Immunology and Detection of Acute HIV-1 Infection

Topic review: Acute HIV infection Piyapan P. M.D.

Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Global report 2010. Geneva: UNAIDS, 2010

The HIV-1 Transmission Event ,[object Object],[object Object],[object Object],[object Object],[object Object]

Florian H. et al. Nat Rev Immunology, 2008

HIV-1 is replicating in the mucosa, submucosa, and draining lymphoreticular tissues Eclipse phase: the virus cannot be detected in plasma, generally lasts 7-21 days. The majority of transmitted and founder viruses (selective transmission advantages) The time to establishment of the CD4 T-cell reservoir may be as short as 24 hours.

The HIV-1 Transmission Event ,[object Object],[object Object],[object Object]

A quasi-species ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The earliest cytokines are produced by dendritic cells, but later by monocytes, macrophages, natural killer [NK] cells, and T cells. Alpha 1-antitrypsin and serum amyloid A, 3 to 5 days after transmission. a large burst of inflammatory cytokines led by INF- α and IL-15

Initial Innate Immune Responses to HIV-1 ,[object Object],[object Object],[object Object],[object Object]

The initial antibody response to the viral envelope is non-neutralizing (misdirected to GP41). Antibodies that neutralize the transmitted founder virus are not detected until 3 months or more after infection that is too late to influence the course of the infection . (directed to GP 120) ,[object Object],[object Object],[object Object],The extreme depletion of activated CD4 T cells in GALT. Vs. The damaged mucosal barriers: leakage of gut bacterial products into sterile tissues.

Fiebig et al. AIDS. 2003 Sep 5;17(13):1871-9.

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[object Object],[object Object],[object Object],[object Object],Palmer S et al. J Clin Microbiol, 2003.

Branson BM. Clin Infect Dis 2007. Eva S. Transfusion, 2008. *4 th -generation, HIV antigen-antibody combination assay 7 days 5 days Eclipse 7 days Window

Public Health Consequences of Acute HIV-1 Infection ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],Brenner BG et al. J Infect Dis 2007

Preventing HIV-1 Infection ,[object Object],[object Object]

[object Object],[object Object],[object Object],X Entry of viruses X Cell to cell transmission X Entry of infected cell

Antiretrovirus ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Managing Acute HIV-1 Infection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ARV for acute HIV-1 infection ,[object Object],[object Object],[object Object]

Thompson MA et al. 2010 recommendations of the International AIDS Society-USA panel. JAMA 2010

Conclusions ,[object Object],[object Object],[object Object],[object Object]

Immunology and Detection of Acute HIV-1 Infection

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Immunology and Detection of Acute HIV-1 Infection