Autoimmunity, alloimmunization and immunotherapy of AIDS

The nature of clinical and physiological manifestations associated with HIV infection suggests that AIDS is an autoimmune disease. The conventional immunotherapeutic approaches aimed at enhancing the immune response against HIV have repeatedly failed when applied in the clinical practice. The results of several dozen therapeutic AIDS vaccine trials have consistently shown that while in vitro measured HIV-specific immune responses were evident as a result of vaccination the clinical improvement has been seldom observed. The clinical benefit, however, was invariably associated with the usage of vaccines that acted in accord with the principles of alloimmunization. The majority of these vaccines were derived from the blood of HIV carriers or a cell culture and thus they inherently contained alloantigens unrelated to HIV. The clinical experience with alloimmunization in a range of autoimmune diseases indicates that immune tolerization is an active immune process with benefits the vaccinees. The alloimmunization, which primarily induces tolerance rather than immune activation, might be a better strategy for the immunotherapy of AIDS. (c) 2005 Elsevier B.V. All rights reserved.