HIV disease progression rates

Last updated

Following infection with HIV-1, the rate of clinical disease progression varies between individuals. Factors such as host susceptibility, genetics and immune function, [1] health care and co-infections [2] as well as viral genetic variability [3] may affect the rate of progression to the point of needing to take medication in order not to develop AIDS.

Contents

Rapid progressors

A small percentage of HIV-infected individuals rapidly progress to AIDS if they fail to take the medication within four years after primary HIV-infection and are termed Rapid Progressors (RP). [4] Indeed, some individuals have been known to progress to AIDS and death within a year after primo-infection. Rapid progression was originally thought to be continent specific, as some studies reported that disease progression is more rapid in Africa, [4] [5] [6] but others have contested this view. [1] [2] [7] [8]

Long term non-progressors

Another subset of individuals who are persistently infected with HIV-1, but show no signs of disease progression for over 12 years and remain asymptomatic are classified as Long Term Non-Progressors (LTNP). In these individuals, it seems that HIV-infection has been halted with regard to disease progression over an extended period of time. [9] [10] [11] [12] However, the term LTNP is a misnomer as that progression towards AIDS can occur even after 15 years of stable infection. [13] LTNP are not a homogeneous group regarding both viral load and specific immune responses against HIV-1. Some LTNPs are infected with HIV that inefficiently replicates [14] [15] whilst others are infected with HIV that is virally fit and replicates normally, but the infected individual has had a strong and broad set of HIV-specific humoral and cell-mediated responses that seems to delay the progression to AIDS. In some cohorts, individuals who experience signs of progression, but whose clinical and laboratory parameters remain stable over long periods of time, are classified as Long Term Survivors (LTS). [3]

Highly exposed persistently seronegative

There is another, smaller percentage of individuals who have been recently identified. These are called Highly Exposed Persistently Seronegative (HEPS). This is a small group of individuals and has been observed only in a group of uninfected HIV-negative sex workers in Kenya and in The Gambia. When these individuals' PBMCs are stimulated with HIV-1 peptides, they have lymphoproliferative activity and have HIV-1 specific CD8+ CTL activity suggesting that transient infection may have occurred. [16] [17] [18] [19] This does not occur in unexposed individuals. What is interesting, is that the CTL epitope specificity differs between HEPS and HIV positive individuals, and in HEPS, the maintenance of responses appears to be dependent upon persistent exposure to HIV. [20]

Prediction of progression rates

During the initial weeks after HIV infection, qualitative differences in the cell-mediated immune response are observed that correlate with different disease progression rates (i.e., rapid progression to WHO stage 4 and the rapid loss of CD4+ T cell levels versus normal to slow progression to WHO stage 4 and the maintenance of CD4+ T cell counts above 500/μL). The appearance of HIV-1-specific CD8+ cytotoxic T cells (CTLs) early after primo-infection has been correlated with the control of HIV-1 viremia. [21] [22] The virus which escapes this CTL response have been found to have mutations in specific CTL epitopes. [23] [24] [25] [26] Individuals with a broad expansion of the V-beta chain of the T cell receptor of CD8+ T cells during primo-infection appear to have low levels of virus six to twelve months later, which is predictive of relatively slow disease progression. In contrast, individuals with an expansion of only a single subset of the V-beta chain of the CD8+ T cells are not able to control HIV levels over time, and thus have high viral loads six to twelve months later. [27] LTNP’s have also been shown to have a vigorous proliferation of circulating activated HIV-1-specific CD4+ T cell [28] and CTL response [29] [30] against multiple epitopes with no detectable broadly cross-reactive neutralizing antibodies in the setting of an extremely low viral load. [13] However, a few reports have correlated the presence of antibodies against Tat in LTNP status.[ citation needed ]

HIV subtype variation and effect on progression rates

The HIV-1 subtype that an individual becomes infected with can be a major factor in the rate of progression from sero-conversion to AIDS. Individuals infected with subtypes C, D and G are 8 times more likely to develop AIDS than individuals infected with subtype A. [31] In Uganda, where subtypes A and D are most prevalent, [32] subtype D is associated with faster disease progression compared with subtype A. [33] Age has also been shown to be a major factor in determining survival and the rate of disease progression, with individuals over 40 years of age at sero-conversion being associated with rapid progression. [34] [35] [36] [37]

