Characterizing the immune system after long-term undetectable viral load in HIV-1-infected children

Thirty two HIV-infected children, on highly active antiretroviral therapy (HAART) and >500 CD4⁺ T cells/mm³, were rated according to the time-course of viral load (VL) during the whole follow-up period (>18 months) in a longitudinal retrospective study. (a) uVL group: 15 children with VL below 400 copies/mL; (b) dVL group: 17 children with higher VL. The uVL group showed higher memory (CD4⁺CD45RO⁺) T cells than did dVL group, and higher number of memory activated CD4⁺CD45RO⁺HLA-DR⁺ than did control group (healthy age-matched uninfected children), whereas CD4⁺CD45RA^hi+CD62L⁺ was similar. However, TCR rearrangement excision circles (TRECs) were higher in uVL group than in dVL group. uVL Group showed CD8⁺CD45RO⁺ and CD8⁺CD45RO⁺CD38⁺ higher number than the control group, but lower than the dVL group. The percentage of CD8⁺CD45RA^hi+CD62L⁺, CD8⁺CD45RA⁺, CD8⁺CD62L⁺, and CD8⁺CD28⁺ was higher in uVL group than in dVL group, and lower than in control group. The uVL group showed higher number of activated (HLA-DR⁺CD38⁺, HLA-DR⁺, HLA-DR⁺CD38^–) CD4⁺ T cells and lower percentages of CD4⁺HLA-DR^–CD38⁺ than dVL group. In activated CD8⁺ T cell, the uVL group had lower CD8⁺HLA-DR⁺CD38⁺, CD8⁺HLA-DR⁺, and CD8⁺CD38⁺ than the dVL group. Preeffector (CD8⁺CD57^–CD28^– and CD8⁺CD45RA^–CD62L^–) T cells were lower in the uVL group than in dVL group. In the effector (CD8⁺CD57⁺, CD8⁺CD57⁺CD28^–, and CD8⁺CD45RA⁺CD62L^–) T cells, HIV-infected-children had higher values than control group. HIV-infected-children who respond to HAART had TRECs reconstitution, decreased immune activation, and lower effector CD8⁺ T cells. Moreover, successful HAART allow the increment of activated CD4⁺ T cells.     

Stimulated proliferative responses in vertically HIV-infected children on HAART correlate with clinical and immunological markers

The objective of the study was to investigate the relationship between various CD4+ T cell subsets and the ability of peripheral blood mononuclear cells (PBMC) to proliferate to several stimuli in vertically human immunodeficiency virus type 1 (HIV-1)-infected children. We studied 29 HIV-1-infected children on highly active antiretroviral therapy (HAART) (median duration: 12.3 months). T cell subsets were determined by flow cytometry. Plasma viral load (VL) was quantified using a standardized molecular method. Proliferative responses were evaluated by [3H]-thymidine incorporation. Decreased proliferative responses of PBMC to pokeweed mitogen (PWM) were found for HIV-1-infected children in Centers for Disease Control (CDC) clinical categories B and C when compared to the control group (P < 0.05). Similarly, children with < or = 15% CD4+ T cells showed a decrease in proliferative responses to PWM (P < 0.01), anti-CD3 + anti-CD28 (P < 0.01) and phytohaemagglutinin (PHA) (P < 0.05) with respect to the control group and to children with CD4+ T cells > or = 25%. Proliferative responses to PWM, anti-CD3+, anti-CD28 and PHA had a statistically significant positive correlation with CD3+/mm3, CD4+/mm3, % CD4 T cells, CD4/CD8 ratio and the percentage of naive T cell subsets (CD4+CD45RO-HLA-DR-, CD4+ CD45RA+ CD62L+, CD4+ CD45RA+), CD4+ CD62L+ and CD4+ T cells co-expressing CD38+ (CD4+ HLA-DR-CD38+, CD4+ CD38+). Moreover, we found a negative correlation between PBMC proliferative responses and % CD8 T cells, memory, memory-activated and activated CD4+ T cell subsets. Lower proliferative responses to PWM (P < 0.01) and PHA (P < 0.01) were associated with higher VL. Our data show that higher proliferative responses to PWM, anti-CD3 + anti-CD28 and PHA are associated with both non-activated and naive CD4+ T cell subsets in HIV-1-infected children on HAART.     

