Given its population of CCR5 - expressing, immunologically activated CD4+ T cells, the gastrointestinal (GI) mucosa is uniquely susceptible to human immunodeficiency virus (HIV) - 1 infection.Recent studies have shown that, as in macaques infected with simian immunodeficiency virus (SIV), intestinal CD4+ T cells are selectively and rapidly depleted in the intestine of HIV - infected patients. Depletion of intestinal CD4+ T cells occurred at all stages of infection regardless of highly active antiretoviral therapy(HAART). Here we discuss the important implications of the recent findings for our understanding of HIV pathogenesis, treatment, and vaccine design. The major significance is that it supports a simple hypothesis to explain the pathogenesis of HIV infection, that most HIV replication occurs in the intestine and that disease progression may correlate with turnover of specific cell subsets in mucosal tissues.
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