IntroductionThe pathogenesis of HIV infection and the complex disease patterns caused by the virus are known to revolve around the dystrophic effects of the infection first, in helper CD4 ϩ T cells, and later in cells of the macrophage lineage in organs such as the lungs, spleen, and brain. [1][2][3][4][5][6] Loss of virus-infected CD4 ϩ T cells heralds the loss of interferon-␥ (IFN-␥)-mediated T-cell responses, and this creates an environment favorable for productive replication of opportunistic pathogens. Some of these agents are powerful inducers of T helper 2 (Th2) immune responses. 7,8 Studies on coreceptor usage of HIV have shown that viruses that use the CCR5 (R5) coreceptor are usually associated with virus invasion across mucosal surfaces and highly productive phase of virus replication in activated memory CD4 ϩ T lymphocytes. In many infected individuals, mutant virus strains that use the CXCR4 (X4) coreceptor evolve following the loss of Th1 cellular immune responses. Most of these viruses are capable of replicating only in naive CD4 ϩ T lymphocytes, including T-cell lines, 9,10 but some are also known to be dual tropic and capable of replicating productively in macrophages. 11,12 Studies on replication of X4 HIV-1 in human macrophage cultures showed that interleukin-4 (IL-4) caused significant enhancement of virus replication. 13 Whether IL-4 induced by opportunistic pathogens in immunocompromised HIV-infected persons causes enhancement of X4 virus replication is not known.We have used the macaque simian-human immunodeficiency virus (SHIV) model of HIV disease to study the role of macrophagetropic X4 viruses in the pathogenesis of AIDS and neurologic disease and, in particular, the interaction between the virus and macaque macrophages. Pathogenic SHIVs that have the X4 env gene of HIV-1 in a background of SIV mac 239 such as SHIV 89.6 P 14 and SHIV KU 15 cause acute loss of naive CD4 ϩ T cells, AIDS, and neurologic disease in macaques. 11 In earlier reports, we had shown that neuropathologic effects by these viruses were associated with expression of IL-4 in the brain, 16 supporting the findings of Gabuzda and Sobel 17 that X4 viruses replicating in brain macrophages can cause neurologic disease and of Valentin et al, 13 who showed that IL-4 promoted HIV replication in human macrophages. In a subsequent study, we used SHIV-infected macaques to determine whether opportunistic pathogens that induce IL-4 could promote replication of the virus in tissue macrophages of these animals. We injected Schistosoma mansoni eggs, potent inducers of Th2 cytokines, into the portal vein or intratracheally into SHIVinfected macaques. This resulted in the development of granulomas in the liver and lung in a milieu rich in IL-4. Macrophages comprising the granulomas were shown to be productively infected with the virus. In the same study, we also showed that macrophages in Freund adjuvant-induced granulomas that were rich in IFN-␥ were poorly permissive for virus replication. 18 These data clearly suggested that IL-4 wa...