Human immunodeficiency virus infection. Diagnostic and treatment issues in an expanding spectrum

Like many other viruses, human immunodeficiency virus (HIV) causes a broad array of host responses. Some persons mount an appropriate immune response after infection and remain asymptomatic, while others become progressively debilitated by the effects of the infection. Paradoxically, autoimmune disease can coexist with the immunodeficiency state. In addition, HIV has proven to be more versatile in its organ system involvement than a simple lymphotropic virus. The clinical manifestations in seropositive persons are complex and may mimic those of other diseases. Because of this complexity, HIV infection should be an important consideration in all persons from defined risk groups who have an unexplained illness. Although the optimal strategy for curtailing these devastating clinical problems is one of prevention, education and behavior modification have not entirely stopped the spread of any sexually transmitted virus. Vaccine development is being intensively studied but still has many scientific and practical problems to overcome. Failing prevention, the next conceivable level of intervention would be effective antiviral therapy. A multitude of agents have shown promise in vitro, but in vivo data are disappointing. One notable exception is the favorable outcome observed in preliminary trials of azidothymidine. Therapy aimed at reconstituting the immune response also has not lived up to its in vitro promise. A more productive approach in the future may be to combine this type of treatment with antiviral agents. Until more definitive methods become available, however, treating the multiple end-organ complications of HIV infection remains a difficult task.