Characterization of HIV-1 Gag-specific T cell responses in chronically infected Indian population

India is at the epicentre of the global HIV/AIDS epidemic in South-east Asia, predominated by subtype C infections. It is important to characterize HIV-1-specific T cell responses in this particular population with the aim of identifying protective correlates of immunity to control HIV-1 infection. In this study, we performed a comprehensive analysis of the breadth and magnitude of T cell responses directed at HIV-1 subtype C Gag, one of the most conserved HIV-1 proteins. The study population consisted of antiretroviral naive, chronic HIV-1 subtype C-infected individuals at various stages of infection. We used recent advanced techniques such as enzyme-linked immunospot (ELISPOT) assay and intracellular cytokine staining to quantify the total CD4(+) and CD8(+) T cell response to HIV-1 gag at single peptide level, regardless of HLA haplotype of the infected individual. The p24-Gag was identified as the most frequently recognized subunit protein with the greatest magnitude of CD4(+) and CD8(+) T cell responses. Stronger and broader CD8 T cell responses were recognized, contrasting with the weaker and narrower CD4 T cell responses with regard to Gag protein subunits. The magnitude of the HIV-specific interferon (IFN)-gamma responses was observed to be higher than the corresponding interleukin (IL)-2 response, indicating the persistence of antigenic load in chronically infected Indian population due to the probable dysfunction of HIV-specific, IFN-gamma-secreting CD8 T cells in absence of IL-2 help.     

Influenza vaccination of HIV-1-positive and HIV-1-negative former intravenous drug users.

The immunogenicity of an anti-influenza vaccine was assessed in 409 former intravenous drug user volunteers and its effect on the levels of HIV-1 RNA, proviral DNA and on CD4+ lymphocyte counts in a subset HIV-1-positive subjects was measured. HIV-1-positive individuals (n = 72) were divided into three groups on the basis of their CD4+ lymphocyte counts, while the 337 HIV-1-negative participants were allocated into group four. Haemagglutination inhibiting (HI) responses varied from 45.8 to 70% in the HIV-1-positive subjects and were significantly higher in group four (80.7% responses to the H1N1 strain, 81.6% to the H3N2 strain, and 83% to the B strain). The percentage of subjects with HI protective antibody titres (> or = 1:40) increased significantly after vaccination, especially in HIV-1 uninfected subjects. Immunization caused no significant changes in CD4+ counts and in neither plasma HIV-1 RNA nor proviral DNA levels. Therefore, vaccination against influenza may benefit persons infected by HIV-1.     

HIV-infected children with moderate/severe immune-suppression: changes in the immune system after highly active antiretroviral therapy

The objective of this study was to monitor the changes in the immune system of HIV-infected children with moderate or severe immunodeficiency after highly active antiretroviral therapy (HAART), comprising a follow-up study in 14 HIV-infected children on HAART at two time points separated approximately by 11.8 +/- 0.4 (9.9; 15.4) months. HIV-infected children had significantly lower TREC levels than the control group, but 1 year after HAART the levels increased significantly (P < 0.05). In contrast, viral load (VL) did not change significantly. A positive correlation between T cell receptor excision circle (TREC) levels and both CD4(+) T cell absolute counts (r = 0.558; P = 0.05) and percentages (r = 0.625; P = 0.030) was found. During follow-up on HAART, the percentages and absolute counts of naive CD4(+) and CD8(+) T cell subsets were increased significantly (P < 0.05). CD4(+) CD45RA(hi+) CD62L(+), CD4(+) CD45RA(+) and CD4(+) CD38(+) percentages, and the CD8(+) CD45RA(hi+) CD62L(+) counts reached similar values to the control group. Also, CD8(+) CD45RO(+) CD38(+) and CD8(+) CD45RO(+) percentages, and CD8(+) CD45RO(+) CD38(+) absolute counts (P < 0.05) decreased with respect to the baseline. Lymphoproliferative responses to pokeweed mitogen (PWM) before HAART were lower in HIV-infected children than the control group, but they recovered to normal levels after a year on HAART. Tumour necrosis factor (TNF)-alpha and interferon (IFN)-gamma production by PHA-activated peripheral blood mononuclear cells (PBMC) was lower before HAART (P < 0.001), but reached similar levels to the control group 1 year after HAART. In HIV-infected children IgG, IgG(1) and IgG(3) plasma levels decreased significantly after HAART. The immune system reconstitution induced by HAART in HIV-infected children seems to be the consequence of decreased immune system activation and naive T cell reconstitution, mainly of thymic origin.     

