The gastrointestinal tract and HIV pathogenesis

Gastrointestinal dysfunction has been recognised as a major manifestation of the human immunodeficiency virus (HIV) infection since the earliest recognition of the syndrome, the acquired immune-deficiency syndrome (AIDS). It was originally thought that these disease manifestations were the sequelae of the immune destruction which characterises AIDS, rather than it being central to the pathogenesis of AIDS. In the past decade, it has been observed that the mucosal immune system and the intestinal immune system are pivotal in the pathogenesis of AIDS, with the most critical events, namely transmission, viral amplication, and CD4+ T-cell destruction occurring in the gastrointestinal tract (GIT). Furthermore, the breakdown of the mucosal barrier with consequent microbial translocation, are considered to be major drivers of AIDS progression.1 In this regard, the GIT mucosal tissue is not only a primary site of viral transmission, but also a major site of viral replication, CD4+ T-cell destruction, regardless of the route of transmission.1