DOCSLIB.ORG

HIV Update • HIV Natural History Review • Acute HIV Infection October 10, 2018 • 2018 Top 10 List • Miscellaneous Issues Relevant Jack Stapleton, MD for Primary Care

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
HIV Update • HIV Natural History Review • Acute HIV Infection October 10, 2018 • 2018 Top 10 List • Miscellaneous Issues Relevant Jack Stapleton, MD for Primary Care 10/10/18 HIV Update • HIV natural history review • Acute HIV infection October 10, 2018 • 2018 Top 10 List • Miscellaneous Issues relevant Jack Stapleton, MD for Primary Care Natural History of HIV Infection No Infection Primary HIV Infection Neurologic Disease Exposure PGL to HIV • Also called: Early Infection Asymptomatic Symptomatic AIDS – Acute Retroviral Syndrome, HIV-Mono Disease • Occurs in 40% to 70% of new HIV infections Acute Disease • 1 - 12 weeks post-exposure 0 0.2 0.7 2.2 6.1 7.3 8.1 8.2 8.1 7.4 6.7 n/100 developing AIDS diagnoses • Average duration ~ 1-8 weeks 0 1 2 3 4 5 6 7 8 9 10 years post-infection • Neuropathic and Dermatopathic presentation No Infection Exposure • Antibody test often negative during illness to HIV IRIS Infection Tx Monitor for side effects Acute HIV Infection Fever 87.5 % Malaise 72.5 % Myalgia 60 % Rash 57.5 % Headache 55 % Night Sweats 50 % Sore Throat 42 % Lymphadenopathy 37.5 % Arthralgia 27.5 % Nasal Congestion 17.5 % Oral Ulcers 7.5% Thrush 5 % Ann. Int. Med. 134:25-29, 2001 1 10/10/18 Kinetics of Viral Load and Immune Response CD4 -Agcount NegativeHIV Ab Serology Positive 2018 HIV/AIDS Top 10 Serology HIV RNA HIV RNA CD4 count 1-12 wks 8-10 yrs 2-3 yrs Number 1 HIV – CD4 Cell Interaction • CD4 = Binding • CCR5 and CXCR4 Though not so new – this still makes Entry Corecptors • Transmitted virus = the Top 10 CCR5 • Polymorphism: Evidence for HIV cure by CCR5D32/ CCR5D32 • Mainly Caucasian CCR5D32 stem cell transplantation • Homozygosity = HIV resistance! Timothy Brown – the “Berlin Patient” R5 Inhibitor therapy = maraviroc CCR5 = “M” tropic Or Non-Syncytia-inducing Schneider et al., Blood epub 12/8/10 “R5” virus Case Summary Sadly • HIV-infected man with AML • SCTx with CCR5D32 homozygous 2006 Follow up studies of • GVHD, Relapse, repeat SCTx 2007 bone marrow/SCTx and/or • 11 years follow up: early treatment of newborns CD4+ T cells reconstituted not successful CCR5D32/CCR5D32 No sign of HIV infection (RNA - DNA) Provides proof of principle • Results “strongly suggest that cure of HIV has been achieved in this patient” 2 10/10/18 Number 2 Treatment Prevents Transmission HPTN 052 U=U Undetectable Viral load Untransmittable HIV How many infectious diseases eradicated by Consequences of U=U medical intervention? • Treat as prevention: goal of HRSA One: Smallpox • Will it stop the spread of HIV? How many infectious diseases eradicated by - Should help treatment? - Other STIs as model None • Caveat’s Including infections curable by single dose therapy: – Other STIs increasing a. Syphilis – Identify all infected? b. Gonorrhea – Adherence? c. Chlamydia d. Bacterial Vaginosis – Resistance? e. Fungal vaginosis – Access? Single pill (Truvada, combination tenofovir + emtricitabine) daily Number 3 PrEP Works (if you take it) (Pre-exposure Prophylaxis) Preexposure chemoprophylaxis for HIV prevention in men who Cumulative probability of HIV Infection have sex with men. Grant et al., NEJM 362:2587, 2010 Weeks since randomization Grant et al., NEJM 362:2587, 2010 3 10/10/18 Detecting Risk Eligibility? Detecting Risk: Eligible? HIV-positive sexual parnter