CD4 responses to conserved HIV-1 T helper epitopes show both negative and positive associations with virus load in chronically infected subjects

Characterization of immune responses to immunodominant CD4 epitopes in HIV-1 that are associated with control of HIV infection could be used to strengthen the efficacy of polyepitope HIV vaccines. We measured both the proliferative and the CD4 interferon (IFN)-gamma and interleukin (IL)-2 cytokine responses specific for 11 previously identified HIV-1 T helper epitopes in 10 HIV-infected non-progressors (LTNPs) (infected for a median of 15 years with a stable CD4 count of >500 cells x 10(6)/l), and seven slow progressors (SPs) (infected for a median of 15 years with a CD4 count that had declined to <500 cells x 10(6)/l). Both groups were antiretroviral treatment-naive at the time of evaluation. The median virus load of SP group was higher than that of the LTNP group (P = 0.0002). The CD4 response to a peptide pool representing all potential CD4 Gag epitopes and to Gag p24 protein was also studied. Compared to SPs, LTNPs had higher numbers of Gag-specific IFN-gamma+IL-2+ CD4s (P = 0.0059). The Gag-specific cytokine and proliferative responses correlated inversely with virus load (P = 0.03 and 0.0002, respectively), highlighting the potential importance of this response in immunity to HIV. A direct correlation was noted between proliferation and the Gag-specific IL-2 (P = 0.0053) rather than IFN-gamma response (P = 0.1336), demonstrating that the proliferation assay reflected the IL-2 rather than the IFN-gamma secreting capacity of CD4 cells. Several subjects with diverse class II DRB1 alleles responded, confirming the 11 selected peptides to be both antigenic and conserved. CD4 cytokine responses to one Gag and two conserved Pol peptides correlated negatively with virus load. The cytokine response to two additional Pol peptides correlated positively with virus load. The data indicate that there is not an absolute correlation between the CD4 immune response to conserved and broadly antigenic helper T cell epitopes in HIV non-progression.     

Increased Interleukin-7 Plasma Levels Are Associated with Recovery of CD4+ T Cells in HIV-Infected Children

To asses the role of interleukin 7 (IL-7) in the thymic reconstitution of CD4 T cells observed in children after successful antiretroviral therapy, a longitudinal study in five vertically HIV-1-infected children was carried out. Thymic function, IL-7 plasma levels, viral load, and T-lymphocytes subsets were determined every 2 or 3 months for about 90 months. In all the children, the drop in CD4+ T cells below 5–10% was associated with a marked increase in IL-7 plasma levels. The drastic decrease in viral load after treatment, led in all the cases to a recover of CD4 to levels higher than 30%, which was associated to an increase in thymic production of T cells and followed by a decrease in IL-7 to the normal levels. We conclude that the drop in CD4 in HIV children would induce an increase of IL-7 as part of a homeostatic mechanism. IL-7 would induce the thymus to produce new T cells to recover the normal levels of CD4 when the viral load was low and so the thymic function was not inhibited. The increase in the thymic production of new T cells recovers the CD4 population, and leads to a normalization of IL-7 levels.     

Lack of in vivo compartmentalization among HIV-1 infected naïve and memory CD4 T cell subsets

Viral compartmentalization between naïve and memory CD4⁺ T cell subsets has been described, but only for individuals who were receiving antiretroviral therapy (ART). We present here an extensive analysis of the viral quasispecies residing in the naïve, central and effector memory CD4⁺ T cell subsets in a number of therapy naïve individuals and representing an array of HIV-1 subtypes. We longitudinally analyzed subset-specific infection and evolution in a subtype B infected individual who switches from CCR5 to dual CCR5/CXCR4 coreceptor usage. We show that the central memory subset, the predominantly infected subset, harbors a more diverse viral population compared to the others. Through sequence analysis of the env C2V3 region we demonstrate a lack of viral compartmentalization among all subsets. Upon coreceptor switch we observe a pronounced increase in the infection level of the naïve population. Our findings emphasize the importance of all CD4⁺ T cell subsets to viral evolution.     

