2). At this point, the infection is established systemically and comes under immunological control click here in Fiebig Stage IV. It remains under control until accumulated damage to lymphoid architecture leads to failure of lymphocyte homeostasis and AIDS. Now that the key immunological and virological milestones during HIV acquisition and post-infection control have been laid out, the evidence implicating Fc-mediated effector function in protection in each of these phases will be considered. Although acquisition must occur first for there to be post-infection control, the discussion will begin with post-infection control because it provides the earliest and

the most comprehensive indication that Fc-mediated effector function contributes to protective

immunity to HIV. Details of Fc-receptor expression on various effector populations and binding to distinct IgG subclasses will not be discussed except in the context of specific examples because several excellent reviews deal with these subjects.[47-49] Instead, the primary focus will be on the evidence that Fc-mediated effector function contributes buy 3-deazaneplanocin A to blocking acquisition or post-infection control of viraemia. The first point at which Fc-mediated effector function might contribute to post-infection control is around day 8 post-T0 when immune complexes of HIV with IgM and IgG appear in the circulation.[29] The coincident appearance of IgM and IgG antibodies in immune complexes so early after infection is surprising. Either immunoglobulin class switching is occurring rapidly or the immune complexes are between virions and naturally occurring ‘innate’ antibodies specific for HIV.[50] Regardless of how the antibodies arise, there is evidence that naturally occurring IgM can neutralize

HIV, although this does not require Fc-mediated effector function.[50] There is also evidence that both neutralizing and non-neutralizing IgG can inhibit infection of macrophages (Mph) and immature monocyte-derived Pyruvate dehydrogenase dendritic cells by an Fc-receptor dependent mechanism.[51-53] Inhibition of macrophage infection was mediated by FcγR1,[51, 52] whereas inhibition of immature monocyte-derived dendritic cell infection was mediated by FcγRIIa.[53] It is not clear the degree to which this inhibition involves phagocytosis (reviewed in refs [54, 55]), but phagocytosis has been implicated indirectly in the passive protection of rhesus macaques against a vaginal challenge with SHIV162p3.[17] It is possible that it is responsible for the disappearance of virion–antibody complexes from the circulation around day 20 post-T0. If so, it will occur at systemic sites because HIV has spread to secondary lymphoid tissues by this time (Fig. 3).