Recent bacterial STI Negative HIV test prior to PrEP High number of sex partners No signs of acute HIV Inconsistent or no condom Use Normal renal function Commercial sex worker Documented HBV infection status In IVDU: HBV vaccination status Sharing injection works Recent drug treatment TelePrEP programs: UI and IDPH PHS guidelines: Expansion to others https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf UI HIV/AIDS Clinic Trends Number 4 300 0 250 0 Total patients seen New patients/year 200 0 Changing Epidemiology Active Clinic patients 150 0 100 0 500 0 198 8 199 1 199 5 200 0 200 5 201 0 201 5 Which HIV prevalence goes with which population? U.S. Statistics • 1.12 million living with HIV, 2015 1. 30.6% 1. Nigeria • 39,800 new infections in 2016 2. 18.9% 2. S. Africa • May be decreasing? 3. 3.3% 3. Urban S. Africa 4. 1.2% 4. General US Pop. • Not reduced in young MSM 5. 0.4% 5. Washington DC • 20% to 50% unaware of infection 4 10/10/18 New HIV Infections by ART: Numbers 5 to 10 transmission category, 2015 New Drugs (5) New HIV Infections by Race/Ethnicity, 2015 Multiple races 3% (1,100) New Combinations (6) Asians 2% (740) Change in guidelines (7) Transmitted Resistance (8) 41% IRIS (9) New Approaches (10) Number 5 – New Drugs More – New Drugs Tenofovir disoproxil fumarate vs Bictegravir (integrase inhibitor) Tenofovir alenfenamide fumarate Doravirine (NNRTI) (TDF vs TAF) Generics TDF, 3TC, EFV, ZDV, NVP, TAF = prodrug – lower [plasma] ABC, FosAPV, ATV Reduces renal toxicity and DDIec, D4T bone mineral loss # 5 & 6 – New Drugs/Combos Number 7: Guideline Changes Tenofovir formulation in combo meds Many changes, some of the key Truvada = TDF Descovy = TAF ones include: Stribild = TDF Genvoya = TAF Treat all patients with HIV VL > 20 Complera = TDF Odefsy = TAF Preferred regimens include: Atripla = TDF Biktarvy = TAF 2 NNRTs + integrase inhibitor; Symfi = TDF Symfi Lo = TAF other regimens in certain patients Delstrigo = TDF Symtuza = TAF Fewer CD4 counts Jaluca (no Tenofovir – 2 drug) https://aidsinfo.nih.gov/ Slide # 43 5 10/10/18 Number 8: Transmitted Resistance (U.S.) • Overall prevalence: 15% ART Resistance • Race/ethnicity not associated with resistance • Lower among 4% with non-subtype B viruses Check HIV genotype: • NNRTI (8%) > NRTI (6%) > PI (4.5%) When starting ART • NNRTIs: K103N (67%) > Y181C (14%) > G190A (9%) • NRTIs: For failing regimen before switch TAMs & T215 revertants >> M184V* (19%) >> K65R (1%) For switch, best done on meds! • PIs: L90M > M46I/L > D30N >> V82A* > I84V* Illustrates importance of pre- treatment drug resistance testing. # 9 = IRIS: Immune Reconstitution Natural History of HIV Infection Inflammatory Syndrome No Infection Neurologic Disease • Paradoxical worsening of pre-existing infectious Exposure PGL diseases following initiation of antiviral therapy (ART) to HIV • Associated with: low CD4 counts (<50), unrecognized Early OI, high microbial burden, starting ART close to the Infection Asymptomatic Symptomatic AIDS time OI therapy is started. Disease Acute Disease • Manifestations: New OI’s (VZV, HSV, PCP, M.Tb., MAI, KS, Cryptococcal disease, Toxoplasmosis). Both No Infection local and systemic inflammation may occur. Exposure to HIV IRIS • Management: If severe, may need to stop ART or Infection Tx Monitor for side effects consider use of corticosteroid therapy. Number 10: New Approaches Miscellaneous Topics Long-acting ART and Abs Licensed: Monoclonal Abs Young women Ibalizumab. IV q 2 weeks Hepatitis B, C co-infection (combination only) Cabotegravir+RPV injectable (PHase III) 6 10/10/18 Transmission & Maternal HIV RNA HIV Therapy & Pregnancy • ART naïve • ARV prophylaxis to prevent perinatal transmission is – Genotype always recommended for all HIV-infected women – If late; consider 4 drug therapy pending genotype • Risk of perinatal transmission greater with higher • Timing - First trimester maternal VL. – May delay Rx if maternal CD4 count is high (>500) – However, perinatal transmission can occur even at – If CD4 350 – 500, debatable, but most would treat undetectable maternal VL, so VL should not be a – Always recommend if CD4 < 350 determining factor in starting ART for perinatal prophylaxis – Avoid teratogenic meds (Efavirenz, Delavirdine, • ARV drugs are highly effective in preventing HIV • Timing – after first trimester transmission, regardless of disease stage – Treat all • Stress adherence NRTIs with high placental transfer Pregant, On therapy 3TC ZDV FTC HIV VL: ABC d4T TDF At least one of these drugs should be used Suppressed, continue unless contraindications EFV, other teratogenic drugs in 1st trimester – NNRTIs Change – this year – Continue EFV unless | in the first 4-6 weeks of pregnancy EFV, DLV: Teratogenic Avoid drugs with adverse potential (d4T/ddI) NVP: Should not start if CD4 >250 Continue NVP regardless of CD4 count RPV: No data HIV Not suppressed: Genotype and ARV Hx; Base change on data Other considerations Report all cases of ARV use in pregnant women to the Antiretroviral Pregnancy Registry: HIV+HBV co-infection: http://www.APRegistry.com Need to Rx both; Vaccine Collects observational, non-experimental data regarding HIV+HCV: ARV exposure during pregnancy to assess potential teratogenicity. No HCV Rx with current meds HBV and/or HCV infected: Vaccinate for HAV 7 10/10/18 Anti-HIV Drugs: 2018 cART - 3 or 4-drug combinations Anti-HIV Drugs: 2018 Triumeq (ABC, 3TC, DTG) NRTI’s (Nucleoside RT Inhibitors) Biktarvy (TAF+BIC+FTC) AZT/ZDV (zidovudine, retrovir), 3TC (lamivudine, CompLera (TDF, FTC, RPV) epivir); Abacavir (ABC, Ziagen); TFV (TDF/TAF) Odefsey (TAF, FTC, RPV) Tenofovir, viread); FTC (Emcitribine); StibiLd (TDF, FTC, ELV, Cobi) Combination NRTIs: Truvada (TDF+FTC); Genvoya (TAF, FTC, ELV, Cobi) Cimduo (generic TDF+3TC); Descovy (TAF+FTC); ATRIPLA (TDF, FTC, EFV) Epzicom (ABC+3TC); Combivir (ZDV, 3TC); Symfi and Symfi Lo (TDF or TAF[Lo], 3TC, EFV) Trizavir (ZDV, 3TC, ABC); Symtuza (TAF, FTC, DRV, Cobi) Seldom, if ever used: ddC (zalcytibine, HIVID); d4T DeLstrigo (TDF, 3TC, doravirine) (stavudine, zerit); ddI (didanosine, videx); ddIEC (didanosine extended release) NeW 2-drug to know about: JuLuca (DTG+RPV) Anti-HIV Drugs: 2018 Anti-HIV Drugs: 2018 Integrase Inhibitors PRI’s (Protease Inhibitors) Raltegravir (isentress); dolutegravir (Tivicay); Darunavir (Prezista, DRV); Ritonavir (Norvir, RTV); Elvitegravir (Vitekta – boosted); bictegravir Atazanavir (Reyataz, ATZ) (only as combo - biktarvy) Combinations: Prezcobix (DRV+cobi); Evotaz (ATZ+CBT) NNRTI’s (Non-Nucleoside RTIs) Seldom, if ever used: Saquinavir (Invirase,SQV); Indinavir Efavirenz (sustiva); Etravirine (intelence); (Crixivan, IDV); Nelfinavir (Viracept, NLV); Amprenavir Rilpivirine (Edurant); Doravirine (Pifeltro) (Angenerase, AMP); Lopinavir/rtv (Kaletra); Seldom, if ever used: Neviripine (virammune); Fosamprenavir; Tipranavir Delavirdine (rescriptor) Monoclonal Antibodies: Ibalizumab (Trogarzo) Entry inhibitors (seldom used) Fuzeon, maraviroc PK Boosting: Cobicistat (tyboost, cobi); Ritonavir 8.
