Pathogenesis of AIDS and Replication of HIV

1. HIV-1 initially infects T cells and macrophages directly or is carried to these cells by dendritic cells.
2. Viral replication in the regional lymph nodes leads to viremia and widespread seeding of lymphoid tissue.
3. The viremia is controlled by the host immune response, and the patient then enters a phase of clinical latency. During this phase, viral replication in both T cells and macrophages continues unabated, but there is some immune containment of virus.
4. There continues a gradual erosion of CD4+ cells by productive infection or other mechanisms. 
5. When the CD4+ cells that are destroyed cannot be replenished, CD4+ cell numbers decline and the patient develops clinical symptoms of full-blown AIDS. 
6. Macrophages are also parasitized by the virus early; they are not lysed by HIV-1, and they can transport the virus to various tissues, particularly the brain.

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