Host genetic susceptibility

The Centers for Disease Control and Prevention (CDC) has released findings that genes influence susceptibility to HIV infection and progression to AIDS. HIV enters cells through an interaction with both CD4 and a chemokine receptor of the 7 transmembrane family. They first reviewed the role of genes in encoding chemokine receptors (CCR5 and CCR2) and chemokines (SDF-1). While CCR5 has multiple variants in its coding region, the deletion of a 32-bp segment results in a nonfunctional receptor, thus preventing HIV entry; two copies of this gene provide strong protection against HIV infection, although the protection is not absolute. This allele is found in around 10% of Europeans but is rare in Africans and Asians. Multiple studies of HIV-infected persons have shown that the presence of one copy of this mutation, named CCR5-Δ32 (CCR5 delta 32) delays progression to the condition of AIDS by about 2 years.[ citation needed ]

The National Institute of Health (NIH) has funded research studies to learn more about this genetic mutation. In such research, NIH has found that there exist genetic tests that can determine if a person has this mutation. Implications of a genetic test may in the future allow clinicians to change treatment for the HIV infection according to the genetic makeup of an individual, [38] Currently there exist several at-home tests for the CCR5 mutation in individuals; however, they are not diagnostic tests.[ citation needed ]

A relatively new class of drugs for HIV treatment relies on the genetic makeup of the individual. Entry inhibitors bind to the CCR5 protein to block HIV from binding to the CD4 cell.[ citation needed ]

The effect of co-infections on progression rates

Coinfections or immunizations may enhance viral replication by inducing a response and activation of the immune system. This activation facilitates the three key stages of the viral life cycle: entry to the cell; reverse transcription and proviral transcription. [39] Chemokine receptors are vital for the entry of HIV into cells. The expression of these receptors is inducible by immune activation caused by infection or immunization, thus augmenting the number of cells that can be infected by HIV-1. [40] [41] Both reverse transcription of the HIV-1 genome and the rate of transcription of proviral DNA rely upon the activation state of the cell and are less likely to be successful in quiescent cells. In activated cells, there is an increase in the cytoplasmic concentrations of mediators required for reverse transcription of the HIV genome. [42] [43] Activated cells also release IFN-alpha which acts on an autocrine and paracrine loop that up-regulates the levels of physiologically active NF-kappa B which activates host cell genes as well as the HIV-1 LTR. [44] [45] The impact of co-infections by micro-organisms such as Mycobacterium tuberculosis can be important in disease progression, particularly for those who have a high prevalence of chronic and recurrent acute infections and poor access to medical care. [46] Often, survival depends upon the initial AIDS-defining illness. [37] Co-infection with DNA viruses such as HTLV-1, herpes simplex virus-2, varicella zoster virus, and cytomegalovirus may enhance proviral DNA transcription and thus viral load as they may encode proteins that can trans-activate the expression of the HIV-1 pro-viral DNA. [47] Frequent exposure to helminth infections, which are endemic in Africa, activates individual immune systems, thereby shifting the cytokine balance away from an initial Th1 cell response against viruses and bacteria which would occur in the uninfected person to a less protective T helper 0/2-type response. [48] HIV-1 also promotes a Th1 to Th0 shift and replicates preferentially in Th2 and Th0 cells. [49] This makes the host more susceptible to and less able to cope with infection with HIV-1, viruses and some types of bacteria. Ironically, exposure to dengue virus seems to slow HIV progression rates temporarily.[ citation needed ]

See also

Related Research Articles

<span class="mw-page-title-main">HIV</span> Human retrovirus, cause of AIDS

The human immunodeficiency viruses (HIV) are two species of Lentivirus that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive. Without treatment, the average survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype.

<span class="mw-page-title-main">HIV vaccine development</span> In-progress vaccinations that may prevent or treat HIV infections

An HIV vaccine is a potential vaccine that could be either a preventive vaccine or a therapeutic vaccine, which means it would either protect individuals from being infected with HIV or treat HIV-infected individuals.

