Abstract
The human immunodeficiency virus (HIV-1) is the etiologic agent of the acquired immune deficiency syndrome (AIDS). As the AIDS epidemic has spread worldwide, the prevailing focus has been on several salient features: first, that the disease is acquired (how can it be avoided?), and secondly, that it results in immunodeficiency (what are the immunopathologic correlates and how can they be reversed?). Far less attention has been devoted to the fact that HIV-1 infection produces a syndrome in which immunodeficiency is but one manifestation. Given the dramatic presentation of visibly end-stage patients, this emphasis is clinically sound. In terms of understanding pathogenesis, however, it is less useful. By analogy, the mechanistic basis of hypertension is not understood upon analysis of its end-stage sequelae: strokes and myocardial infarcts; likewise, the presentation of ketoacidosis does not immediately suggest a pancreatic β-cell defect in insulin production. To understand the syndrome of HIV-1 disease, it is perhaps more appropriate to expand our preclinical studies towards the basic pathogenic mechanisms of the virus which occur early in the course of disease, and which eventually lead to the clinical manifestations of immunodeficiency, wasting, neurological disorders, etc. In this manner, common reducible pathways may be delineated which would allow treatments to prevent late stage AIDS.
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Mccune, J.M., Kaneshima, H. (1995). The Hematopathology of HIV-1 Disease: Experimental Analysis in Vivo. In: Human Hematopoiesis in SCID Mice. Medical Intelligence Unit. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-22008-5_7
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