Loss of naive cells accompanies memory CD4+ T-cell depletion during long-term progression to AIDS in simian immunodeficiency virus-infected macaques

Human immunodeficiency virus and simian immunodeficiency virus (SfV) induce a slow progressive disease, characterized by the massive loss of memory CD4(+) T cells during the acute infection followed by a recovery phase in which virus replication is partially controlled. However, because the initial injury is so severe and virus production persists, the immune system eventually collapses and a symptomatic fatal disease invariably occurs. We have assessed CD4(+) T-cell dynamics and disease progression in 12 SIV-infected rhesus monkeys for nearly 2 years. Three macaques exhibiting a rapid progressor phenotype experienced rapid and irreversible loss of memory, but not naive, CD4(+) T lymphocytes from peripheral blood and secondary lymphoid tissues and died within the first 6 months of virus inoculation. In contrast, SIV-infected conventional progressor animals sustained marked but incomplete depletions of memory CD4(+) T cells and continuous activation/proliferation of this T-lymphocyte subset. This was associated with a profound loss of naive CD4(+) T cells from peripheral blood and secondary lymphoid tissues, which declined at rates that correlated with disease progression. These data suggest that the persistent loss of memory CD4(+) T cells, which are being eliminated by direct virus killing and activation-induced cell death, requires the continuous differentiation of naive into memory CD4(+) T cells. This unrelenting replenishment process eventually leads to the exhaustion of the naive CD4(+) T-cell pool and the development of disease.