HIV Compartmentalization: Pathogenesis and Clinical Implications

Infection with HIV results in the dissemination of the virus to a number of target compartments which may act as sanctuary sites for the virus. Sanctuary sites for HIV may be divided into cellular and anatomical sites. Cellular sites for HIV include both productively and latently infected CD4+ lymphocytes, macrophages and dendritic cells while anatomical sites include blood, lymph nodes, central nervous system (CNS), genital tract, spleen and lung. Some of these sites may be inaccessible to some classes of antiretroviral drugs e.g. some protease inhibitors penetrate poorly into the CNS and genital tract. Mathematical models have been used to predict the importance of sanctuary sites and trafficking of virus between compartments on the pathogenesis of HIV infection. This review will discuss recent understanding of the role of sanctuary sites in the persistence of HIV in the host.