Reviews and feature articlesHIV-1 superinfection☆
Section snippets
AIDS virus superinfections in animal models
The potential for HIV-1 superinfection to occur was first described in chimpanzees,23 although the reality of this phenomenon occurring in human subjects remained speculative. Supporting in vitro evidence for HIV-1 superinfection was generated from studies documenting the ability to superinfect chronically HIV-1–infected T cells.23 In contrast, other in vitro studies indicated that reinfection might be prevented through various aspects, including CD4 downregulation and post entry interference.24
HIV-1 superinfection
Although the data from animal models show that superinfection is possible, until recently, no convincing case of HIV-1 superinfection in human subjects had been described. A number of studies, however, had reported HIV-1 coinfection with 2 genetically distinct HIV-1 strains belonging either to the same subtype (intrasubtype) or different subtypes (intersubtype).11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22 Because most of these coinfections were identified in cross-sectional studies, the
HIV-1 recombination
Aside from these few documented reports, perhaps the most compelling data that HIV-1 superinfections are occurring comes from the growing number of circulating recombinant forms of group M HIV-1 viruses being identified. Fig 2 illustrates the phylogenetic relationship (sequence heterogeneity) between group M (subtypes A-K), group O, and group N HIV-1 strains. Therefore recombinant forms of group M viruses stand to further increase the global sequence heterogeneity of HIV-1. To date, there are
Conclusions-implications for vaccine design
A number of recent reports indicate that HIV-1 superinfection can occur in infected individuals. These data are worrisome because they challenge the assumption that virus-specific immune responses induced by a primary infection are protecting against subsequent infection with a secondary HIV-1 strain. However, it is not possible at this time to determine the frequency by which HIV-1 superinfection occurs and to evaluate the factors that might influence the outcome of a second encounter with a
Acknowledgements
We thank Christian Brander and Bruce D. Walker for thoughtful and critical review of this manuscript.
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