SZL2111 HIV/AIDs

LESSON 3
The Immune system
Learning outcomes

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Upon completing this topic, you should be able to :

Have an overview of the Human Immune system(IS)
Understand various types of immunity
Describe various stages of immune response
What is immunodeciency?
Various disorders and diseases associated with immune
system

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3.1. Overview of the Immune System

Immune system is a system of biological structures and processes
within an organism that protects against diseases by identifying
and killing pathogens and tumor cells. The immune system

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is made up of organs that are involved in ghting invasion by

foreign bodies. They include;

3.1.1. The bone marrow

The bone marrow is the production site of the white blood
cells(WBC) involved in immunity WBC involved includes the
B-lymphocytes (B cells) and the T lymphocytes (T cells). The
B-lymphocytes mature in the bone marrow and then enter the

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circulation. T lymphocytes move from the bone marrow to the

thymus, where they mature into several kinds of cells capable
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of dierent functions Lymphoid organs The Lymphoid tissues
include the thymus gland, the spleen, the lymph nodes, the
tonsils and adenoids, and similar tissues in the gastrointestinal, respiratory, and reproductive systems The lymph nodes are

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distributed throughout the body. They are connected by lymph

channels and capillaries, which remove foreign material from the
lymph before it enters the bloodstream. The lymph nodes also
serve as centers for immune cell proliferation. The remaining
lymphoid tissues, such as the tonsils and adenoids and other
mucoid lymphatic tissues, contain immune cells that defend the
body against microorganisms

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3.1.2. Types of Immunity

Innate/ Inborn/Natural/Non-specic immunity;

Present at birth Provide non-specic immunity to any foreign
invador regardless of invadors' composition. Operates under cer-

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tain mechanisms or factors

Physical/mechanical barrier

 Skin protects from entry of pathogens to our body

 Respiratory tracts- the hairs /cilia along the tract
leads to coughing & sneezing in presence of microorganism hence act as lters to clear the pathogens from
upper respiratory tract.

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Biochemical factors Acidic gastric juices e.g. Hydrochloric

acid in the stomach. Enzymes present in sweat, saliva and
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breast milk respond by destroying invading microorganisms. Blood protein factors e.g. interferons, compliments,
acute phase proteins destroy by puncturing holes in the
body.

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Genetic - control People may become carriers but not sick

Cellular factors - WBCs participate both in natural & acquired immune responses. The cells ght invading foreign bodies by releasing cell mediators. Other cells (nongranular) e.g. monocytes & macrophages are phagocytic
i.e. engulf, digest &kill microorganism Inammatory responses. The inammatory response is a major function
of the natural (nonspecic) immune system elicited in re-

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sponse to tissue injury or invading organisms. Chemical

mediators assist this response by: Minimizing blood loss
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Walling o the invading organism. Activating phagocytes
and promoting formation of brous scar tissues. Regeneration of injured tissue.

Acquired/ Adaptive / Specic Immunity

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Immunologic responses are acquired during life. Are not present

at birth. They develop as a result of immunization/vaccination.
Also developed after contracting a disease i.e. weeks or months
after exposure to the disease, the body produces an IR sucient to defend against re-infection. The two types of acquired
immunity: active and passive. In active acquired immunity, the
immunologic defenses are developed by the person's own body.

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This immunity generally lasts many years or even a lifetime.

Passive acquired immunity is temporary immunity transmitted
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from another source that has developed immunity through previous disease or immunization. For example, gamma-globulin
and antiserum, obtained from the blood plasma of people with
acquired immunity, are used in emergencies to provide immu-

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nity to diseases when the risk for contracting a specic disease

is great and there is not enough time for a person to develop
adequate active immunity.
Both types of acquired immunity involve humoral and cellular (cell-mediated) immunologic responses. It's divided into 2
forms
1. Humoral immunity (AMI) Involves antibodies produced
by B cells The antibodies recognize & bind specically to

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foreign antigens & may cause one of the following: -Break/

splitdown the membrane of Ag (lysis) -Coat the Ag mak7

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ing it easier for phagocytosis (opsonization) -Neutralize activities of toxins/ virus/ bacteria (neutralization) -Direct
killing of foreign Ag ( cytotoxicity / cell killing) -Clump
parasites together (agglutination)

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2. Cell mediated immunity (CMI) - Two most important T

cell subtypes are involved in CMI T helper and T killer
cells

Cells of the Immune System

1. T-Cells  T lymphocytes are divided into two major subsets that dier in functions and identity (functionally and
phenotypically (identiably) dierent).