The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs as a strategy to control HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life-cycle. The use of multiple drugs that act on different viral targets is known as highly active antiretroviral therapy (HAART). HAART decreases the patient's total burden of HIV, maintains function of the immune system, and prevents opportunistic infections that often lead to death. HAART also prevents the transmission of HIV between serodiscordant same-sex and opposite-sex partners so long as the HIV-positive partner maintains an undetectable viral load.

<span class="mw-page-title-main">Cytotoxic T cell</span> T cell that kills infected, damaged or cancerous cells

A cytotoxic T cell (also known as TC, cytotoxic T lymphocyte, CTL, T-killer cell, cytolytic T cell, CD8+ T-cell or killer T cell) is a T lymphocyte (a type of white blood cell) that kills cancer cells, cells that are infected by intracellular pathogens (such as viruses or bacteria), or cells that are damaged in other ways.

<span class="mw-page-title-main">T helper cell</span> Type of immune cell

The T helper cells (Th cells), also known as CD4+ cells or CD4-positive cells, are a type of T cell that play an important role in the adaptive immune system. They aid the activity of other immune cells by releasing cytokines. They are considered essential in B cell antibody class switching, breaking cross-tolerance in dendritic cells, in the activation and growth of cytotoxic T cells, and in maximizing bactericidal activity of phagocytes such as macrophages and neutrophils. CD4+ cells are mature Th cells that express the surface protein CD4. Genetic variation in regulatory elements expressed by CD4+ cells determines susceptibility to a broad class of autoimmune diseases.

The spread of HIV/AIDS has affected millions of people worldwide; AIDS is considered a pandemic. The World Health Organization (WHO) estimated that in 2016 there were 36.7 million people worldwide living with HIV/AIDS, with 1.8 million new HIV infections per year and 1 million deaths due to AIDS. Misconceptions about HIV and AIDS arise from several different sources, from simple ignorance and misunderstandings about scientific knowledge regarding HIV infections and the cause of AIDS to misinformation propagated by individuals and groups with ideological stances that deny a causative relationship between HIV infection and the development of AIDS. Below is a list and explanations of some common misconceptions and their rebuttals.

<i>Simian immunodeficiency virus</i> Species of retrovirus

Simian immunodeficiency virus (SIV) is a species of retrovirus that cause persistent infections in at least 45 species of non-human primates. Based on analysis of strains found in four species of monkeys from Bioko Island, which was isolated from the mainland by rising sea levels about 11,000 years ago, it has been concluded that SIV has been present in monkeys and apes for at least 32,000 years, and probably much longer.

<span class="mw-page-title-main">CCR5</span> Immune system protein

C-C chemokine receptor type 5, also known as CCR5 or CD195, is a protein on the surface of white blood cells that is involved in the immune system as it acts as a receptor for chemokines.

AIDS-defining clinical conditions is the list of diseases published by the Centers for Disease Control and Prevention (CDC) that are associated with AIDS and used worldwide as a guideline for AIDS diagnosis. CDC exclusively uses the term AIDS-defining clinical conditions, but the other terms remain in common use.

<span class="mw-page-title-main">Envelope glycoprotein GP120</span> Glycoprotein exposed on the surface of the HIV virus

Envelope glycoprotein GP120 is a glycoprotein exposed on the surface of the HIV envelope. It was discovered by Professors Tun-Hou Lee and Myron "Max" Essex of the Harvard School of Public Health in 1984. The 120 in its name comes from its molecular weight of 120 kDa. Gp120 is essential for virus entry into cells as it plays a vital role in attachment to specific cell surface receptors. These receptors are DC-SIGN, Heparan Sulfate Proteoglycan and a specific interaction with the CD4 receptor, particularly on helper T-cells. Binding to CD4 induces the start of a cascade of conformational changes in gp120 and gp41 that lead to the fusion of the viral membrane with the host cell membrane. Binding to CD4 is mainly electrostatic although there are van der Waals interactions and hydrogen bonds.

