Immunopathogenesis of human immunodeficiency virus: Implications for immune-based therapies

Human immunodeficiency virus (HIV) infection leads to a state of CD4 lympho penia and generalized immune activation with subsequent development of oppo rtunistic infections and neoplasms. The use of highly active antiretroviral treatment has dramatically improved the clinical outcome for HIV-infected patients, but the associated cost and toxicity and the eventual development of drug resistance have underscored the need for additional therapeutic st rategies. Immune-based therapies, such as treatment with cytokines or immun osuppressants, adoptive immunotherapy, and therapeutic immunizations, are b eing intensely investigated as potential supplements to antiretroviral ther apy. Although much data have been generated as a result of these efforts, t o date there has been little evidence of the clinical efficacy of these str ategies. Randomized clinical studies remain critical in evaluating the clin ical significance and the role of immune-based therapies in the therapeutic armamentarium against HIV.