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(a) The T helper subset, (CD4+ T cell) - The main function is to augment or potentiate immune responses by
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the secretion of specialized factors that activate other
WBCs to ght o infection. They interact with B
cells or T killer cells & help them respond to foreign
agents.

T helper1-controls intracellular pathogens

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(CMI)
(b) T helper2 - controls extra cellular pathogens (AMI)
b)T killer/suppressor subset (CD8+ T cell). These
cells are important in directly killing certain tumor
cells, viral-infected cells and sometimes parasites. They
directly bind to foreign agents, attack & kill those
cells thus eliminating them from the body. The CD8+
T cells are also important in down-regulation of im-

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mune responses.
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NB: Both types of T cells can be found throughout the

body. They often depend on the secondary lymphoid organs (the lymph nodes and spleen) as sites where activation occurs, but they are also found in other tissues of

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the body, most conspicuously the liver, lung, blood, and

intestinal and reproductive tracts.
2. Natural Killer Cells (NK) Are similar to the killer T cell
subset (CD8+ T cells). They directly kill certain tumors
such as melanomas, lymphomas and viral-infected cells,
most notably herpes and cytomegalovirus-infected cells.
NK cells, unlike the CD8+ (killer) T cells, kill their targets without a prior sensitization. But kill more eectively

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when activated by T h cell.

3. B Cells  The major function of B lymphocytes is the
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production of antibodies in response to foreign proteins of
bacteria, viruses, and tumor cells. Antibodies are specialized proteins that specically recognize and bind to one
particular protein that specically recognize and bind to

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one particular protein. Antibody production and binding

to a foreign substance or antigen, is critical as a means
of signaling other cells to engulf, kill or remove that substance from the body.
4. Granulocytes or Polymorphonuclear (PMN) Leukocytes It is a group of WBCs. Granulocytes are composed of
three cell types identied as neutrophils, eosinophils and
basophils, based on their staining characteristics with cer-

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tain dyes. These cells are important in the removal of

bacteria and parasites from the body. They engulf these
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foreign bodies and degrade them using their powerful enzymes.
(a) Neutrophils -a/c60% - complete dvpt in the BM enter blood & remain incirculation for 10hours - leave

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thro capillary wall & enter connective tissue - after

a day or 2 they enter the digestive tract or urinary
tract & are swept out of the body by waters.
(b) Eosinophils a/c 3% of circulating WBCs - help control allergic reactions & helminth infections
(c) Basophils- a/c less than 1% - controls allergic reactions, inammatory reactions, clotting process & fat
metabolism

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5. Macrophages  They are often referred to as scavengers or

antigen-presenting cells (APC). This is because they pick
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up and ingest foreign materials and present these antigens
to other cells of the immune system such as T cells and B
cells. This is one of the important rst steps in the initiation of an immune response. Stimulated macrophages

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exhibit increased levels of phagocytosis and are also secretory. Monocytes - they cross capillary wall, enter tissue &
dierentiate to macrophages, - destroy bacteria, dead cells
and other matters - Are CD4+
6. Dendritic Cells  Dendritic cells function as APCs. In fact,
they are more ecient APCs than macrophages. These
cells are usually found in the structural compartment of
the lymphoid organs such as the thymus, lymph nodes and

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spleen. They are also found in the bloodstream and other

tissues of the body. It is believed that they capture anti13

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gen or bring it to the lymphoid organs where an immune
response is initiated. They are extremely hard to isolate.
Recent nding is that dendritic cells bind high amount of
HIV, and may be a reservoir of virus that is transmitted