HIV-associated neurocognitive disorders (HAND) are neurological disorders associated with HIV infection and AIDS. It is a syndrome of progressive deterioration of memory, cognition, behavior, and motor function in HIV-infected individuals during the late stages of the disease, when immunodeficiency is severe. HAND may include neurological disorders of various severity. HIV-associated neurocognitive disorders are associated with a metabolic encephalopathy induced by HIV infection and fueled by immune activation of macrophages and microglia. These cells are actively infected with HIV and secrete neurotoxins of both host and viral origin. The essential features of HIV-associated dementia (HAD) are disabling cognitive impairment accompanied by motor dysfunction, speech problems and behavioral change. Cognitive impairment is characterised by mental slowness, trouble with memory and poor concentration. Motor symptoms include a loss of fine motor control leading to clumsiness, poor balance and tremors. Behavioral changes may include apathy, lethargy and diminished emotional responses and spontaneity. Histopathologically, it is identified by the infiltration of monocytes and macrophages into the central nervous system (CNS), gliosis, pallor of myelin sheaths, abnormalities of dendritic processes and neuronal loss.

Entry inhibitors, also known as fusion inhibitors, are a class of antiviral drugs that prevent a virus from entering a cell, for example, by blocking a receptor. Entry inhibitors are used to treat conditions such as HIV and hepatitis D.

HIV superinfection is a condition in which a person with an established human immunodeficiency virus infection acquires a second strain of HIV, often of a different subtype. These can form a recombinant strain that co-exists with the strain from the initial infection, as well from reinfection with a new virus strain, and may cause more rapid disease progression or carry multiple resistances to certain HIV medications.

CD4 immunoadhesin is a recombinant fusion protein consisting of a combination of CD4 and the fragment crystallizable region, similarly known as immunoglobulin. It belongs to the antibody (Ig) gene family. CD4 is a surface receptor for human immunodeficiency virus (HIV). The CD4 immunoadhesin molecular fusion allow the protein to possess key functions from each independent subunit. The CD4 specific properties include the gp120-binding and HIV-blocking capabilities. Properties specific to immunoglobulin are the long plasma half-life and Fc receptor binding. The properties of the protein means that it has potential to be used in AIDS therapy as of 2017. Specifically, CD4 immunoadhesin plays a role in antibody-dependent cell-mediated cytotoxicity (ADCC) towards HIV-infected cells. While natural anti-gp120 antibodies exhibit a response towards uninfected CD4-expressing cells that have a soluble gp120 bound to the CD4 on the cell surface, CD4 immunoadhesin, however, will not exhibit a response. One of the most relevant of these possibilities is its ability to cross the placenta.

Long-term nonprogressors (LTNPs), are individuals infected with HIV, who maintain a CD4 count greater than 500 without antiretroviral therapy with a detectable viral load. Many of these patients have been HIV positive for 30 years without progressing to the point of needing to take medication in order not to develop AIDS. They have been the subject of a great deal of research, since an understanding of their ability to control HIV infection may lead to the development of immune therapies or a therapeutic vaccine. The classification "Long-term non-progressor" is not permanent, because some patients in this category have gone on to develop AIDS.

AntiViral-HyperActivation Limiting Therapeutics (AV-HALTs) are an investigational class of antiretroviral drugs used to treat Human Immunodeficiency Virus (HIV) infection. Unlike other antiretroviral agents given to reduce viral replication, AV-HALTs are single or combination drugs designed to reduce the rate of viral replication while, at the same time, also directly reducing the state of immune system hyperactivation now believed to drive the loss of CD4+ T helper cells leading to disease progression and Acquired Immunodeficiency Syndrome (AIDS).

<span class="mw-page-title-main">HIV/AIDS research</span> Field of immunology research

HIV/AIDS research includes all medical research that attempts to prevent, treat, or cure HIV/AIDS, as well as fundamental research about the nature of HIV as an infectious agent and AIDS as the disease caused by HIV.

A small proportion of humans show partial or apparently complete innate resistance to HIV, the virus that causes AIDS. The main mechanism is a mutation of the gene encoding CCR5, which acts as a co-receptor for HIV. It is estimated that the proportion of people with some form of resistance to HIV is under 10%.

Gene Martin Shearer is an American immunologist who works at the National Institutes of Health (NIH). He first achieved fame for his discovery in 1974 that T lymphocytes recognized chemically modified surface antigens only in the context of self major histocompatibility complex (MHC) encoded molecules, identifying the central feature of antigen recognition by T lymphocytes known as MHC restriction. His discovery of MHC restriction using chemically modified surface antigens was simultaneous with the discovery of MHC restricted T lymphocyte recognition of virus infected cells by Rolf Zinkernagel and Peter Doherty, who received the 1996 Nobel Prize in Physiology or Medicine.

