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HIV/AIDS in Practice An Expert Commentary With Carl Dieffenbach , PhD A Clinical Context Report

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.

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HIV/AIDS in Practice An Expert Commentary With Carl Dieffenbach , PhD A Clinical Context Report

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  1. HIV/AIDS in PracticeAn Expert Commentary With Carl Dieffenbach, PhDA Clinical Context Report

  2. Jointly Sponsored by: and Clinical Context: HIV/AIDS in PracticeExpert Commentary

  3. Clinical Context: HIV/AIDS in PracticeExpert Commentary This activity is supported by an independent educational grant from Bristol-Myers Squibb.

  4. 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.

  5. HIV/AIDS in PracticeClinical Context SeriesTarget 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

  6. Activity Learning Objective 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.

  7. CME Information: Physicians • Statement of Accreditation This 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.

  8. CME Information • Credit Designation Projects 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.

  9. CME Information: Physicians • Credit for Family Physicians MedPageToday "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.

  10. CE Information: Nurses • 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.

  11. CE Information: Pharmacists • 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.

  12. Discussant Carl W. Dieffenbach, PhD Director Division of AIDS (DAIDS) National Institute of Allergy & Infectious Diseases (NIAID) National Institutes of Health (NIH) Bethesda, Maryland

  13. Disclosure Information Carl W. Dieffenbach, PhD, has disclosed that he has no relevant financial relationships or conflicts of interest to report.

  14. 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.

  15. SSe Seminal/Vaginal Fluid

  16. Prevent contact with HIV • Prevent contact with HIV • Barrier methods • Reduce/eliminate infectivity from the source • ART as prevention • reduces the amount of virus in secretions • Reduce target cell susceptibility • Prophylaxis with ART

  17. 0 5 10 15 20 25 30 35 40 plasma gp41 Antibody, Day 13 (Non-Neutralizing) Autologous gp120 Neutralizing Antibody 11 Weeks 108 ? Delay 107 Acute HIV-1 Infection 106 105 104 eclipse 103 CD8 T Cell Responses CD8 T Cell Responses 102 Virus Concentration in Extracellular Fluid or Plasma (Copies/ml) 101 0 Virus dissemination (new virus mutants) 10-1 Autologous Neutralizing Antibody Escape (new Plasma virus mutants) Transit 10-2 T0 10-3 10-4 10-5 45 50 55 60 65 70 Time Post Exposure (days) Transmission T Cell Induced Mutations No Antibody Induced Mutations First Definite Antibody Induced Mutations

  18. Establishment of a Pool of Latently-Infected, Resting CD4+ T Cells During Primary HIV Infection

  19. HIV Replication Cycle fusion binding core and preintegration complex reverse transcription uncoating APOBEC TRIM5α transcription nuclear import mRNA translation integration assembly coreceptor CD4 APOBEC Vif budding

  20. HIV Replication Cycle fusion binding core and preintegration complex reverse transcription uncoating APOBEC TRIM5α transcription nuclear import mRNA translation integration assembly coreceptor CD4 APOBEC Vif budding

  21. A Cure for HIV Infection • The problem: current HIV therapy, while effective, is merely suppressive

  22. Summary At the end of this activity, participants should understand: • 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

  23. Summary • 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

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