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The AIDS Epidemic at Year 30: Is There an End in Sight?
Slide 1.
The AIDS Epidemic at Year 30: Is There an End in Sight?
Slide 1.
Objectives
Slide 2.
Bottom Line
Slide 3.
The History We Must Recall
Slide 4.
The First Reported Cases
Slide 5.
Bay Area Infectious Disease Specialists (1980-81)
Slide 6.
San Francisco General Hospital
Slide 7.
Dying and Death - Everywhere
Slide 8.
Dying and Death - Everywhere
Slide 9.
The Fear Factor
Slide 10.
1993: 10,000 and Counting
Slide 11.
The San Francisco Response
Slide 12.
Molly Cooke
Slide 13.
Julie Gerberding
Slide 14.
John Luce
Slide 15.
Bill Schecter
Slide 16.
Establishment of Infection Control Guidelines
Slide 17.
The Response: Patient Care
Slide 18.
The Response: Patient Care
Slide 19.
The Response: Patient Care
Slide 20.
The Response: Diagnosis and Treatment
Slide 21.
Prevention
Slide 22.
Recognition and prevention of mother-to-child transmission
Slide 	23.
Recognition and prevention of mother-to-child transmission
Slide 24.
Recognition and prevention of mother-to-child transmission
Slide 25.
The Original Discoveries of HIV
Slide 26.
The Formation of Research Networks to Promote "Translational Science"
Slide 27.
Construction of an AIDS Research Facility
Slide 28.
The Impact - Citywide
Slide 29.
The Pill Burden (1996) AZT/3TC/Indinavir
Slide 30.
The Pill Burden (2006) Atripla (sustiva, emtricitabine, tenofovir)
Slide 31.
Dramatically Improved Life Expectancy in Early HAART Era
Slide 32.
HAART Era Extended Life Expectency Even Further
Slide 33.
Antiretroviral Medications (2011)
Slide 34.
Expanding the Pipeline to the World: The US President's Emergency Plan for AIDS Relief (PEPFAR)
Slide 35.
The AIDS Epidemic: Latest Estimates
Slide 36.
The AIDS Epidemic
Slide 37.
The Number of People Living with HIV Is Increasing
Slide 38.
The Number of People Dying of AIDS Is Decreasing
Slide 39.
Adults and Children Estimated to Be Living with HIV
Slide 40.
Adults and Children Newly Infected with HIV
Slide 41.
Adults and Children Dying from HIV/AIDS
Slide 42.
Exploding Foci Around the World...
Slide 43.
...with an Ever-Increasing Proportion of Women Living with HIV
Slide 44.
The AIDS Epidemic at Year 30
Slide 45.
How Do We Make the Epidemic Go Away?
Slide 46.
How Do We Make the Epidemic Go Away?
Slide 47.
Strategies
Slide 48.
Condom Use and HIV Prevalence Among Sex Workers in Cambodia
Slide 49.
Multiple Sexual Partners in the Past Year, Uganda
Slide 50.
How Do We Make the Epidemic Go Away?
Slide 51.
Antiretroviral Drugs
Slide 52.
Promise of Pre-Exposure Treatment:
Slide 53.
Promise of Treatment after Infection:
Slide 54.
Antiretroviral Therapy and TB Incidence in Botswana, 1990-2007
Slide 55.
Antiretroviral Treatment
Slide 56.
Problems: Compliance
Slide 57.
Problems: Cost
Slide 58.
Problems: Cost
Slide 59.
Problems: Cost
Slide 60.
Problems: Cost
Slide 61.
Problems: Efficacy
Slide 62.
Problems: Efficacy
Slide 63.
Even on Optimal HAART, HIV+ Patients Live 10 Years Less than Controls
Slide 64.
Many Age-Associated Diseases Are More Common in Treated HIV Disease than in Controls
Slide 65.
> 80% of Patients on Optimal HAART Have Persistent Low Level Viremia
Slide 66.
Even After 10 Years of Optimal Therapy, HIV Persists
Slide 67.
After 10 Years of Optimal Therapy, CD4+ T Cell Recovery Is Incomplete in Many
Slide 68.
