Human Immunodeficiency Viruses Types 1 and 2
Human immunodeficiency viruses types 1 and 2 (HIV-1 and HIV-2) are retroviruses that attack and destroy cells essential to the regulation of immune function, primarily the CD4-bearing lymphocytes. Of the two viruses, HIV-1 accounts for the vast majority o
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Richard A. Kaslow, Emily J. Erbelding, and Paul A. Goepfert
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Introduction
Human immunodeficiency virus type 1 (HIV-1) is a retrovirus that may produce an acute, usually self-limited mononucleosis-like syndrome but more inevitably causes a broad array of progressive clinical manifestations, widely known as the acquired immunodeficiency syndrome (AIDS). HIV type 2 (HIV-2) causes a similar but far less widespread infection and a generally more indolent chronic disease. This chapter emphasizes HIV-1 and selectively covers the more distinctive aspects of HIV-2. For centuries pandemic influenza and smallpox have decimated the inhabitants of whole countries, often surging through in a matter of weeks or months, then virtually disappearing almost as fast. HIV/AIDS insinuated itself into human populations over years, and its less dramatic appearance and its chronicity have posed a different but no less formidable threat. Since its recognition in 1981, AIDS has had a profound impact not simply on the health of nearly all nations of the world but on their economic, social, ethical, legal, and political structures. During those three decades, more resources have probably been invested in research on and care of individuals with HIV-1 infection than for any R.A. Kaslow, MD, MPH (*) Department of Epidemiology, University of Alabama at Birmingham School of Public Health, 2230 California St NW, Apt 2BE, Birmingham, AL 20008-3950, USA e-mail: [email protected] E.J. Erbelding, MD Division of AIDS, National Institute of Allergy and Infectious Diseases, NIH, Building 6700B, Room 4133, Bethesda, MD 20892, USA e-mail: [email protected] P.A. Goepfert, MD Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, 1900 University Boulevard, THT 229, Birmingham, AL 35294, USA e-mail: [email protected]
other infectious disease in history. Cumulative expenditures on research alone exceed the equivalent of tens of billions of US dollars. In terms of the information generated, as a crude comparison, for the period from late 1981 through 2012, the National Center for Biotechnology Information bibliographic resource PubMed lists more than 250,000 publications under the terms “AIDS” or “HIV,” compared with about 100,000 for “tuberculosis” and 55,000 for “influenza,” the two infectious diseases probably commanding the next highest levels of interest and support for research. In the years since the initial recognition of AIDS, teams of epidemiologists, virologists, immunologists, and scientists from many other disciplines have assembled an exquisitely detailed and comprehensive understanding of the two etiologic agents and their simian cousins, the complex biological and behavioral responses made by humans and primates and the factors in the physical, biological, and social environment that have driven this infection so relentlessly to pandemic proportions. Despite what has often seemed like painfully slow progress against the onslaught of HIV, multiple effective therapeutic agents have been devel
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