The Relationship between the Human Immunodeficiency Virus and the Acquired Immunodeficiency Syndrome (Draft)

DRAFT
HIV disease, however, is not uniformly expressed in all individuals. A small proportion
of persons infected with the virus develop AIDS and die within months following primary
infection, while approximately 5 percent of HIV-infected individuals exhibit no signs of disease
progression even after 12 or more years (Graziosi et al., 1994; Pantaleo et al., 1994;
Buchbinder et al., 1994; Ho, 1994). Host factors such as age or genetic differences between
individuals as well as exogenous influences such as co-infection with other microbes may
determine the rate and severity of HIV disease expression in different people (Fauci, 1993a;
Pantaleo et al., 1993a). Such variables have been termed "clinical illness promotion factors"
or co-factors and appear to influence the onset of clinical disease among those infected with
any pathogen (Evans, 1982). Most people infected with hepatitis B, for example, show no
symptoms or only jaundice and clear their infection, while others suffer disease ranging from
chronic liver inflammation to cirrhosis and hepatocellular carcinoma (Robinson, 1990). Cofactors probably also determine why some smokers develop lung cancer, while others do not
(Craib et al., 1992).
A number of studies suggest that individuals who experience a symptomatic, acute HIV
syndrome develop AIDS more rapidly than those who are asymptomatic following primary
infection, probably due to more extensive initial viral replication and spread throughout the
body in the symptomatic group (Bachemeyer et al., 1993; Tindall and Cooper, 1991; Keet et
al., 1993; Pedersen et al., 1989, 1993).
As disease progresses, increasing amounts of infectious virus, viral antigens, and HIVspecific nucleic acids in the body correlate with a worsening clinical course (Allain et al., 1987;
Nicholson et al., 1989; Ho et al., 1989; Schnittman et al., 1989; Mathez et al., 1990; Genesca
et al., 1990; Schnittman et al, 1990a; Schnittman et al, 1991; Hufert et al., 1991; Saag et al.,
1991; Aoki-Sei et al., 1992; Yeriy et al., 1992; Bagnarelli et al., 1992; Ferre et al., 1992;
Michael et al., 1992; Pantaleo et al., I1993b; Connor et al., 1993; Saksela et al., 1994).

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