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Figure 7 | BMC Infectious Diseases

Figure 7

From: Cerebrospinal fluid HIV infection and pleocytosis: Relation to systemic infection and antiretroviral treatment

Figure 7

Model of CSF HIV infection. The diagram provides a simple schematic of hematogenous infection with T cells (including HIV-infected CD4 cells) and intrathecal macrophages separated by the blood-brain endothelial barrier. The model presumes that virus reaches the CNS principally within infected cells. T cells are shown as round cells, either infected (bar within nucleus) or uninfected (no bar). Similarly, the macrophages are shown as flat, elongated cells with or without infection (again, bar in nucleus). Both virus (circles with central dot) and cytokine/chemokine (smaller solid circles) are produced or provoked by infection on both sides of the barrier. Cells particularly involved in the illustrated process are highlighted in red and also may show thickened outline when active and broken line when the action is attenuated. Panels A, B, and C presents a simplified schematic of two basic types of CSF infection, transitory and autonomous, along with a combination of these types in mixed or amplified infection. Panels D-G apply these models to the relationships of plasma and CSF HIV (Δplasma:CSF) in four of the settings described in this report, including D. the high Δplasma:CSF in subjects with pleocytosis >10 cells/μL related to exuberant transitory infection; E the high Δplasma:CSF in ADC patients due to enhanced autonomous infection; F. the low Δplasma:CSF in subjects with < 50 blood CD4 cells/μL related to reduced transitory infection; and G the low Δplasma:CSF in treatment failures also related to decreased transitory infection.

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