HIV-1 infection alters CD4+ memory T-cell phenotype at the site of disease in extrapulmonary tuberculosis

HIV-1-infected people have an increased risk of developing extrapulmonary tuberculosis (TB), the immunopathogenesis of which is poorly understood. Here, we conducted a detailed immunological analysis of human pericardial TB, to determine the effect of HIV-1 co-infection on the phenotype of Mycobacterium tuberculosis (MTB)-specific memory T cells and the role of polyfunctional T cells at the disease site, using cells from pericardial fluid and blood of 74 patients with (n = 50) and without (n = 24) HIV-1 co-infection. The MTB antigen-induced IFN-γ response was elevated at the disease site, irrespective of HIV-1 status or antigenic stimulant. However, the IFN-γ ELISpot showed no clear evidence of increased numbers of antigen-specific cells at the disease site except for ESAT-6 in HIV-1 uninfected individuals (p = 0.009). Flow cytometric analysis showed that CD4+ memory T cells in the pericardial fluid of HIV-1-infected patients were of a less differentiated phenotype, with the presence of polyfunctional CD4+ T cells expressing TNF, IL-2 and IFN-γ. These results indicate that HIV-1 infection results in altered phenotype and function of MTB-specific CD4+ T cells at the disease site, which may contribute to the increased risk of developing TB at all stages of HIV-1 infection.     

Regulatory T cells and chronic immune activation in human immunodeficiency virus 1 (HIV-1)-infected children

The function of CD4⁺ T cells with regulatory activity (T_regs) is the down-regulation of immune responses. This suppressive activity may limit the magnitude of effector responses, resulting in failure to control human immunodeficiency virus 1 (HIV-1) infection, but may also suppress chronic immune activation, a characteristic feature of HIV-1 disease. We evaluated the correlation between viral load, immune activation and T_regs in HIV-1-infected children. Eighty-nine HIV-1-infected children (aged 6–14 years) were included in the study and analysed for HIV-1 plasmaviraemia, HIV-1 DNA load, CD4 and CD8 cell subsets. T_reg cells [CD4⁺ CD25^highCD127^lowforkhead box P3 (FoxP3^high)] and CD8-activated T cells (CD8⁺CD38⁺) were determined by flow cytometry. Results showed that the number of activated CD8⁺CD38⁺ T cells increased in relation to HIV-1 RNA plasmaviraemia (r = 0·403, P < 0·0001). The proportion of T_regs also correlated positively with HIV-1 plasmaviraemia (r = 0·323, P = 0·002), but correlated inversely with CD4⁺ cells (r = −0·312, P = 0·004), thus suggesting a selective expansion along with increased viraemia and CD4⁺ depletion. Interestingly, a positive correlation was found between the levels of T_regs and CD8⁺CD38⁺ T cells (r = 0·305, P = 0·005), and the percentage of T_regs tended to correlate with HIV-1 DNA load (r = 0·224, P = 0·062). Overall, these findings suggest that immune activation contributes to the expansion of T_reg cells. In turn, the suppressive activity of T_regs may impair effector responses against HIV-1, but appears to be ineffective in limiting immune activation.     

Cellular tropisms and co-receptor usage of HIV-1 isolates from vertically infected children with neurological abnormalities and rapid disease progression

The longitudinal evolution of HIV-1 phenotypes was studied in a cohort of six vertically infected children with early onset and rapid progression of clinical disease. Among 30 viral isolates obtained from peripheral blood, tropisms for both human blood-derived cells (macrophages, T-lymphocytes), and for human neural (brain-derived) cells (microglia, astrocytes) were determined, as was chemokine co-receptor usage. All children harbored from birth macrophage-tropic isolates using the CCR5 co-receptor. Two children later developed T-cell tropic isolates with CXCR4 and CCR3 usage. While all six patients developed neurological abnormalities, only three produced neural cell tropic isolates, which used CCR5. However, early and persistent finding of both astrocyte- and microglia-tropic isolates in one patient did associate with the most rapid progression to brain atrophy among the six patients. Viral phenotypic properties determined in cell culture did not specifically predict clinical features or course, and the development of AIDS did not coincide with, or depend on, the appearance T-tropic, syncytia-inducing viruses.     

抗CD4及抗CXCR4抗体阻断HIV—1感染细胞作用的研究

为探讨抗ＣＤ４ 及抗ＣＸＣＲ４ 抗体在阻断Ｉ型人免疫缺陷病毒（ＨＩＶ－ １） 感染应用中的意义, 本文应用上述两种抗体分别与ＳｕｐＴ１ 细胞及人外周血单个核细胞（ＰＢＭＣ） 共培育, 以封闭ＨＩＶ－ １ 在上述细胞上的受体。然后, 以ＨＩＶ１ ＮＬ４３ 病毒株感染上述细胞, 通过测定感染细胞上清中ＨＩＶ－ １ 的Ｐ２４ 蛋白含量, 观察上述抗体对ＨＩＶ－ １ 感染细胞的阻断作用。结果显示, 无论是抗ＣＤ４ 或抗ＣＸＣＲ４ 的抗体单独应用或是两者联合应用, 均可明显地抑制ＨＩＶ－ １ 感染细胞的作用。该结果为今后开拓ＡＩＤＳ的抗体治疗提供了理论基础。     