Load more

Recommended publications
  • Are We Standing in Our Own Way on the Path to a Cure for HIV/AIDS
    PROFILE Are we standing in our own way on the path to a cure for HIV/AIDS lthough there are many reasons to celebrate the life-extending benefits from antiretroviral Atherapeutics (ART) for HIV/AIDS and the ability to chronically manage patients’ disease for decades, the majority of people around the world living with the virus do not have access to ART and those that do, have over decades developed life-threatening side effects. Our inability to identify a cure to HIV lies not only in the as-of- yet failure of the medical research community to identify and develop appropriate means of ridding the body of the virus but also government and industrial policies that promote public opinion exclusively focused on chronic management scenarios instead of broadly exploring innovation for cure. “An inconvenient truth” (Davis Guggenheim) mates of the magnitude of the global forced government policy for early epidemic. As the majority of Ameri - and expanded access to experimental There are approximately 37 million cans are not rountinely tested for HIV, drugs, the medical community and people living with HIV and 39 million the virus can go years without being society are struggling with the fact have died of AIDS-related diseases diagnosed in an HIV positive person. that we are barely managing the HIV since the start of the epidemic in 1981. With these statistics it is no wonder epidemic and AIDS crisis. For years we As of March 2015, only 15 million that every day an estimated 5,600 have been locked into thinking of people have access to treatments for people globally become newly infected solutions in terms of a chronic disease HIV.
    [Show full text]
  • HIV/AIDS and Cancer Cure: Is It the Same Battle?
    HIV/AIDS and Cancer cure: Is it the same battle? Monsef Benkirane Molecular Virology Laboratory [email protected] IAS HIV Cure & Cancer Forum Paris, France www.iasociety.org Dynamic of imatinib-treated Chronic Myeloid Leukemia Mature cancer cells Highly divinding Cancer Stem cells www.iasociety.org Persistence and resistance are theBarriers to Cure HIV/AIDS Cancer Latent provirus Quiescent / slow-cycling Quiescent/ slow-cycling Long-lived Long-lived Indefinite proliferative potential Non sensitive to ART Enhanced repair capacity Not visible to the immune system highly resistant to DNA HIV-specific CD8 T cell response damage/Tolerance decreases with cART Enhanced checkpoint kinase expression drug efflux transporter Renewed by dedifferentiation of proliferating cancer HIV/AIDS and cancer are Residual diseases Although their molecular bases are different, similar cure strategies are being developed www.iasociety.org which cure and how to achieve it? Two main strategies are being pursued Eradication, which will require a complete elimination of infected cells, for which the Berlin patient represents a proof of concept. Considering the Boston patients, eradication will require elimination of HIV infected cells and replacement with HIV resistant cells. Remission: HIV controllers and the VISCONTI patients suggest that remission is achievable. This strategy should include monitoring of inflammatory and procoagulant indices. – Find and diminish size of the reservoir (LRAs, bNAbs, CAR-T cell) – Reduce seeding of latent pool with early/more ART – Reverse latency (LRAs, TLR7) – Increase HIV-specific immune function (vaccines or anti PD-L1) – Reduce immune activation – Gene therapy targeting the virus and the host – Allogeneic stem cell transplantation Combination therapy may be necessary While proof-of-concepts are there, we still have to gain important knowledge to achieve HIV eradication or remission Strategies to eradicate latent reservoirs.
