 count < 350?
Slide 12.
Median time from study entry to CD4+ count < 350 cells in AIEDRP cohort: 660 days (95% C.I. 559-788)
Slide 13.
Relationship of number of Sx to initial viral load
Slide 14.
Univariate and multivariate mixed model to predict set point viral load
Slide 15.
Univariate and multivariate mixed model to predict set point viral load
Slide 16.
Treatment Conclusions
Slide 17.
HIV Prevention and Early HIV
Slide 18.
Rates of HIV Transmission by Stage of HIV, Rakai (Wawer, et al, JID, 2005)
Slide 19.
Typical Course of HIV Infection
Slide 20.
Dose of SIV needed for infection is 100-fold lower in acute infection
Slide 21.
Dose of SIV needed for infection is 100-fold lower in acute infection
Slide 22.
Acute/Early HIV and Transmission Summary
Slide 23.
Update on diagnosis
Slide 24.
HIV Superinfection
Slide 25.
HIV Superinfection
Slide 26.
Superinfection: does it matter
Slide 27.
HIV Superinfection
Slide 28.
Window Period of Superinfection Susceptibility: Genetically Distinguishable Strains of HIV-2 IV Inoculation of Pig-tailed Macaques
Slide 29.
HIV Superinfection
Slide 30.
Slide 31.
High Incidence of New Strains In Recent Seroconverters
Slide 32.
The NYC Case
Slide 33.
NYC Case: Rapid Progression
Slide 34.
Multiclass drug resistance
Slide 35.
The CT Cases
Slide 36.
Transmission Event
Slide 37.
CT01 History
Slide 38.
CT02
Slide 39.
CT02: Superinfection
Slide 40.
Is there a window of susceptibility to superinfection?
Slide 41.
Can Superinfection lead to acquisition of drug resistance?
Slide 42.
What might be preventing superinfection?
Slide 43.
Monogram Neutralization Assay
Slide 44.
Autologous Longitudinal Neutralizing Antibodies Continue to Develop for Years
Slide 45.
Neutralization of Heterologous Virus
Slide 46.
Neutralization of Heterologous Virus Develops over Time
Slide 47.
Neutralizing antibody titers to heterologous virus are lower in those acquiring superinfection
Slide 48.
Counseling messages
Slide 49.
Primary Drug Resistance
Slide 50.
Recent drop in transmitted drug resistance: UCSF Options cohort
Slide 51.
Transmitted drug resistance: UCSF Options cohort 96 - '08
Slide 52.
Transmitted Drug Resistance (TDR) Conclusions
Slide 53.
Acknowledgements
Slide 54.

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