Dynamics of virus versus host interaction in children with human immunodeficiency virus type 1 infection

To investigate the dynamic interplay between human immunodeficiency virus type 1 (lllV-l) replica-tion and the extent of immune destruction in Hl'V-f-dnfected children, virus burden in lymphoid tissues (LN) and peripheral blood was compared with changes in LN architecture and cytokine levels constitutively expressed in LN. In agreement with results of a preliminary study, the plasma lllV-l RNA level correlated with the amount of provirus in LN. However, the level was also associated with a degree of destruction of lymphoid follicular architecture and an alteration of immune cytokine expression. Expression of interleukin (IL)-4 was higher in LN with higher virus replication. Reduction of plasma viremia was associated with an increase in IL-2 mRNA levels in LN. These findings suggest that measurable virus burden in the peripheral blood is not a simple reflection of viral replication in LN but is also influenced by the extent of progressive immune destruction. Various measurements of virus burden in the peripheral blood of human immunodeficiency virus type I (HIV-I)-in-fected persons, especially the amount ofHIV-I RNA in plasma, are increasingly used as surrogate markers for disease progres-sion or response to antiretroviral therapy [I, 2]. The level o