    [Show full text]
  • (Rftca) Accelerates a Global Cure for Aids with License of Chromocell’S Proprietary Cell Engineering Technology
    RESEARCH FOUNDATION TO CURE AIDS (RFTCA) ACCELERATES A GLOBAL CURE FOR AIDS WITH LICENSE OF CHROMOCELL’S PROPRIETARY CELL ENGINEERING TECHNOLOGY • The Chromovertâ Technology platform provides an opportunity to create a scalable cell therapy cure for HIV/AIDS by enabling the purification of sufficient numbers of curative cells following the use of other biotechnologies already demonstrated to engineer cells that mimic natural biological resistance to HIV/AIDS; • With this technology, RFTCA will establish a new and charitable non-for-profit research incubator hub in order to research, develop and commercialize a safe and scalable cure for all those in need, regardless of ability to pay; • Chromovert Technology was invented at The Rockefeller University by Kambiz Shekdar, Ph.D., and is pioneered and owned by Chromocell Corporation, a life sciences company that was spun-out of the university. September 4, 2019 – NEW YORK, NY. – Research Foundation to Cure AIDS (RFTCA) has obtained a worldwide license to biotechnology known as Chromovertâ Technology, to research, develop and commercialize a cure for HIV/AIDS. This is the first and only case of an IRS Code § 501(c)3 not-for-profit organization holding rights to biotechnology with the promise to cure AIDS. RFTCA’s mission is to develop an AIDS cure and to make it available and affordable to all of the 37 million people living with HIV/AIDS worldwide. The emphasis in the medical community, until recently, has been on containing the AIDS epidemic with treatment and prevention alone. But recent advances in stem cell biology and cellular engineering have created new opportunities that could lead to a global cure.
    [Show full text]
  • Editing a Cure
    MILESTONES infection and prompted further research into gene-based therapies to genome editing target HIV. Although genome editing had had been been proven efficient in rendering proven efficient T cells refractory to HIV infection, in rendering it was not until years later, in 2014, T cells that a team led by Pablo Tebas and Carl June at the University of refractory to Pennsylvania in Philadelphia showed HIV infection this could be done in infected Credit: Bloomberg/Rob Waters via Getty Images Getty via Bloomberg/Rob Waters Credit: individuals. The clinical trial enrolled 12 patients who were infused with autologous CD4+ T cells modified at the CCR5 locus by zinc-finger nucleases (ZFNs). The patients who stopped ART after cell transfusion exhibited slow viral rebound and proliferation of the modified T cells, MILESTONE 18 indicating enhanced control of the virus. Moreover, one study participant with no viral rebound Editing a cure during ART interruption was found to harbor a single mutated copy of CCR5 and after transfusion a large Timothy Ray Brown—also known transplantation and interruption of proportion of this patient’s T cells as the ‘Berlin patient’—is the only antiretroviral therapy (ART). were resistant to HIV. person ever to be cured of HIV. His Although at the time of transplant Together, these findings story and the research that followed Brown also carried HIV variants demonstrated that gene-targeting are intimately linked to the discovery, tropic for the CXCR4 chemokine approaches could provide a safer back in 1996, that homozygosity for receptor, Hütter reasoned that their and more practical approach than a CCR5 allele with a 32-base-pair numbers might have been too low to the risky and restrictive HSCT and deletion (delta32/delta32) renders allow reseeding of the new immune opened the door for ZFNs and some individuals resistant to system.
