THE MOLECULAR-BIOLOGY AND PATHOGENESIS OF HIV-1 INFECTION

A fundamental difficulty in understanding the pathogenesis of human immunodeficiency virus (HIV) infection has been the prediction, based on early studies, that very few target cells in infected individuals harbor and express HIV. However, the recent application of more sensitive methods of viral detection indicates that the viral burden and magnitude of expression may be significantly higher than previously believed. The level of HIV replication in vivo appears to represent a balance between the complex viral mechanisms regulating HIV gene expression and the ability of the host immune system to recognize and eliminate infected cells. The activation and attenuation of HIV production also appears to intimately depend on important cellular factors involved in the normal host response to immunologic or inflammatory stimuli. Emerging data are illuminating a preliminary, but increasingly coherent, framework for understanding the pathogenesis of HIV-associated disease. Improved understanding of the natural history of HIV infection may facilitate the derivation and improved application of therapeutic interventions for treatment of the acquired immunodeficiency syndrome.