FIGURE 20-8 Clinical course of HIV disease. A, Plasma viremia, blood CD4+ T cell counts, and clinical stages of disease. About 12 weeks after infection, blood-borne virus (plasma viremia) is reduced to very low levels (detectable only by sensitive reverse transcriptase-polymerase chain reaction assays) and stays this way for many years. Nonetheless, CD4+ T cell counts steadily decline during this clinical latency period because of active viral replication and T cell infection in lymph nodes. When CD4+ T cell counts drop below a critical level (about 200/mm3), the risk for infection and other clinical features of AIDS is high. (From Pantaleo G, C Graziosi, and AS Fauci. New concepts in the immunopathogenesis of human immunodeficiency virus infection. New England Journal of Medicine 328:327-335, 1993. Copyright © 1993 Massachusetts Medical Society. All rights reserved.) B, Immune response to HIV infection. A CTL response to HIV is detectable by 2 to 3 weeks after the initial infection and peaks by 9 to 12 weeks. Marked expansion of virus-specific CD8+ T cells occurs during this time, and up to 10% of a patient's CTLs may be HIV specific at 12 weeks. The humoral immune response to HIV peaks at about 12 weeks.

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