The genital tract immune milieu: An important determinant of HIV susceptibility and secondary transmission
The genital tract immune milieu: An important determinant of HIV susceptibility and secondary transmission
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DOI：
10.1016/j.jri.2007.02.002
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发表时间：
2008-01-01
影响因子：
3.4
通讯作者：
Rebbapragada, A.
中科院分区：
文献类型：
--
作者：
Kaul, R.;Pettengell, C.;Rebbapragada, A.
艾滋病毒通常是在接触艾滋病毒感染者的生殖器分泌物后通过生殖器或直肠粘膜通过性途径获得的。大多数暴露于HIV不会导致感染，这可能是由于完整的粘膜上皮以及生殖道中存在的先天和适应性粘膜免疫因子提供的保护。另一个重要的粘膜传播决定因素可能是潜在HIV靶细胞的数量和激活状态，包括CCR5/CD4+ T细胞和DC-SIGN+树突状细胞。同时存在其他生殖器感染，包括经典性传播感染（sti），可以通过破坏上皮屏障，将HIV靶细胞募集到生殖道，或通过产生促炎的局部免疫环境来增强HIV易感性。在艾滋病毒感染者中，生殖器合并感染增加了生殖器分泌物中的艾滋病毒水平，从而增加了二次性传播。作为重要的艾滋病毒辅助因子的共同感染包括人类巨细胞病毒（CMV）、单纯疱疹病毒2型（HSV2）、淋病奈瑟菌和许多其他感染。侧重于生殖器合并感染的战略，如疫苗、杀微生物剂和抑制疗法，在短期内是可行的，并有可能遏制这一流行病。2007爱思唯尔爱尔兰有限公司版权所有。
HIV is generally sexually acquired across the genital or rectal mucosa after exposure to the genital secretions of an HIV-infected partner. Most exposures to HIV do not result in infection, likely due to protection afforded by an intact mucosal epithelium, as well as by innate and adaptive mucosal immune factors present in the genital tract. Another important mucosal determinant of transmission may be the number and activation status of potential HIV target cells, including CCR5/CD4+ T cells and DC-SIGN+ dendritic cells. The simultaneous presence of other genital infections, including classical sexually transmitted infections (STIs), can enhance HIV susceptibility either by breaching the epithelial barrier, recruiting HIV target cells to the genital tract, or by generating a pro-inflammatory local immune milieu. In HIV-infected individuals, genital co-infections increase HIV levels in the genital secretions, thereby increasing secondary sexual transmission. Co-infections that act as important HIV cofactors include human cytomegalovirus (CMV), Herpes simplex virus type 2 (HSV2), Neisseria gonorrhoeae and many others. Strategies focused on genital co-infections, such as vaccines, microbicides and suppressive therapy, are feasible in the short term and have the potential to curb the pandemic. (c) 2007 Elsevier Ireland Ltd. All rights reserved.