M. Juliana “Julie” McElrath is a senior vice president and director of the vaccine and infection disease division at Fred Hutchinson Cancer Research Center and the principal investigator of the HIV Vaccine Trials Network Laboratory Center in Seattle, Washington. She is also a professor at the University of Washington.

References

  1. 1 2 Morgan, D.; C. Mahe; B. Mayanja; J.M. Okongo; R. Lubega; J.A. Whitworth (2002). "HIV-1 infection in rural Africa: is there a difference in median time to AIDS and survival compared with that in industrialized countries?". AIDS. 16 (4): 597–603. doi: 10.1097/00002030-200203080-00011 . PMID   11873003. S2CID   35450422.
  2. 1 2 Morgan, D.; C. Mahe; B. Mayanja; J.A. Whitworth (2002). "Progression to symptomatic disease in people infected with HIV-1 in rural Uganda: prospective cohort study". BMJ. 324 (7331): 193–196. doi:10.1136/bmj.324.7331.193. ISSN   1180-9639. PMC   64788 . PMID   11809639.
  3. 1 2 Campbell, G.R.; et al. (2004). "The glutamine-rich region of HIV-1 Tat protein involved in T cell apoptosis". Journal of Biological Chemistry. 279 (46): 48197–48204. doi: 10.1074/jbc.M406195200 . PMID   15331610.
  4. 1 2 Anzala, O.A.; N.J. Nagelkerke; J.J. Bwayo; D. Holton; S. Moses; E.N. Ngugi; J.O. Ndinya-Achola; F.A. Plummer (1995). "Rapid progression to disease in African sex workers with human immunodeficiency virus type 1 infection". Journal of Infectious Diseases. 171 (3): 686–689. doi:10.1093/infdis/171.3.686. PMID   7876618.
  5. N'Galy B, Ryder RW, Bila K, Mwandagalirwa K, Colebunders RL, Francis H, Mann JM, Quinn TC (1988). "Human immunodeficiency virus infection among employees in an African hospital". N. Engl. J. Med. 319 (17): 1123–7. doi:10.1056/NEJM198810273191704. PMID   3262826.
  6. Whittle, H.; A. Egboga; J. Todd; T. Corrah; A. Wilkins; E. Demba; G. Morgan; M. Rolfe; N. Berry; R. Tedder (1992). "Clinical and laboratory predictors of survival in Gambian patients with symptomatic HIV-1 or HIV-1 infection". AIDS. 6 (7): 685–689. doi:10.1097/00002030-199207000-00011. PMID   1354448. S2CID   21272316.
  7. French, N.; A. Mujugira; J. Nakiyingi; D. Mulder; E.N. Janoff; C.R. Gilks (1999). "Immunologic and clinical stages in HIV-1-infected Ugandan adults are comparable and provide no evidence of rapid progression but poor survival with advanced disease". Journal of Acquired Immune Deficiency Syndromes. 22 (5): 509–516. doi: 10.1097/00126334-199912150-00013 . PMID   10961614.
  8. Buchbinder, S.P.; M.H. Katz; N.A. Hessol; P.M. O'Malley; S.D. Holmberg (1994). "Long-term HIV-1 infection without immunologic progression". AIDS. 8 (8): 1123–1128. doi:10.1097/00002030-199408000-00014. PMID   7986410. S2CID   22313180.
  9. Cao, Y.; L. Qin; L. Zhang; J. Safrit; D.D. Ho (1995). "Virologic and immunologic characterization of long-term survivors of human immunodeficiency virus type 1 infection". New England Journal of Medicine. 332 (4): 201–208. doi: 10.1056/NEJM199501263320401 . PMID   7808485.
  10. Easterbrook, P.J. (1994). "Non-progression in HIV infection". AIDS. 8 (8): 1179–1182. doi:10.1097/00002030-199408000-00023. PMID   7832923.
  11. Lévy, J.A. (1993). "HIV pathogenesis and long-term survival". AIDS. 7 (11): 1401–1410. doi:10.1097/00002030-199311000-00001. PMID   8280406.