    [Show full text]
  • Investigating Neuronal Injury in a HIV Cure Strategy
    12th International Symposium on Neuropsychiatry and HIV 14th June 2019 Investigating neuronal injury in a HIV cure strategy Jasmini Alagaratnam Clinical Research Fellow Imperial College London Why can’t ART cure HIV? The viral reservoir HIV reservoir sites Major reservoirs HIV infects CD4+ cells Dormant memory T cells in lymph nodes and blood2 Some become Macrophages and resting memory cells; dendritic cells in various tissues (especially in ‘reservoir’ lymph nodes, gut and central nervous system)2 Research into HIV cure has intensified Data on the safety aspects of HIV cure strategies are limited1 1. Dubé K. Trends Microbiol. 2014 Oct;22(10):547-9 Kick and kill Potential CNS risks of ‘kick and kill’ 1. Direct neuronal injury: • Viral rebound releasing viral proteins which are neurotoxic • LRA toxicities 2. Indirect neuronal injury: • CNS IRIS, CD8+ mediated encephalitis • Following HIV vaccines which may modify immune responses • Inflammation & immune activation • Following viral rebound or HIV vaccines 3. Removal of cells with crucial function 4. Reversal of other integrated viruses in a resting phase CSF Neurofilament Light Chain protein (NFL) • NFL maintains structure of axons • Sensitive and dynamic biomarker of active neuroaxonal damage in the CNS • Elevated concentrations are reported in a variety of neurodegenerative conditions including HIV Plasma neurofilament light chain (NFL) • Highly sensitive assay measuring plasma NFL has recently been developed • Strongly correlates with CSF NFL • Removes the barriers of repeated CSF sampling
    [Show full text]
  • World AIDS Day 2015
    World AIDS Day 2015 Year-by-Year Milestones in HIV/AIDS (Adapted from “The POZ Timeline: Milestones in the HIV/AIDS Pandemic” with additions compiled by Eric Brus, Director of HIV Health Promotion, AIDS Action Committee) 1981 • In the June 5 Morbidity and Mortality Weekly Report, CDC reports a rare form of pneumonia in five gay men, which are later determined to be the first published cases of AIDS. • The first AIDS service organization, Gay Men’s Health Crisis (GMHC), is founded in New York City. • U.S. Year-End Statistics: A total of 159 cases of the new disease are recorded during 1981. The Fenway Community Health Center reports the first AIDS case in New England. In Massachusetts, there is a sharp increase in the number of new AIDS cases each year from 1981 through 1990. Between 1985 and 1990, an average of 700 AIDS cases are reported each year. 1982 • CDC introduces the term Acquired Immune Deficiency Syndrome, or AIDS, as a replacement for Gay- Related Immune Deficiency (GRID). • The Community-based KS/AIDS Foundation is formed, which later becomes the San Francisco AIDS Foundation. • U.S. Year-End Statistics: 771 cases of AIDS reported to date, with 618 deaths. 1983 • The primary cause of AIDS is confirmed: French researchers isolate a virus, dubbed LAV, that kills CD4 cells in a patient with AIDS. U.S. scientists make a similar discovery in 1984, involving an isolated virus dubbed HTLV-III. • The Advisory Committee of People With AIDS releases The Denver Principles, officially launching the self-empowerment movement among people living with HIV/AIDS.
    [Show full text]
  • HIV Update: an Epidemic Transformed an Evidence-Based Review of New Developments in HIV Treatment and Prevention
    1.5 HOURS CE Continuing Education HIV Update: An Epidemic Transformed An evidence-based review of new developments in HIV treatment and prevention. ABSTRACT: The field of HIV treatment and prevention has evolved rapidly over the past four decades. New therapies that are more potent and streamlined have transformed HIV into a chronic disease, while the use of such preventive strategies as preexposure prophylaxis and postexposure prophylaxis provide effective options for reducing the risk of HIV infection. These medical breakthroughs have enabled more people liv- ing with HIV (PLWH) to reach older adulthood. But they also mean that nurses are seeing more PLWH who have developed long-term complications of living with HIV or of exposure to antiretroviral therapy, as well as concurrent chronic conditions associated with advanced age. Nurses play a critical role in caring for PLWH and those at risk for HIV infection. This article discusses HIV epidemiology, describes the current state of HIV treatment and prevention, and highlights common comorbidities often seen in PLWH who are over age 50. Keywords: HIV, older adults, PEP, postexposure prophylaxis, preexposure prophylaxis, PrEP, prevention, treatment wasn’t supposed to be here,” said John Mar- prevention of HIV over the past several decades, chese to the nurse as he watched the last few patients like Mr. Marchese are no longer a rarity. “I drops of his chemotherapy drug infuse into Nearly 38 years after the Centers for Disease Con- the port implanted in his chest. (This case is a com- trol and Prevention (CDC) reported that five young, posite based on my experience.) The nurse caring for white, previously healthy gay men in Los Angeles had him smiled while preparing to disconnect his iv tub- been diagnosed with pneumocystis pneumonia and ing and flush the port.