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to CD4+ T cells during an activation event. Cells that

possess CD4 markers include:
T helper cells
Macrophages
Monocytes
Colon cells
Dendritic cells
Retinal cells

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NB: HIV attaches to any CD4+ cell. Immune response

to invasion

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When bacteria, viruses or other pathogens overcome the body's
natural immunity and gain entry into the blood system, three
specic mechanism of acquired immunity are initiated. They
include:

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The phagocytic immune response

The humoral or antibody immune response
The cellular or cell mediated immune response
1. Phagocytic immune response
The rst line of defense, the phagocytic immune re-

sponse, involves the WBCs (granulocytes and macrophages

which have the ability to ingest foreign particles. These

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cells move to the point of attack, where they engulf

and destroy the invading agents.
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2. Humoral or Antibody immune response
The humoral response is characterized by production
of antibodies by the B-lymphocytes in response to a
specic antigen. Although the B-lymphocyte is ulti-

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mately responsible for the production of antibodies,

both the macrophages of natural immunity and the
special T-cell lymphocytes of cellular immunity are
involved in recognizing the foreign substance and in
producing antibodies.
3. Antigen recognition
The part of the invading or attacking organism that
is responsible for stimulating antibody production is

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called an antigen (or an immunogen). For example,

an antigen can be a small patch of proteins on the
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outer surface of the microorganism. A single bacterium, even a single large molecule, such as a toxin
(diphtheria or tetanus toxin), may have several such
antigens, or markers, on its surface, thus inducing

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the body to produce a number of dierent antibodies. Once produced, an antibody is released into the
bloodstream and carried to the attacking organism.
There it combines with the antigen, binding with it
like an interlocking piece of a jigsaw puzzle .

3.1.3. Stages in an immune response

Recognition stage
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The immune system's ability to recognize antigens as foreign, or non-self, is the initiating event in any immune
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response (g 2.2). The body must rst recognize invaders
as foreign before it can react to them. The body accomplishes recognition using lymph nodes and lymphocytes
for surveillance. Lymph nodes are widely distributed in-

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ternally and externally near the body's surfaces. They

continuously discharge small lymphocytes into the bloodstream. These lymphocytes patrol the tissues and vessels
that drain the areas served by that node.
Lymphocytes are found in the lymph nodes and in the circulating blood. The volume of lymphocytes in the body is
impressive. These lymphocytes recirculate from the blood
to lymph nodes and from the lymph nodes back into the

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bloodstream, in a never-ending series of patrols. Some circulating lymphocytes can survive for decades. Some of
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these small, hardy cells maintain their solitary circuits for
the lifetime of the person.
The exact way in which circulating lymphocytes recognize
antigens on foreign surfaces is not known; however, the-

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orists think that recognition depends on specic receptor

sites on the surface of the lymphocytes. Macrophages play
an important role in helping the circulating lymphocytes
process the antigens. When foreign materials enter the
body, a circulating lymphocyte comes into physical contact with the surfaces of these materials. Upon contact,
the lymphocyte, with the help of macrophages, either removes the antigen from the surface or in some way picks

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up an imprint of its structure, which comes into play with

subsequent re-exposure to the antigen.
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In a streptococcal throat infection, for example, the streptococcal organism gains access to the mucous membranes
of the throat. A circulating lymphocyte moving through
the tissues of the neck comes in contact with the organ-

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ism. The lymphocyte, familiar with the surface markers

on the cells of its own body, recognizes the antigens on
the microbe as dierent (non-self) and the streptococcal
organism as antigenic (foreign). This triggers the second
stage of the immune responseproliferation.

Proliferation stage
The circulating lymphocyte containing the antigenic mes-

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sage returns to the nearest lymph node. Once in the node,

the sensitized lymphocyte stimulates some of the resident
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dormant T and-lymphocytes to enlarge, divide, and proliferate. T lymphocytes dierentiate into cytotoxic (or
killer) T cells, whereas-lymphocytes produce and release
antibodies. Enlargement of the lymph nodes in the neck

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in conjunction with a sore throat is one example of the

immune response.