  12. 1 2 Harrer, T.; et al. (1996). "Strong cytotoxic T cell and weak neutralizing antibody responses in a subset of persons with stable nonprogressing HIV type 1 infection". AIDS Research and Human Retroviruses. 12 (7): 585–592. doi:10.1089/aid.1996.12.585. PMID   8743084.
  13. Deacon, N.J.; et al. (1995). "Genomic structure of an attenuated quasi species of HIV-1 from a blood transfusion donor and recipients". Science. 270 (5238): 988–991. Bibcode:1995Sci...270..988D. doi:10.1126/science.270.5238.988. PMID   7481804. S2CID   37165030.
  14. Kirchhoff, F.; T.C. Greenough; D.B. Brettler; J.L. Sullivan; R.C. Desrosiers (1995). "Brief report: absence of intact nef sequences in a long-term survivor with nonprogressive HIV-1 infection". New England Journal of Medicine. 332 (4): 228–232. doi: 10.1056/NEJM199501263320405 . PMID   7808489.
  15. Clerici, M.; J.M. Levin; H.A. Kessler; A. Harris; J.A. Berzofsky; A.L. Landay; G.M. Shearer (1994). "HIV-specific T- helper activity in seronegative health care workers exposed to contaminated blood". JAMA. 271 (1): 42–46. doi:10.1001/jama.271.1.42. PMID   8258885.
  16. Pinto, L.A.; J. Sullivan; J.A. Berzofsky; M. Clerici; H.A. Kessler; A.L. Landay; G.M. Shearer (1995). "ENV-specific cytotoxic T lymphocyte responses in HIV seronegative health care workers occupationally exposed to HIV-contaminated body fluids". Journal of Clinical Investigation. 96 (2): 867–876. doi:10.1172/JCI118133. PMC   185273 . PMID   7635981.
  17. Rowland-Jones, S.; et al. (1995). "HIV-specific cytotoxic T-cells in HIV-exposed but uninfected Gambian women". Nature Medicine. 1 (1): 59–64. doi: 10.1038/nm0195-59 . PMID   7584954. S2CID   10365931.
  18. Fowke, K.R.; et al. (1996). "Resistance to HIV-1 infection among persistently seronegative prostitutes in Nairobi, Kenya". Lancet. 348 (9038): 1347–1351. doi:10.1016/S0140-6736(95)12269-2. PMID   8918278. S2CID   21584303.
  19. Kaul, R.; et al. (2001). "New insights into HIV-1 specific cytotoxic T cell responses in exposed, persistently seronegative Kenyan sex workers". Immunology Letters. 79 (1–2): 3–13. doi:10.1016/S0165-2478(01)00260-7. PMID   11595284.
  20. Koup, R.A.; J.T. Safrit; Y.Z. Cao (1994). "Temporal association of cellular immune responses with the initial control of viremia in primary human immunodeficiency virus type 1 syndrome". Journal of Virology. 68 (7): 4650–4655. doi:10.1128/JVI.68.7.4650-4655.1994. PMC   236393 . PMID   8207839.
  21. Borrow, P.; H. Lewicki; B.H. Hahn; G.M. Shaw; M.B. Oldstone (1994). "Virus-specific CD8+ cytotoxic T-lymphocyte activity associated with control of viremia in primary human immunodeficiency virus type 1 infection". Journal of Virology. 68 (9): 6103–6110. doi:10.1128/JVI.68.9.6103-6110.1994. PMC   237022 . PMID   8057491.
  22. Phillips, R.E.; et al. (1991). "Human immunodeficiency virus genetic variation that can escape cytotoxic T cell recognition". Nature. 354 (6353): 453–459. Bibcode:1991Natur.354..453P. doi: 10.1038/354453a0 . PMID   1721107. S2CID   4257933.
  23. Borrow, P.; et al. (1997). "Antiviral pressure exerted by HIV-1-specific cytotoxic T cells (CTLs) during primary infection demonstrated by rapid selection of CTL escape virus". Nature Medicine. 3 (2): 205–211. doi:10.1038/nm0297-205. PMID   9018240. S2CID   8808145.
  24. Price, D.A.; P.J. Goulder; P. Klenerman; A.K. Sewell; P.J. Easterbrook; M. Troop; C.R. Bangham; R.E. Phillips (1997). "Positive selection of HIV-1 cytotoxic T lymphocyte escape variants during primary infection". PNAS. 94 (5): 1890–1895. Bibcode:1997PNAS...94.1890P. doi: 10.1073/pnas.94.5.1890 . PMC   20013 . PMID   9050875.
