Lecture 2 - Manifestations of Disease[1]

Lecture 2 - Manifestations of Disease[1] - AIDS Course:...

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University of North Carolina 01/10/11 AIDS Course: Treatment and Clinical Manifestations Charles van der Horst, MD Professor of Medicine February 2, 2010
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University of North Carolina 01/10/11 Early HIV Chronology 1981 First AIDS Patient Described 1982 First Pediatric Patient Described 1983 HIV Isolated (Gallo/Montaner) 1985 HIV ELISA Test Approved
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University of North Carolina 01/10/11 State of the US Epidemic: 1985 No drugs Few health care workers willing to work with patients No laboratory tests to monitor disease CD4, viral load, drug resistance tests No easy way to diagnose opportunistic infections (OIs) Did not know that OIs needed to be suppressed forever No good medicines to treat depression Few social service agencies helping High stigma and discrimination
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University of North Carolina 01/10/11 US Epidemic: Progress through Science and Legislation 1986 AZT shown effective 1986 AIDS Clinical Trials Group funded by NIH 1990 Ryan White CARE Act 1992 Housing Opportunities for Persons with AIDS 1994 ACTG 076 HIV transmission interrupted from mother to child (AZT) 1995 First protease inhibitor- saquinavir 1997 ACTG 320 Triple therapy
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University of North Carolina 01/10/11
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University of North Carolina 01/10/11
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University of North Carolina 01/10/11 Natural History of HIV Infection Infection with HIV Clinically latent period 0.5–15 (?) years 2–3 years 6–24 weeks HIV RNA load CD4 lymphocytes Clinical symptoms
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University of North Carolina 01/10/11 New CDC Recommendations for Screening for HIV infection: Screening for HIV should be routine for all patients age 13-64 In all health care settings Screen all patients initiating treatment for TB Screen all patients seeking treatment for STDs, all patients attending STD clinics every time they return with a new complaint.
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University of North Carolina 01/10/11
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University of North Carolina 01/10/11 Life Cycle of HIV DS dna COMPLEX fusion inhibitor reverse transcriptase inhibitors protease inhibitors integrase inhibitors maturation inhibitors CD4 attachment inhibitors chemokine receptor inhibitors HIV entry inhibitors
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University of North Carolina 01/10/11 HIV Reverse Transcriptase with RNA/DNA helix
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University of North Carolina 01/10/11
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University of North Carolina 01/10/11
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University of North Carolina 01/10/11
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University of North Carolina 01/10/11 Phase II AZT Trial 9/86 Stratum AZT Placebo Low CD4 1 15 High CD4 0 4 Total 1 19
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University of North Carolina 01/10/11
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University of North Carolina 01/10/11
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University of North Carolina 01/10/11 NRTIs Retrovir Videx Zerit Hivid Epivir Ziagen Viread Emtriva ZDV ddI d4T ddC 3TC Abacavir Tenofovir FTC NNRTIs Intelence Etravirine Viramune Rescriptor Sustiva Nevirapine Delavirdine Efavirenz Protease Inhibitors Fortovase Viracept Crixivan Norvir Agenerase Kaletra Reyataz Aptivus Prezista Entry Inhibitors Fuzeon T-20 Selzentry Maraviroc Integrase Inhibitors Isentress Raltegravir Saquinavir
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This note was uploaded on 01/09/2011 for the course PUBH 420 taught by Professor Strauss during the Spring '09 term at UNC.

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Lecture 2 - Manifestations of Disease[1] - AIDS Course:...

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