Response stage
In the response stage, the changed lymphocytes function
either in a humoral or a cellular fashion. The production
of antibodies by the-lymphocytes in response to a specic
antigen begins the humoral response. Humoral refers to

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the fact that the antibodies are released into the bloodstream and so reside in the plasma (uid fraction of the
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blood).
With the initial cellular response, the returning sensitized
lymphocytes migrate to areas of the lymph node (other
than those areas containing lymphocytes programmed to

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become plasma cells). Here, they stimulate the residing

lymphocytes to become cells that will attack microbes directly rather than through the action of antibodies. These
transformed lymphocytes are known as cytotoxic (killer)
T cells. The T stands for thymus, signifying that during embryologic development of the immune system, these
T lymphocytes spent time in the thymus of the developing fetus, where they were genetically programmed to be-

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come T lymphocytes rather than the antibody-producinglymphocytes. Viral rather than bacterial antigens induce
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a cellular response. This response is manifested by the increasing number of T lymphocytes (lymphocytosis) seen
in the blood smears of people with viral illnesses, such as
infectious mononucleosis.

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Most immune responses to antigens involve both humoral

and cellular responses, although one usually predominates.
For example, during transplantation rejection, the cellular
response predominates, whereas in the bacterial pneumonias and sepsis, the humoral response plays the dominant
protective role.

Eector stage
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In the eector stage, either the antibody of the humoral

response or the cytotoxic (killer) T cell of the cellular re23

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sponse reaches and couples with the antigen on the surface
of the foreign invader. The coupling initiates a series of
events that in most instances results in the total destruction of the invading microbes or the complete neutraliza-

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tion of the toxin. The events involve interplay of antibodies (humoral immunity), complement, and action by the
cytotoxic T cells (cellular immunity).

Production of B-Lymphocytes
B-lymphocytes stored in the lymph nodes are subdivided
into thousands of clones, each responsive to a single group
of antigens having almost identical characteristics. When
the antigenic message is carried back to the lymph node,

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specic clones of the-lymphocyte are stimulated to enlarge,

divide, proliferate, and dierentiate into plasma cells capa24

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ble of producing specic antibodies to the antigen. Otherlymphocytes dierentiate into-lymphocyte clones with a
memory for the antigen. These memory cells are responsible for the more exaggerated and rapid immune response

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in a person who is repeatedly exposed to the same antigen.

3.1.4. Role of antibodies in Humoral Immune Responses

Antibodies are large proteins called immunoglobulins because they are found in the globulin fraction of the plasma
proteins. Each antibody molecule consists of two subunits,
each of which contains a light and a heavy peptide chain.
The sub-units are held together by a chemical link com-

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posed of disulde bonds. Each subunit has a portion that

serves as a binding site for a specic antigen referred to
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as the Fab fragment. This site provides the "lock" portion that is highly specic for an antigen. An additional
portion, known as the Fc fragment, allows the antibody
molecule to take part in the complement system.

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Antibodies defend against foreign invaders in several ways,

and the type of defense employed depends on the structure
and composition of both the antigen and the immunoglobulin. The antibody molecule has at least two combining
sites, or Fab fragments. One antibody can act as a crosslink between two antigens, causing them to bind or clump
together. This clumping eect, referred to as agglutination, helps clear the body of the invading organism by

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facilitating phagocytosis. Some antibodies assist in removing oending organisms through opsonization. In this
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process, the antigenantibody molecule is coated with a
sticky substance that also facilitates phagocytosis.
Antibodies also promote the release of vasoactive substances,
such as histamine and slow-reacting substance, two of the

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chemical mediators of the inammatory response. In addition, antibodies are involved in activating the complement
system.