    [Show full text]
  • Shank Retroviruses and AIDS 2017
    Retroviruses and AIDS 12/8/17 Peter Shank, Professor Emeritus of Medical Science [email protected] ■ History of retroviruses ■ Biology of HIV/AIDS and some advances in the last decade AIDS death rate males age 25-44 History ■ Vallee and Carre 1904 equine infectious anemia was a “filterable” agent ■ Ellermann and Bang 1908 leukemia in the chicken was a “filterable” agent ■ Peyton Rous 1911 sarcoma in chickens caused by “filterable” agent ■ Bittner 1942 mammalian RNA tumor virus Mouse Mammary Tumor Virus (MMTV) ■ 1970 Baltimore and Temin simultaneously discover Reverse Transcriptase in retroviruses ■ 1976 Bishop and Varmus discover the src gene has a counterpart in normal cells History Cont. ■ 1980 a retrovirus associated with human leukemia HTLV-I ■ 1983 a retrovirus associated with acquired immune deficiency syndrome HTLV-III, ARV or LAV now HIV 1975 Nobel Prize in Medicine ■ David Baltimore ■ Howard Temin 1934- 1994 ■ Prize was shared with Renato Dulbecco Bishop and Varmus ■ Recipients of the 1989 Nobel Prize in Medicine Harold also wrote a memoir in 2009 Varmus in his Nobel lecture said: ■ In describing the formation of RSV DNA ■ “These problems were solved by the unexpectedly elegant configuration of viral DNA, as worked out mainly by Peter Shank, Steve Hughes, and Hsing-Jien Kung in our group.” Nobel Prize in Medicine 2008 Luc Montagnier Francois Barre-Sinousi shared with Harald vur Hausen Retrovirus Structure ■ Positive polarity RNA ca. 7-11 kb ■ RNA capped and polyadenylated but doesn’t function as mRNA ■ Enveloped particles
    [Show full text]
  • First Man Cured of HIV Dies of Cancer: Charity 30 September 2020
    First man cured of HIV dies of cancer: charity 30 September 2020 The first person to be cured of HIV, Timothy Ray foundation. Brown—known as the "Berlin Patient"—has died after a battle with cancer, the International Aids "I am living proof that there could be a cure for Society (IAS) announced Wednesday. AIDS," he told AFP in 2012. "It's very wonderful, being cured of HIV." Brown made medical history and became a symbol of hope for the tens of millions of people living with 'Champion' the virus that causes AIDS when he was cured more than a decade ago. Ten years after Brown was cured, a second HIV sufferer—dubbed "the London Patient"—was He had been living with a recurrence of leukaemia revealed to be in remission 19 months after for several months and received hospice care at undergoing a similar procedure. his home in Palm Springs, California. The patient, Adam Castillejo, is currently HIV-free. "On behalf of all its members... the IAS sends its In August a California woman was reported to have condolences to Timothy's partner, Tim, and his no traces of HIV despite not using anti-retroviral family and friends," said IAS President Adeeba treatment. Kamarulzaman. It is thought she may be the first person to be cured "We owe Timothy and his doctor, Gero Hutter, a of HIV without undergoing the risky bone marrow great deal of gratitude for opening the door for treatment. scientists to explore the concept that a cure for HIV is possible." Sharon Lewin, president-elect of the IAS and director of the Doherty Institute in Melbourne, Brown was diagnosed with HIV while was studying Australia, praised Brown as a "champion and in Berlin in 1995.
