HIV: Acute (Primary) Infection. David H

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Presentation transcript:

HIV: Acute (Primary) Infection. David H 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 1

Acute (Primary) HIV Spach/HIV/Acute HIV/PP 1

Spach/HIV/Acute HIV/PP 1

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 1

Acute (Primary) HIV HIV Antibodies HIV RNA Acute HIV “Set Point” 3 months 6 months Spach/HIV/Acute HIV/PP 1

Acute HIV Early Events in Transmucosal Infection From: Kahn J, Walker BD. N Engl J Med 1998;339:33-9. Spach/HIV/Acute HIV/PP 1

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 1,000 2) A negative HIV antibody test and HIV RNA 200,000 3) A positive HIV antibody test and HIV RNA of 2,000 4) A positive HIV antibody test and HIV RNA of 50,000 Spach/HIV/Acute HIV/PP 1

HIV: Manifestations of Primary Infection From: Vanhems P. AIDS 2000;14:375. Spach/HIV/Acute HIV/PP 1

Acute (Primary) HIV HIV Antibodies HIV RNA “Set Point” 3 months Spach/HIV/Acute HIV/PP 1

Plasma HIV RNA Levels Acute HIV “Set Point” 6 months Spach/HIV/Acute HIV/PP 1

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

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 1

Immune Response to Acute HIV Infection 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 1

HIV Primary Infection Isolates N = 108 Patients Newly 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 1

HIV Primary Infection Isolates N = 141 Patients Phenotypic Data From: Little SJ. JAMA 1999;282:1142-9. Spach/HIV/Acute HIV/PP 1

HIV Primary Infection Isolates N = 80 Patients Genotypic Data From: Boden D. JAMA 1999;282:1135-1141. Spach/HIV/Acute HIV/PP 1