3.1.5. Types of Immunoglobulins

The body can produce ve dierent types of immunoglobulins.
(Immunoglobulins are commonly designated by the abbreviation
Ig.) Each of the ve types, or classes, is identied by a specic

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letter of the alphabet (IgA, IgD, IgE, IgG, and IgM). Classication is based on the chemical structure and biologic role of the
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individual immunoglobulin. The following list summarizes some
outstanding characteristics of the immunoglobulins: 
IgG (75% of Total Immunoglobulin) Appears in serum
and tissues (interstitial uid) Assumes major role in

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blood borne and tissue infections Activates complement

system Enhances phagocytosis Crosses placenta
IgA (15% of Total Immunoglobulin) Appears in body
uids (blood, saliva, tears, breast milk, and pulmonary,
gastrointestinal, prostatic, and vaginal secretions) Protects against respiratory, gastrointestinal, and genitourinary infections Prevents absorption of antigens from food
Passes to neonate in breast milk for protection

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IgM (10% of Total Immunoglobulin) Appears mostly in

intravascular serum Appears as the rst immunoglobulin
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produced in response to bacterial and viral infections
Activates complement system
IgD (0.2% of Total Immunoglobulin) Appears in small
amounts in serum Possibly inuences B-lymphocyte dif-

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ferentiation, but plays unclear role

IgE (0.004% of Total Immunoglobulin) Appears in serum
Takes part in allergic and some hypersensitivity reactions
Combats parasitic infections

3.1.6. Cellular (or cell mediated) immune response

It is called cellular because it involves production of special
cells T lymphocytes (or T cells) that are primarily respon-

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sible for cellular immunity. These lymphocytes spend time

in the thymus, where they are programmed to become T
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cells rather than antibody-producinglymphocytes (Figure
2.3). Several types of T cells exist, each with designated
roles in the defense against bacteria, viruses, fungi, parasites, and malignant cells. T cells attack foreign invaders

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directly rather than by producing antibodies.

Cellular reactions are initiated by the binding of an antigen with an antigen receptor located on the surface of a
T cell. This may occur with or without the assistance of
macrophages. The T cells then carry the antigenic message, or blueprint, to the lymph nodes, where the production of other T cells is stimulated. Some T cells remain
in the lymph nodes and retain a memory for the antigen.

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Other T cells migrate from the lymph nodes into the general circulatory system and ultimately to the tissues, where
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Figure 3.1: Cellular (or cell mediated) immune response

they remain until they either come in contact with their

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respective antigens or die.

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Role of T lymphocytes
Two major categories of eector T cells are helper T cells and
cytotoxic T cells. These cells participate in destroying foreign
organisms. Other T cells include suppressor T cells and mem-

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ory T cells. T cells interact closely with-cells, indicating that

humoral and cellular immune responses are not separate, unrelated processes but rather branches of the immune response that
can and do aect each other.
1. Helper T cells (helper CD4 cells) are activated upon recognition of antigens and stimulate the rest of the immune
system. When activated, helper T cells secrete cytokines
that attract and activate-cells, cytotoxic T cells, natu-

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ral killer cells, macrophages, and other cells of the immune system (Laurence J. 1995). Separate subpopula32

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tions of helper T cells produce dierent types of cytokines
and determine whether the immune response will be the
production of antibodies or a cell-mediated immune response. Helper T cells produce lymphokines, one cate-

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gory of cytokines. These lymphokines activate other T

cells (interleukin-2, or IL-2), natural and cytotoxic T cells
(interferon-gamma), and other inammatory cells (tumor
necrosis factor). Helper T2 cells produce IL-4 and IL-5,
lymphokines that activate-cells to grow and dierentiate
(Laurence J. 1995, Roit I; et al 1989)).
2. Cytotoxic T cells (killer T cells) attack the antigen directly by altering the cell membrane and causing cell lysis

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(disintegration) and releasing cytolytic enzymes and cytokines. Lymphokines can recruit, activate, and regulate
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other lymphocytes and WBCs. These cells then assist in
destroying the invading organism.
3. Suppressor T cells, has the ability to decrease B-cell production, thereby keeping the immune response at a level

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that is compatible with health (e.g. sucient to ght infection adequately without attacking the body's healthy
tissues). Memory T cells are responsible for recognizing
antigens from previous exposure and mounting an immune
response.

