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  • Print publication year: 2005
  • Online publication date: February 2010

3 - The immunology of pediatric HIV disease

from Part I - Scientific basis of pediatric HIV care

Summary

HIV-1 infection leads to profound immune dysfunction, resulting in the clinical manifestations of acquired immunodeficiency syndrome (AIDS). The damage that HIV-1 does to the immune system results from the direct, harmful effects that occur when HIV-1 infects a cell, the effects that virions and parts of virions have on cells that do not become infected, and the chronic cell activation that results from infection and the host's response to infection. Abnormal function of HIV-1-affected cells can then lead to dysfunction of other cell types, since the immune system is a highly interconnected system. The main target cells of HIV-1 include cells that are critical in the immune control of the virus, impairing the ability of the host to mount an effective immune response.

Immunopathogenesis

Primary infection

The majority of adult and adolescent HIV-1 infections are the result of exposure of HIV-1 to mucosal surfaces. This is likely true also for mother-to-child transmission that occurs peripartum and during breastfeeding. Studies of macaques inoculated intravaginally with simian immunodeficiency virus, an animal model for HIV-1, demonstrate the events of primary infection [1]. Dendritic cells, resident in the mucosa, transport HIV-1 to regional lymph nodes within 48 hours of exposure. Within the lymph node, CD4+ T cells become infected through interactions with dendritic cell-associated HIV-1. Subsequently, large numbers of new virions are produced, and infected T cells and free virus can be found in the peripheral blood and in lymph tissue throughout the body approximately 4–11 days after infection.

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