How does HIV cause AIDS? The homing theory

The mechanism by which HIV causes depletion of CD4⁺ T cells in infected individuals remains unknown. Numerous theories have been proposed, but none can fully explain all of the events observed to occur in patients. Recent studies have shown that HIV binding to resting CD4⁺ T cells upregulates L- selectin, causing the cells to home from the blood into lymph nodes at an enhanced rate. It is possible that the disappearance of CD4⁺ T cells in the blood is actually the result of them leaving the blood, which can help explain the loss of CD4⁺ T cells in the blood occurring at a much faster rate than in lymphoid tissues. Furthermore, secondary signals through homing receptors received during the homing process induce many of these cells into apoptosis. These cells die in the lymph nodes without producing HIV particles, which can explain the 'bystander effect' observed in the lymph nodes of HIV infected individuals. If this scenario occurs in HIV⁺ patients, it might explain many of the clinical observations.