Roles of null lymphocytes and natural killer cells in

cellular immune responses
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Null lymphocytes and natural killer (NK) cells are other lymphocytes that assist in combating organisms. These are distinct
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from-cells and T cells and lack the usual characteristics of-cells
and T cells.
1. Null lymphocytes, a subpopulation of lymphocytes, destroy antigens already coated with antibody. These cells

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have special Fc receptor sites on their surfaces that allow

them to couple with the Fc end of antibodies (antibodydependent, cell-mediated cytotoxicity, Beattie, T et al 2002).
2. Natural killer cells, another subpopulation of lymphocytes,
defend against microorganisms and some types of malignant cells. NK cells are capable of directly killing invading
organisms and producing cytokines. The helper T cells
contribute to the dierentiation of null and NK cells (Lau-

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rence J. 1995).
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3.1.7. Complement System

Circulating plasma proteins, which are made in the liver
and activated when an antibody couples with its antigen,
are known as complement. These proteins interact sequen-

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tially with one another in a cascade or "falling domino"

eect. This complement cascade alters the cell membranes
on which antigen and antibody complex form, permitting
uid to enter the cell and leading eventually to cell lysis
and death. In addition, activated complement molecules
attract macrophages and granulocytes to areas of antigen
antibody reactions. These cells continue the body's defense by devouring the antibody-coated microbes and by

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releasing bacterial agents.

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Complement plays an important role in the immune response. Destruction of an invading or attacking organism or toxin is not achieved merely by the binding of the
antibody and antigens; it also requires activation of com-

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plement, the arrival of killer T cells, or the attraction of

macrophages.

3.2. Immunodeciency
When some or one of the components of the immune system is lacking, disorders or abnormalities arises and this is
referred to as an immunodeciency. These abnormalities
or disorders are either as a result of genetic abnormally

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(congenital) or are acquired within the course of life due

to a number of factors
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Old age
Nutrition
Autoimmune disorder
Neoplastic disease
Chronic illness and surgery
Medication
Lifestyle and other factors
Stress

1. Age - People at the extremes of the lifespan are more likely

to develop problems related to immune system functioning
than are those in their middle years. Frequency and severity of infections are increased in elderly people, possibly

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from a decreased ability to respond adequately to invading organisms. Both the production and the function of
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T and B -lymphocytes may be impaired. The incidence
of autoimmune diseases also increases with aging, possibly
from a decreased ability of antibodies to dierentiate between self and non-self. Failure of the surveillance system

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to recognize mutant, or abnormal, cells may be responsible

for the high incidence of cancer associated with increasing
age.
2. Declining function of various organ systems associated with
increasing age also contributes to impaired immunity. Decreased gastric secretions and motility allow normal intestinal ora to proliferate and produce infection, causing gastroenteritis and diarrhea. Decreased renal circula-

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tion, ltration, absorption, and excretion contribute to risk

for urinary tract infections. Moreover, prostatic enlarge39

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ment and neurogenic bladder can impede urine passage
and subsequently bacterial clearance through the urinary
system. Urinary stasis, common in elderly people, permits the growth of organisms. Exposure to tobacco and

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environmental toxins impairs pulmonary function. Prolonged exposure to these agents decreases the elasticity of
lung tissue, the eectiveness of cilia, and the ability to
cough eectively. These impairments hinder the removal
of infectious organisms and toxins, increasing the elderly
person's susceptibility to pulmonary infections and cancers. Finally, with aging, the skin becomes thinner and
less elastic. Peripheral neuropathy and the accompanying

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decreased sensation and circulation may lead to stasis ulcers, pressure ulcers, abrasions, and burns. Impaired skin
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integrity predisposes the aging person to infection from
organisms that are part of normal skin ora.
3. Nutrition - Adequate nutrition is essential for optimal functioning of the immune system. Vitamin intake, essential

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for DNA and protein synthesis, if inadequate, may lead

to protein-calorie deciency and subsequently to impaired
immune function. Vitamins also help in the regulation of
cell proliferation and maturation of immune cells. Excess
or deciency of trace elements (i.e., copper, iron, manganese, selenium, or zinc) in the diet generally suppresses
immune function. Fatty acids are the building blocks that
make up the structural components of cell membranes.

