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HIV/AIDS in Practice An Expert Commentary With Carl Dieffenbach , PhD A Clinical Context Report. Jointly Sponsored by: and. Clinical Context: HIV/AIDS in Practice Expert Commentary. Clinical Context: HIV/AIDS in Practice Expert Commentary. - PowerPoint PPT Presentation
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HIV/AIDS in Practice
An Expert Commentary With Carl Dieffenbach, PhD
A Clinical Context Report
Jointly Sponsored by:
and
Clinical Context: HIV/AIDS in PracticeExpert Commentary
This activity is supported by an independent educational grant from
Bristol-Myers Squibb.
Clinical Context: HIV/AIDS in PracticeExpert Commentary
HIV/AIDS in PracticeClinical Context Series
The goal of this series is to provide up-to-date information and multiple perspectives on the pathogenesis, symptoms, risk factors, and complications of HIV/AIDS, as well as current and emerging treatments and best practices in the management of HIV/AIDS.
HIV/AIDS in PracticeClinical Context Series
Target Audience
HIV/AIDS specialists, virologists, infectious disease specialists, primary care physicians, nurses, nurse practitioners, physician assistants, pharmacists, and other healthcare professionals involved in the management of HIV/AIDS
Upon successful completion of this educational program, participants should be able to:
Review the relevance and significance of the activity in the broader context of clinical care.
Activity Learning Objective
• Statement of AccreditationThis activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Projects In Knowledge and MedPage Today. Projects In Knowledge is accredited by the ACCME to provide continuing medical education for physicians.
CME Information: Physicians
• Credit DesignationProjects In Knowledge designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credits.™ Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CME Information
• Credit for Family PhysiciansMedPage Today "News-Based CME" has been reviewed and is acceptable for up to 2098 Elective credits by the American Academy of Family Physicians. AAFP accreditation begins January 1, 2011. Term of approval is for one year from this date. Each article is approved for 0.5 Elective credits. Credit may be claimed for one year from the date of each article.
CME Information: Physicians
• Statement of Accreditation– Projects In Knowledge, Inc. (PIK) is accredited as a
provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
– Projects In Knowledge is also an approved provider by the California Board of Registered Nursing, Provider Number CEP-15227.
– This activity is approved for 0.50 nursing contact hours.
– There is no fee for this activity.DISCLAIMER: Accreditation refers to educational content only and does not imply
ANCC, CBRN, or PIK endorsement of any commercial product or service.
CE Information: Nurses
• Projects In Knowledge® is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This program has been planned and implemented in accordance with the ACPE Criteria for Quality and Interpretive Guidelines. This activity is worth up to 0.5 contact hours (0.05 CEUs). The ACPE Universal Activity Number assigned to this knowledge-type activity is 0052-9999-11-2108-H04-P.
CE Information: Pharmacists
Carl W. Dieffenbach, PhDDirector
Division of AIDS (DAIDS)National Institute of Allergy & Infectious
Diseases (NIAID)National Institutes of Health (NIH)
Bethesda, Maryland
Discussant
Carl W. Dieffenbach, PhD,has disclosed that he has no relevant financial relationships or conflicts of interest to report.
Disclosure Information
Dori F. Zaleznik, MD, Associate Clinical Professor of Medicine, Harvard Medical School, Boston; Michael Smith; and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner, have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
The staffs of Projects In Knowledge and MedPage Today have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
Disclosure Information
SSeSeminal/Vaginal Fluid
Prevent contact with HIV
Prevent contact with HIV Barrier methodsReduce/eliminate infectivity from the sourceART as prevention reduces the amount of virus in secretionsReduce target cell susceptibility Prophylaxis with ART
10-510-4
10-3
10-2
10-10
101
102
103
104105
106
107
108
Transmission
Viru
s Con
cent
ratio
n in
Ext
race
llula
r Fl
uid
or
Plas
ma
(Cop
ies/
ml)
Acute HIV-1 Infection
Time Post Exposure (days)
0 5 10 15 20 30 3525 40 45 50 55 60 65 70
Virus dissemination Transi
t
eclipse
T0
CD8 T CellResponses
plasma gp41 Antibody, Day 13 (Non-Neutralizing)
AutologousNeutralizing
Antibody Escape (new
Plasma virus mutants)
Autologous gp120Neutralizing Antibody
11 Weeks
CD8 T CellResponses
(new virus mutants)
? Delay
T Cell Induced MutationsNo Antibody Induced Mutations
First Definite Antibody Induced Mutations
Establishment of a Pool of Latently-Infected, Resting CD4+ T Cells During Primary HIV Infection
HIV Replication Cycle
binding
CD4
fusion
coreceptor
uncoating
core andpreintegrationcomplex
integration
transcription
translation
assembly
budding
mRNA
TRIM5α
reverse transcription
APOBEC
Vif
APOBEC
nuclear import
binding
CD4
fusion
coreceptor
uncoating
core andpreintegrationcomplex
integration
transcription
translation
assembly
budding
mRNA
TRIM5α
reverse transcription
APOBEC
Vif
APOBEC
nuclear import
HIV Replication Cycle
A Cure for HIV Infection The problem: current HIV therapy, while effective, is
merely suppressive
• HIV targets activated CD4-positive T cells
• Transmission is made easier by breaks in the genital and anal mucosa
• HIV forms a reservoir in lymphoid tissue early in the course of infection
SummaryAt the end of this activity, participants should understand:
• The course of untreated infection includes a period of latency of months or years during which a patient may have few or no symptoms
• The HIV replication cycle offers several targets for intervention, including reverse transcription, maturation, entry, and integration
Summary
Recommended