  25. Rowland-Jones, S.L.; et al. (1992). "Human immunodeficiency virus variants that escape cytotoxic T-cell recognition". AIDS Research and Human Retroviruses. 8 (9): 1353–1354. doi:10.1089/aid.1992.8.1353. PMID   1466955.
  26. Pantaleo, G.; et al. (1997). "The qualitative nature of the primary immune response to HIV infection is a prognosticator of disease progression independent of the initial level of plasma viremia". PNAS. 94 (1): 254–258. Bibcode:1997PNAS...94..254P. doi: 10.1073/pnas.94.1.254 . PMC   19306 . PMID   8990195.
  27. Rosenberg, E.S.; J.M. Billingsley; A.M. Caliendo; S.L. Boswell; P.E. Sax; S.A. Kalams; B.D. Walker (1997). "Vigorous HIV-1-specific CD4+ T cell responses associated with control of viremia". Science. 278 (5342): 1447–1450. Bibcode:1997Sci...278.1447R. doi:10.1126/science.278.5342.1447. PMID   9367954.
  28. Rowland-Jones, S.L.; et al. (1999). "Broadly cross-reactive HIV-specific cytotoxic T-lymphocytes in highly exposed persistently seronegative donors". Immunology Letters. 66 (1–3): 9–14. doi:10.1016/S0165-2478(98)00179-5. PMID   10203028.
  29. Dyer, W.B.; et al. (199). "Strong Human Immunodeficiency Virus (HIV)-Specific Cytotoxic T-Lymphocyte Activity in Sydney Blood Bank Cohort Patients Infected with nef-Defective HIV Type 1". Journal of Virology. 73 (1): 436–443. doi:10.1128/JVI.73.1.436-443.1999. PMC   103850 . PMID   9847349.
  30. Kanki, P.J.; et al. (1999). "Human immunodeficiency virus type 1 subtypes differ in disease progression". Journal of Infectious Diseases. 179 (1): 68–73. doi: 10.1086/314557 . PMID   9841824.
  31. Kaleebu, P.; et al. (2000). "Molecular epidemiology of HIV type 1 in a rural community in southwest Uganda". AIDS Research and Human Retroviruses. 16 (5): 393–401. doi:10.1089/088922200309052. PMID   10772525.
  32. Kaleebu, P.; et al. (2002). "Effect of human immunodeficiency virus (HIV) type 1 envelope subtypes A and D on disease progression in a large cohort of HIV-1-positive persons in Uganda". Journal of Infectious Diseases. 185 (9): 1244–1250. doi: 10.1086/340130 . PMID   12001041.
  33. Koblin, B.A.; et al. (1999). "Long-term survival after infection with human immunodeficiency virus type 1 (HIV-1) among homosexual men in hepatitis B vaccine trial cohorts in Amsterdam, New York City, and San Francisco, 1978-1995". American Journal of Epidemiology. 150 (10): 1026–1030. doi: 10.1093/oxfordjournals.aje.a009926 . PMID   10568617.
  34. Pezzotti, P.; N. Galai; D. Vlahov; G. Rezza; C.M. Lyles; J. Astemborski (1999). "Direct comparison of time to AIDS and infectious disease death between HIV seroconverter injection drug users in Italy and the United States: results from the ALIVE and ISS studies. AIDS Link to Intravenous Experiences. Italian Seroconversion Study". Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. 20 (3): 275–282. doi: 10.1097/00042560-199903010-00010 . PMID   10077177.
  35. Collaborative Group on AIDS Incubation and HIV Survival including the CASCADE EU Concerted Action. Concerted Action on SeroConversion to AIDS and Death in Europe (2000). "Time from HIV-1 seroconversion to AIDS and death before widespread use of highly active antiretroviral therapy: a collaborative re-analysis". Lancet. 355 (9210): 1131–1137. doi:10.1016/S0140-6736(00)02061-4. PMID   10791375. S2CID   30898766.
