Immunopathogenesis of HIV infection.

The rate of progression of HIV disease may be substantially different among HIV-infected individuals. Following infection of the host with any virus, the delicate balance between virus replication and the immune response to the virus determines both the outcome of the infection, i.e. the persistence versus elimination of the virus, and the different rates of progression. During primary HIV infection, a burst of viremia occurs that disseminates virus to the lymphoid organs. A potent immune response ensues that substantially, but usually not completely, curtails virus replication. This inability of the immune system to completely eliminate the virus leads to establishment of chronic, persistent infection that over time leads to profound immunosuppression. The potential mechanisms of virus escape from an otherwise effective immune response have been investigated. Clonal deletion of HIV-specific cytotoxic T-cell clones and sequestration of virus-specific cytotoxic cells away from the major site of virus replication represent important mechanisms of virus escape from the immune response that favor persistence of HIV. Qualitative differences in the primary immune response to HIV (i.e. mobilization of a restricted versus broader T-cell receptor repertoire) are associated with different rates of disease progression. Therefore, the initial interaction between the virus and immune system of the host is critical for the subsequent clinical outcome.