HIV-1 and its causal relationship to immunosuppression and nervous system disease in AIDS: A review

Acquired immune deficiency syndrome (AIDS), caused by human immunodeficienc y virus type 1 (HIV-1), has claimed more than 10 million lives over the pas t 15 years. There are approximately 30 million HIV-positive people worldwid e, 89% of whom reside in sub-Saharan Africa and Asia. The intricate relatio nship between the virus and HN-related human multisystem pathology prompted scientists to modify many previously established concepts about infectious diseases and immunology, and to test new ones. The results of this work he lped resolve many, albeit not all, long-standing problems concerning HIV-1 immune escape, its cellular tropism, and pathogenesis of HIV-related immuno suppression and nervous system disease. The most impressive advances have b een made in antiretroviral drug treatment of HIV infection, which has resul ted in dramatically reducing AIDS-related mortality, morbidity, and perinat al transmission. However, considering the magnitude of the worldwide HIV-AI DS pandemic, prohibitive cost and unusually exacting nature of combination drug treatment, as well as the emergence of drug-resistant HIV mutants, the disease and virus remain formidable and unpredictable, particularly in the area of prevention and vaccine development. Here, we have reviewed the mos t pertinent recently published studies of various aspects of HIV/AIDS inten ded to answer the following questions: what have we learned and what remain s to be determined regarding this unorthodox viral disorder? HUM PATHOL 31: 1274-1298. Copyright (C) 2000 by W.B. Saunders Company.