  36. 1 2 Morgan, D.; G.H. Maude; S.S. Malamba; M.J. Okongo; H.U. Wagner; D.W. Mulder; J.A. Whitworth (1997). "HIV-1 disease progression and AIDS-defining disorders in rural Uganda". Lancet. 350 (9073): 245–250. doi:10.1016/S0140-6736(97)01474-8. PMID   9242801. S2CID   22453416.
  37. Gonzalez, E.; et al. (2005). "The influence of CCL3L1 gene-containing segmental duplications on HIV-1/AIDS susceptibility". Science. 307 (5714): 1422–1424. Bibcode:2005Sci...307.1434G. doi:10.1126/science.1101160. PMID   15637236. S2CID   8815153.
  38. Lawn, S.D.; S.T. Butera; T.M. Folks (2001). "Contribution of Immune Activation to the Pathogenesis and Transmission of Human Immunodeficiency Virus Type 1 Infection". Clinical Microbiology Reviews. 14 (4): 753–777. doi:10.1128/CMR.14.4.753-777.2001. PMC   89002 . PMID   11585784.
  39. Wahl, S.M.; T. Greenwell-Wild; G. Peng; H. Hale-Donze; T.M. Doherty; D. Mizel; J.M. Orenstein (1998). "Mycobacterium avium complex augments macrophage HIV-1 production and increases CCR5 expression". PNAS. 95 (21): 12574–12579. Bibcode:1998PNAS...9512574W. doi: 10.1073/pnas.95.21.12574 . PMC   22872 . PMID   9770527.
  40. Juffermans NP, Speelman P, Verbon A, Veenstra J, Jie C, van Deventer SJ, van Der Poll T (2001). "Patients with active tuberculosis have increased expression of HIV coreceptors CXCR4 and CCR5 on CD4(+) T cells" (PDF). Clinical Infectious Diseases. 32 (4): 650–652. doi: 10.1086/318701 . PMID   11181132.
  41. Zack, J.A.; S.J. Arrigo; S.R. Weitsman; A.S. Go; A. Haislip; I.S. Chen (1990). "HIV-1 entry into quiescent primary lymphocytes: molecular analysis reveals a labile, latent viral structure". Cell. 61 (2): 213–222. doi:10.1016/0092-8674(90)90802-L. PMID   2331748. S2CID   324887.
  42. Kinoshita, S.; B.K. Chen; H. Kaneshima; G.P. Nolan (1998). "Host control of HIV-1 parasitism in T cells by the nuclear factor of activated T cells". Cell. 95 (5): 595–604. doi: 10.1016/S0092-8674(00)81630-X . PMID   9845362. S2CID   17954556.
  43. Gaynor, R. (1992). "Cellular transcription factors involved in the regulation of HIV-1 gene expression". AIDS. 6 (4): 347–363. doi:10.1097/00002030-199204000-00001. PMID   1616633.
  44. Baeuerle, P.A. (1991). "The inducible transcription activator NF-kappa B: regulation by distinct protein subunits". Biochimica et Biophysica Acta (BBA) - Reviews on Cancer. 1072 (1): 63–80. doi:10.1016/0304-419x(91)90007-8. PMID   2018779.
  45. Blanchard, A.; L. Montagnier; M.L. Gougeon (1997). "Influence of microbial infections on the progression of HIV disease". Trends in Microbiology. 5 (8): 326–331. doi:10.1016/S0966-842X(97)01089-5. PMID   9263412.
  46. Gendelman, H.E.; et al. (1986). "Trans-activation of the human immunodeficiency virus long terminal repeat sequence by DNA viruses". PNAS. 83 (24): 9759–9763. Bibcode:1986PNAS...83.9759G. doi: 10.1073/pnas.83.24.9759 . PMC   387220 . PMID   2432602.
  47. Bentwich, Z.; A. Kalinkovich; Z. Weisman (1995). "Immune activation is a dominant factor in the pathogenesis of African AIDS". Immunology Today. 16 (4): 187–191. doi:10.1016/0167-5699(95)80119-7. PMID   7734046.
  48. Maggi, E.; et al. (1994). "Ability of HIV to promote a TH1 to TH0 shift and to replicate preferentially in TH2 and TH0 cells". Science. 265 (5169): 244–248. doi:10.1126/science.8023142. PMID   8023142.