title: Human immunodeficiency virus type 1 infection despite prior immunization with a recombinant envelope vaccine regimen.
abstract: With efforts underway to develop a preventive human immunodeficiency virus type 1 (HIV-1) vaccine, it remains unclear which immune responses are sufficient to protect against infection and whether prior HIV-1 immunity can alter the subsequent course of HIV-1 infection. We investigated these issues in the context of a volunteer who received six HIV-1LAI envelope immunizations and 10 weeks thereafter acquired HIV-1 infection through a high-risk sexual exposure. In contrast to nonvaccinated acutely infected individuals, anamnestic HIV-1-specific B- and T-cell responses appeared within 3 weeks in this individual, and neutralizing antibody preceded CD8+ cytotoxic responses. Despite an asymptomatic course and an initial low level of detectable infectious virus, a progressive CD4+ cell decline and dysfunction occurred within 2 years. Although vaccination elicited immunity to HIV-1 envelope, which was recalled upon HIV-1 exposure, it was insufficient to prevent infection and subsequent immunodeficiency.
authors.affiliation: Department of Medicine, University of Washington School of Medicine, Seattle 98195, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: McElrath
authors.forename: L
authors.initials: L
authors.lastname: Corey
authors.forename: P D
authors.initials: PD
authors.lastname: Greenberg
authors.forename: T J
authors.initials: TJ
authors.lastname: Matthews
authors.forename: D C
authors.initials: DC
authors.lastname: Montefiori
authors.forename: L
authors.initials: L
authors.lastname: Rowen
authors.forename: L
authors.initials: L
authors.lastname: Hood
authors.forename: J I
authors.initials: JI
authors.lastname: Mullins
mesh_terms: D016915:AIDS Vaccines; D000328:Adult; D000595:Amino Acid Sequence; D001402:B-Lymphocytes / Q000276:immunology; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D015686:Gene Products, env / Q000096:biosynthesis / Q000737:chemistry / Q000276:immunology*; D015483:HIV Antibodies / Q000097:blood*; D019302:HIV Envelope Protein gp160; D015658:HIV Infections / Q000276:immunology*; D006679:HIV Seropositivity; D015497:HIV-1; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008969:Molecular Sequence Data; D011498:Protein Precursors / Q000276:immunology; D012309:Risk-Taking; D012900:Smallpox Vaccine; D013601:T-Lymphocytes / Q000276:immunology; D013997:Time Factors; D014614:Vaccines, Synthetic
chemical_list: D016915:AIDS Vaccines; D015686:Gene Products, env; D015483:HIV Antibodies; D019302:HIV Envelope Protein gp160; D011498:Protein Precursors; D012900:Smallpox Vaccine; D014614:Vaccines, Synthetic