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The natural history of HIV infection

Sabin, Caroline A.a; Lundgren, Jens D.b

Current Opinion in HIV and AIDS: July 2013 - Volume 8 - Issue 4 - p 311–317
doi: 10.1097/COH.0b013e328361fa66
THIRTY YEARS OF HIV AND AIDS: Edited by David A. Cooper and Giuseppe Pantaleo

Purpose of review To review recent published literature around three areas: long-term nonprogression/viral control; predictors of viral load set point/disease progression; and the potential impact of antiretroviral therapy (ART) in early HIV infection.

Recent findings The natural course of untreated HIV infection varies widely with some HIV-positive individuals able to maintain high CD4 cell counts and/or suppressed viral load in the absence of ART. Although similar, the underlying mechanistic processes leading to long-term nonprogression and viral control are likely to differ. Concerted ongoing research efforts will hopefully identify host factors that are causally related to these phenotypes, thus providing opportunities for the development of novel treatment or preventive strategies. Although there is increasing evidence that initiation of ART during primary infection may prevent the immunological deterioration which would otherwise be seen in untreated HIV infection, recent studies do not address the longer term clinical benefits of ART at this very early stage.

Summary A better understanding of the relative influences of viral, host, and environmental factors on the natural course of HIV infection has the potential to identify novel targets for intervention to prevent and treat HIV-infected persons.

aResearch Department of Infection and Population Health, University College London (UCL), Royal Free Campus, London, UK

bDepartment of Infectious Diseases, Copenhagen University Hospital/Rigshospitalet and Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark

Correspondence to Professor Caroline A. Sabin, Research Department of Infection and Population Health, UCL, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK. Tel: +44 207 794 0500 ext 34752; e-mail:

This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2013 Lippincott Williams & Wilkins, Inc.