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Lipids are precursors of vitamins A, D, E, and K as well

as cholesterol. Both excess and deciency of fatty acids
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SZL2111 HIV/AIDs
have been found to suppress immune function.
4. Depletion of protein reserves results in atrophy of lymphoid tissues, depression of antibody response, reduction
in the number of circulating T cells, and impaired phago-

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cytic function. As a result, susceptibility to infection is

greatly increased. During periods of infection and serious
illness, nutritional requirements may be exaggerated further, potentially contributing to depletion of protein, fatty
acid, vitamin, and trace elements and an even greater risk
of impaired immune response and sepsis.

3.2.1. Autoimmune disorders

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In general, autoimmune disorders are more common in females

than in males. This is believed to be the result of the activ42

SZL2111 HIV/AIDs
ity of the sex hormones. The ability of sex hormones to modulate immunity has been well established. There is evidence
that estrogen modulates the activity of T lymphocytes (especially suppressor cells), whereas androgens act to preserve IL-

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2 production and suppressor cell activity. The eects of sex

hormones on B -cells are less pronounced. Estrogen activates
the autoimmune-associated B-cell population that expresses the
CD5 marker (an antigenic marker on the-cell). Estrogen tends
to enhance immunity, whereas androgen tends to be immunosuppressive.Autoimmune disorders include lupus erythematosus,
rheumatoid arthritis, or psoriasis

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SZL2111 HIV/AIDs

3.2.2. Neoplastic disease

Immunosuppression contributes to the development of cancers;
however, cancer itself is immunosuppressive. Large tumors can
release antigens into the blood, and these antigens combine with

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circulating antibodies and prevent them from attacking the tumor cells. Furthermore, tumor cells may possess special blocking
factors that coat tumor cells and prevent destruction by killer
T lymphocytes. During the early development of tumors, the
body may fail to recognize the tumor antigens as foreign and
subsequently fail to initiate destruction of the malignant cells.
Hematologic cancers, such as leukemia and lymphoma, are associated with altered production and function of WBCs and

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lymphocytes. All treatments that an individual has received or

is currently receiving, such as radiation or chemotherapy, are
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SZL2111 HIV/AIDs
vital. Radiation destroys lymphocytes and decreases the population of cells required to replace them. The size or extent
of the irradiated area determines he extent of Immunosuppression. Whole-body irradiation may leave the patient totally im-

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munosuppressed. Chemotherapy also destroys immune cells and

causes Immunosuppression.

3.2.3. Chronic illness and surgery

Chronic illness may contribute to immune system impairments in various ways. Renal failure is associated with
a deciency in circulating lymphocytes. In addition, immune defenses may be altered by acidosis and uremic tox-

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ins. In diabetes, an increased incidence of infection has

been associated with vascular insuciency, neuropathy,
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SZL2111 HIV/AIDs
and poor control of serum glucose levels. Recurrent respiratory tract infections are associated with chronic obstructive pulmonary disease as a result of altered inspiratory
and expiratory function and ineective airway clearance.

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Additionally, surgical removal of the spleen, lymph nodes,

or thymus or organ transplantation may place an individual at risk for impaired immune function.

3.2.4. Special problems

Conditions such as burns and other forms of injury and
infection may contribute to altered immune system function. Major Burns or other factors cause impaired skin

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integrity and compromise the body's rst line of defense.

Loss of large amounts of serum with burn injuries depletes
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SZL2111 HIV/AIDs
the body of essential proteins, including immunoglobulins.

The physiologic and psychological stressors asso-

ciated with surgery or injury stimulates cortisol release

from the adrenal cortex; increased serum cortisol also con-

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tributes to suppression of normal immune responses.

