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Acute and Recent HIV InfectionQuestion 8/10

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A 28-year-old cisgender man who has sex with men was recently diagnosed with HIV. He describes having a severe mononucleosis illness about 6 months ago, and he believes he acquired HIV around that time. Initial laboratory studies show a CD4 cell count of 635 cells/mm3 and an HIV RNA level of 71,328 copies/mL.

Which one of the following is believed to play the most important role in the immune response and control of acute HIV?

The cytotoxic T-lymphocytes (CTLs) respond to initial HIV infection by detecting viral peptides that are processed in cells infected with HIV. The CTL response can reduce HIV spread to other cells, but it is not adequate to eradicate HIV from the body. In general, the more robust the HIV-specific CTL response, the lower the plasma HIV RNA level and the slower the progression to AIDS.
Figure 1. Immune Response to Acute HIV: Cytotoxic T-Lymphocyte Responses
The cytotoxic T-lymphocytes (CTLs) respond to initial HIV infection by detecting viral peptides that are processed in cells infected with HIV. The CTL response can reduce HIV spread to other cells, but it is not adequate to eradicate HIV from the body. In general, the more robust the HIV-specific CTL response, the lower the plasma HIV RNA level and the slower the progression to AIDS.
Source: Walker BD, Goulder PJ. AIDS. Escape from the immune system. Nature. 2000;407:313-4.
Illustration: David H. Spach, MD
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Question Last Updated
September 19th, 2023

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