Relation of the pathogenesis of human immunodeficiency virus infection to various strategies for its control

This paper reviews functionally important insights into the pathogenesis of human immunodeficiency virus (HIV) infection. The major sequela of this infection is early and progressive involvement of the immune system, with widespread immune dysfunction. This pathogenetic feature has a major impact on strategies for control of the infection. The immunosuppression caused by the virus leads to higher levels of viral replication and enhanced potential for development or selection of variant viruses, including forms that are more virulent or even drug resistant. Therefore, control of HIV infection and disease may require antiviral agents and CD4 receptor competitors as well as recombinant DNA-derived lymphokines and subunit vaccine immunotherapies. To be successful, such therapies must work to counter infection in monocytes and nonlymphoid cells as well as in T4 lymphocytes. Because many limbs of the immune system are affected by HIV infection, the complexities of this pathogen can be unraveled only by the careful study of immune functions during the disease and of effective interventions to control infection and disease and to restore immune functions.