Document 0022
 DOCN  M9460022
 TI    Human immunodeficiency virus and acquired immunodeficiency syndrome: an
       update.
 DT    9404
 AU    Schnittman SM; Fauci AS; Division of AIDS, National Institute of Allergy
       and Infectious; Diseases, National Institutes of Health, Bethesda,
       Maryland.
 SO    Adv Intern Med. 1994;39:305-55. Unique Identifier : AIDSLINE
       MED/94189359
 AB    Research progress in the understanding of HIV and its effects on the
       human immune system continues at a rapid pace. Such research is yielding
       new ideas for chemotherapeutic agents, immunologic stimulators and
       modifiers, and potential vaccines. Clinical trials to test these
       approaches are under way. Despite the accomplishments, the epidemic
       progresses unchecked, resulting in continued suffering and death and
       enormous demands on the health care system of many nations. Clinicians
       have had to deal with new and difficult opportunistic infections. Yet
       advances in the treatment and prevention of these illnesses have
       benefited many AIDS victims. In the United States, the AIDS epidemic is
       now concentrating in the inner cities, involving injection drug users,
       minorities, heterosexuals, women and their offspring. In the developing
       world, AIDS continues to be predominantly a heterosexually transmitted
       disease, where more than one third of prostitutes in central African
       cities are infected. The major burden of the AIDS epidemic in the
       remainder of this and the next century will be in India and Southeast
       Asia, again predominantly via heterosexual spread. A great deal is now
       understood concerning the life cycle of HIV. More light has been shed on
       the interaction of HIV and CD4+ T cells, the cellular and viral factors
       involved in viral expression vs. latency, the function of the viral
       regulatory and structural proteins and the role of cytokines in
       regulation of HIV expression. Our understanding of the precise
       mechanisms whereby HIV causes a loss of CD4+ T cells remains incomplete.
       The direct infection and cell killing of CD4+ T cells is important and
       is supported by recent evidence demonstrating a high viral burden in
       these cells in the lymphoid tissue of patients. Over the last 1 to 2
       years, there has been new evidence for indirect mechanisms of CD4+
       T-cell depletion and/or dysfunction including: autoimmune reactions,
       perturbations of specific V beta T-cell receptor populations, infection
       of T-cell precursors in bone marrow and thymus, immunosuppression and
       dysregulation by viral proteins, possible super-antigen effects, and
       antigen-induced apoptosis or programmed cell death. New information has
       come forth in our understanding of B-cell abnormalities in HIV
       pathogenesis, including the putative role of IL-6 in B-cell activation
       and the identification of EBV in B-cell lymphomas in the CNS of patients
       with AIDS. It is expected that these and future discoveries concerning
       immunopathogenesis of HIV infection will help steer the therapeutic
       effort. Major strides continue to be made in the therapeutic arena for
       HIV infection and its complications.(ABSTRACT TRUNCATED AT 400 WORDS)
 DE    *Acquired Immunodeficiency Syndrome/EPIDEMIOLOGY/THERAPY  AIDS Vaccines
       AIDS-Related Opportunistic Infections/THERAPY  Female  Gene Therapy
       Human  *HIV Infections/EPIDEMIOLOGY/THERAPY  *HIV-1  Male  Viral
       Vaccines  Zidovudine/THERAPEUTIC USE  JOURNAL ARTICLE  REVIEW  REVIEW,
       TUTORIAL

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