T Cell Activation (Inflammation) Remains Abnormal in Many on Optimal HAART
Slide 69.
T Cell Activation (Inflammation) Remains Abnormal in Many on Optimal HAART
Slide 70.
High Levels of T Cell Activation (Inflammation) Predict Mortality
Slide 71.
Might persistent virus drive T cell activation and inflammation?
Slide 72.
How Do We Make the Epidemic Go Away?
Slide 73.
Vaccines
Slide 74.
Approach to Date: Generate a Strong Immune Response to Clear Virus
Slide 75.
Approach to Date: Generate a Strong Immune Response to Clear Virus
Slide 76.
Vaccines That Induce Adaptive Immunity Have Yet to Work
Slide 77.
Hopeful Next Steps
Slide 78.
The Balance of HIV Spread and Clearance
Slide 79.
The Balance of HIV Spread and Clearance
Slide 80.
Since Inflammation Can Lead to Virus Spread...
Slide 81.
...Might a Vaccine Instead Be Aimed at Blocking Inflammation?
Slide 82.
How Do We Make the Epidemic Go Away?
Slide 83.
Eradication/Cure
Slide 84.
Is It Possible?
Slide 85.
Is It Possible?
Slide 86.
"The Berlin Patient"
Slide 87.
"The Berlin Patient"
Slide 88.
Viral Clearance in Perinatally-Infected Infants
Slide 89.
Viral Clearance in Perinatally-Infected Infants
Slide 90.
How Might Eradication Be Achieved?
Slide 91.
How Might Eradication Be Achieved?
Slide 92.
The Key Components of Viral Persistence
Slide 93.
How Might Eradication Be Achieved?
Slide 94.
Understanding How HIV Persists
Slide 95.
Long-lived Reservoir of Resting CD4+ TCM Cells with Latent Genomes
Slide 96.
Long-lived Reservoir of Resting CD4+ TCM Cells with Latent Genomes
Slide 97.
Homeostatic Proliferation of CD4+ TCM Cells that Harbor Latent Genomes
Slide 98.
Homeostatic Proliferation of CD4+ TCM Cells that Harbor Latent Genomes
Slide 99.
Homeostatic Proliferation of CD4+ TCM Cells that Harbor Latent Genomes
Slide 100.
Myeloid-T Cell Interactions Leading to Viral Persistence and/or Replication
Slide 101.
Latency may be sustained by negative regulators (e.g., PD-1) and certain chemokines
Slide 102.
Latency may be sustained by negative regulators (e.g., PD-1) and certain chemokines
Slide 103.
Foci of viral replication and spread may be driven by activation of indoleamine 2,3-dioxygenase
Slide 104.
Foci of viral replication and spread may be driven by activation of indoleamine 2,3-dioxygenase
Slide 105.
Virus might be directly transmitted by infected macrophages, whose survival is enhanced by macrophage colony stimulating factor (MCSF)
Slide 106.
Virus might be directly transmitted by infected macrophages, whose survival is enhanced by macrophage colony stimulating factor (MCSF)
Slide 107.
Lack of Effective HIV-Specific Immunity
Slide 108.
Lack of Effective HIV-Specific Immunity
Slide 109.
Vaccine-mediated induction of protective immune responses and/or suppression of inflammation
Slide 110.
Multiple Therapies May Eradicate HIV
Slide 111.
Is This Dream Possible?
Slide 112.
Is This Dream Possible?
Slide 113.
Martin Delaney
Slide 114.
Slide 115
Slide 115.
Realization of the Dream
Slide 116.
Realization of the Dream
Slide 117.
Funded Collaboratories (July 1, 2011)
Slide 118.
Martin Delaney Collaboratory to Eradicate HIV
Slide 119.
DARE: Delaney AIDS Research Enterprise to Find a Cure
Slide 120.
Towards a Cure The Funding Pipeline
Slide 121.
Ongoing Cure-Related Trials
Slide 122.
Is There an End in Sight?
Slide 123.
Is There an End in Sight?
Slide 124.