Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
DEFECTS IN HOST DEFENSES IN HIV INFECTION AND AIDS: CHARACTERISTICS AND PATHOGENESIS
Infect Dis Ther; 3:57-70 1989. Unique Identifier : AIDSLINE ICDB/90665438 Steinberg JP; Phair JP; Dept. of Medicine, Northwestern Univ. Medical Sch., Chicago, IL
Abstract:
With the discovery of HIV-1, a unifying hypothesis of infection followed by impairment and depletion of CD4 cells, followed by immunodeficiency leading to AIDS seemed plausible. HIV can infect many cells, including macrophages and B cells. Primary infection of these cells may be important in the development of the immunodeficiency characterizing AIDS. Characteristics and pathogenesis of the immunologic abnormalities in AIDS are reviewed, including T-lymphocyte defects (quantitative and functional abnormalities); natural killer cell activity; monocyte/macrophage, B lymphocyte, and polymorphonuclear (PMN) leukocyte function; suppressor substances; pathogenesis; and clinical consequences. The clinical consequences of the profound immunosuppression seen in AIDS are unrelenting infections with a wide range of opportunistic pathogens and 'opportunistic tumors' such as Kaposi's sarcoma (KS). The opportunistic infections typically are those associated with defective cell-mediated immunity. The organisms involved are primarily intracellular pathogens that can escape, or are unaffected by the antimicrobial actions of antibody and complement. A clear relationship exists between progressive cytomegalovirus (CMV) disease and the absence of in vitro cytotoxic T-cell response to CMV-infected cells. Histoplasmosis, coccidioidomycosis, and tuberculosis are relatively common infections in AIDS patients (pts) from areas endemic for the organisms. Pts with AIDS cannot mount antibody response to new antigens, yet infections indicative of B-cell dysfunction are not diagnostic of AIDS in adults. Pneumonias caused by Haemophilus influenzae and Streptococcus pneumoniae do occur at increased frequency in pts with AIDS and are commonly bacteremic. Because of past exposure to these organisms, the spontaneously secreting B cells in pts with AIDS probably afford some protection against these pathogens. Encapsulated organisms more commonly cause disease in pediatric pts with AIDS, possibly because of the lack of prior exposure to these bacteria and the absence of spontaneously produced protective antibody. Although a clear-cut defect in PMN leukocyte function has not been delineated, there are reports of serious staphylococcal infections, including pneumonia and cellulitis, complicating the course of pts with KS. HIV infects and alters the function of B cells and macrophages, but the relative importance of infection of the different cell types in the development of immunodeficiency is not known. (36 Refs)
Keywords: Acquired Immunodeficiency Syndrome/*IMMUNOLOGY B-Lymphocytes/IMMUNOLOGY CD4-Positive T-Lymphocytes/IMMUNOLOGY Glycoproteins/ANALYSIS Human HIV Infections/*IMMUNOLOGY HIV-1/*IMMUNOLOGY HIV-2/*IMMUNOLOGY Killer Cells, Natural/IMMUNOLOGY Leukocyte Count Macrophages/IMMUNOLOGY Monocytes/IMMUNOLOGY Opportunistic Infections/IMMUNOLOGY JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL 901030
M90A0696
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Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