1. Medications

 In large doses, antibiotics, corticosteroids, cyto-

toxic agents, salicylates, nonsteroidal anti-inammator

drugs, and anesthetics can cause immune suppression.
2. Lifestyle and Other Factors

 Like any other body system, the immune sysJJ II

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tem functions depend on the function of other

body systems. Poor nutritional status, smoking,
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SZL2111 HIV/AIDs
excessive consumption of alcohol and exposure
to environmental radiation and pollutants have
been associated with impaired immune function.

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3.2.5. Role of immune system in HIV pathogenesis

The immune system is responsible for body defense against
attack from pathogenesis
It is made up of white blood cells which include granulocytes such as neutrophils and basophils, and agranulocytes
such as monocytes and lymphocytes.
T-helper lymphocytes have a CD4+ marker that the HIV
use for entry into the cell and replicates

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T-helper lymphocytes are important in immune regulation because when they are activated they recruit other
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immune cell involved in immune responses.
HIV uses the CD4+ cells to replicate and produce more
viral particles.
CD4 are killed and destroyed as viral production progresses

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Cytotoxic T-lymphocytes with CD8+ marker target any

virally infected CD4+ cells and kills them
Macrophages which have a CD4+ marker too act as reservoir and are also killed by cytotoxic
As virtually infected cells are killed by cytotoxic T-lymphocytes
and more of the CD4+ cells destroyed as a result of viral
replication, their numbers goes down.

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The immune system is depleted of these crucial cells involved in body defense and becomes vulnerable to attack
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SZL2111 HIV/AIDs
by opportunistic pathogens.

Example

. Briey describe the sexual transmission of HIV/AIDS

Solution : The risk of transmission through unprotected vaginal

sex is thought to be lower than anal sex, though still highly

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signicant. However, where there is a risk of vaginal tears or

sores e.g. in the presence of sexually transmitted infection, the
risk of transmission is increased signicantly. HIV transmission
through oral sex is a much debated subjected. However, the
virus is present in blood and semen, which means that in theory,
this is a possible transmission route. There may be an increased
risk if there is ejaculation, bleeding gums, lips, or inammation

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caused by common throat infections. The sharing of sex toys

also carries a risk of HIV transmission. If more than one person
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SZL2111 HIV/AIDs
is going to use a vibrator or dildo, is essential that it is cleaned
thoroughly between uses or covered with afresh condom before
each use. .

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SZL2111 HIV/AIDs
Exercise 1.

 Revision Questions

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Discuss the role of immune system in HIV pathogenesis

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References and Additional Reading Materials

1. Maranga R. O, Muya S. M and Ogila K. O (2008) Fundamentals of HIV/AIDS Education. Signon Publishers.
2. Barry D. S. (1999) AIDS and HIV in Perspectives. CPU.

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ISBN-13: 9780521627665
3. Ellison G. Parker M., Camphpbell C (2003) Learning from
HIV and AIDS. Cambridge CPU.ISBN-13: 9780521709286.
4. Shavitri Ramaiah (2008) HIV/AIDS; Health solutions. Sterling Publishers Ltd. ISBN-9788120733305.

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SZL2111 HIV/AIDs

Solutions to Exercises
Exercise 1. The immune system is responsible for body defense against attack from pathogens. It is made up of white
blood cells which include granulocytes such as neutrophils and

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basophils, and agranulocytes such as monocytes and lymphocytes. T-helper lymphocytes have a CD4+ marker that the HIV
uses for entry into the cell and replicates. T-helper lymphocytes
are important in immune regulation because when they are activated they recruit other immune cell involved in immune responses. HIV uses the CD4+ cells to replicate and produce more
viral particles. CD4 are killed and destroyed as viral production
progresses. Cytotoxic T-lymphocytes with CD8+ marker target

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any virally infected CD4+ cells and kills them. Macrophages

which have a CD4+ marker too act as reservoir and are also
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SZL2111 HIV/AIDs
killed by cytotoxic. As virtually infected cells are killed by cytotoxic T-lymphocytes and more of the CD4+ cells destroyed
as a result of viral replication, their numbers goes down. The
immune system is depleted of these crucial cells involved in
pathogens.

Exercise 1

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body defense and becomes vulnerable to attack by opportunistic

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55