    [Show full text]
  • First Man Cured
    Why the London Patient matters: What does a second HIV 'cure' mean? By now, many people have heard the news that there was a second man ‘cured’ of HIV. It was a top headline last week, based on a presentation of research at the 2019 Conference on Retroviruses and Opportunistic Infections (CROI) – one of the premier scientific conferences for HIV-related research. Some are saying, “I didn’t know someone had already been cured.” Others ask, “Was he really cured?” Importantly, many people living with HIV are asking, “How does this apply to me?” First Man Cured Scientists in the field agree that the first man deemed cured of his HIV infection is Timothy Ray Brown, who underwent a stem-cell transplant in Berlin in 2007. For years, he was known only as, the ‘Berlin Patient,’ until he went public with his identity in 2010, as he wanted to be part of the search for a cure for HIV. Brown was not trying to cure his HIV infection when he agreed to a stem-cell transplant more than a decade ago. His main concern was life-threatening acute myeloid leukemia that hadn’t responded to chemotherapy. The transplant was a desperate attempt to cure his deadly cancer. He endured two stem-cell transplants, intense conditioning, full body irradiation, a bout with graft-versus-host disease and neurological damage, but eventually From left to right, Julie Patterson, London Patient doctor Dr. Ravi Brown defeated his cancer. Gupta, Timothy Ray Brown, and U=U founder Bruce Richman at CROI 2019 (Photo credit: Bruce Richman) Simultaneously, he had stopped taking his anti-retroviral therapy (ART) and a few months later, he discovered that his HIV was in remission.
    [Show full text]
  • Full Recommendations: Towards an Hiv Cure 2016 Contents
    FULL RECOMMENDATIONS: TOWARDS AN HIV CURE 2016 CONTENTS INTRODUCTION ............................................................................................................................................................................... 4 1. MOLECULAR BIOLOGY OF HIV LATENCY AND REVERSAL STRATEGIES .............................................................7 2. VIRAL RESERVOIRS, IMMUNOLOGY OF HIV PERSISTENCE AND “KILL” STRATEGIES ..................................13 3. MODELS FOR HIV CURE OR SUSTAINABLE REMISSION AND PAEDIATRIC HIV CURE ...............................21 4. GENE AND CELL THERAPY ................................................................................................................................................... 27 5. NOVEL BIOMARKERS AND TECHNOLOGIES TO ANALYSE AND QUANTIFY HIV RESERVOIRS .............33 6. SOCIAL SCIENCES AND HEALTH SYSTEMS RESEARCH ...........................................................................................39 7. METHODOLOGY ........................................................................................................................................................................46 8. ACKNOWLEDGEMENTS ..........................................................................................................................................................46 9. BIBLIOGAPHY .............................................................................................................................................................................. 47 FULL RECOMMENDATIONS
    [Show full text]
  • Boston Patients
    ---------------------------------------------------------------------------------------- MEDIA COVERAGE Boston patients July 2013 – January 2014 ---------------------------------------------------------------------------------------- Summary PART 1: July 2013 Wire Reuters……………………………………………………………………………………………………………… 5 Asian News International (ANI)…………..…………………………………………………………….. 6 Associated Press (AP)………………………………………………………………………………………... 7 Associated Press (AP)………………………………………………………………………………………... 8 Associated Press (AP)………………………………………………………………………………………... 9 Agence France Press (AFP)………………………………………………………………………………… 10 Bloomberg………………………………………………………………………………………………………… 12 United Press International (UPI)……………………………………………………………………….. 14 EFE……………………………………………………………………………………………………………………. 15 Broadcasting NBC-2……………………………………………………………………………………………………………….. 17 BBC…………………………………………………………………………………………………………………… 19 ABC RADIO………………………………………………………………………………………………………… 22 ABC RADIO………………………………………………………………………………………………………… 23 NBC…………………………………………………………………………………………………………………… 24 ForexTV…………………………………………………………………………………………………………….. 27 CBN…………………………………………………………………………………………………………………… 28 CBS……………………………………………………………………………………………………………………. 29 Al Jazeera………………………………………………………………………………………………………….. 31 CNN………………………………………………………………………………………………………………….. 32 NBC…………………………………………………………………………………………………………………… 35 Newspapers, magazines and blogs The New York Times…………………………………………………………………………………………. 37 The Wall Street Journal…………………………………………………………………………………….. 40 Financial Times………………………………………………………………………………………………….
    [Show full text]