The microRNA‐9/B‐lymphocyte‐induced maturation protein‐1/IL‐2 axis is differentially regulated in progressive HIV infection

The fine control of T‐cell differentiation and its impact on HIV disease states is poorly understood. In this study, we demonstrate that B‐lymphocyte‐induced maturation protein‐1 (Blimp‐1/Prdm1) is highly expressed in CD4⁺ T cells from chronically HIV‐infected (CHI) patients compared to cells from long‐term nonprogressors or healthy controls. Stimulation through the T‐cell receptor in the presence ofIL‐2 induces Blimp‐1 protein expression. We show here that Blimp‐1 levels are translationally regulated by microRNA‐9 (miR‐9). Overexpression of miR‐9 induces Blimp‐1 repression, restoring IL‐2 secretion in CD4⁺ T cells via reduction in the binding of Blimp‐1 to the il‐2 promoter. In CHI patients where IL‐2 expression is reduced and there is generalized T‐cell dysfunction, we show differential expression of both miR‐9 and Blimp‐1 in CD4⁺ cells compared with levels in long‐term nonprogressors. These data identify a novel miR‐9/Blimp‐1/IL‐2 axis that is dysregulated in progressive HIV infection.     

HIV‐1 and hijacking of the host immune system: the current scenario

Human immunodeficiency virus (HIV) infection is a major health burden across the world which leads to the development of acquired immune deficiency syndrome (AIDS). This review article discusses the prevalence of HIV, its major routes of transmission, natural immunity, and evasion from the host immune system. HIV is mostly prevalent in Sub‐Saharan Africa and low income countries. It is mostly transmitted by sharing syringe needles, blood transfusion, and sexual routes. The host immune system is categorized into three main types; the innate, the adaptive, and the intrinsic immune system. Regarding the innate immune system against HIV, the key players are mucosal membrane, dendritic cells (DCs), complement system, interferon, and host Micro RNAs. The major components of the adaptive immune system exploited by HIV are T cells mainly CD4+ T cells and B cells. The intrinsic immune system confronted by HIV involves (apolipoprotein B mRNA‐editing enzyme, catalytic polypeptide‐like 3G) APOBEC3G, tripartite motif 5‐α (TRIM5a), terherin, and (SAM‐domain HD‐domain containing protein) SAMHD1. HIV‐1 efficiently interacts with the host immune system, exploits the host machinery, successfully replicates and transmits from one cell to another. Further research is required to explore evasion strategies of HIV to develop novel therapeutic approaches against HIV.     

Detection of human herpesvirus 7 DNA in peripheral blood reflects mainly CD4+ cell count in patients infected with HIV

The opportunistic behavior and the potential interactions of human herpesvirus 7 (HHV-7) with human immunodeficiency virus (HIV)-1 in HIV-1-infected patients were investigated in comparison with HHV-6, another human roseolovirus. Roseolovirus DNAs were detected and quantified in peripheral blood mononuclear cells (PBMCs) from 198 HIV-seronegative healthy blood donors, 38 HIV-1-infected patients classified as long-term non-progressors, and 99 HIV-1-infected patients classified as progressors. The rate of HHV-7 DNA detection was higher in healthy donors (78%) than in long-term non-progressors (47%; P = 0.0003) or in progressors (52%; P < 0.0001). HHV-7 cell load was higher in healthy donors (median: 212 EqCop/10(6) PBMCs) and in long-term non-progressors (median: 105 EqCop/10(6) PBMCs) than in progressors (median: 48 EqCop/10(6) PBMCs; P < 0.0001 and P = 0.015, respectively). Among progressors, HHV-7 detection was correlated positively with the CD4(+) T-lymphocyte count (P = 0.028). Neither HHV-7 detection rate nor cell load was correlated with the HIV-1 plasma load. As a whole, HHV-6 detection rate and cell load were lower than the HHV-7 counterparts, albeit exhibiting similar differences between healthy donors, long-term non-progressors, and progressors. In conclusion, HHV-7 infection does not appear to be stimulated by HIV-1 infection, nor interact with it. Rather, HHV-7 detection rate and cell load reflect CD4(+) T-lymphocyte count, with higher values in healthy donors and long-term non-progressors than in progressors.     

Study of CD4+CD8+ double positive T-lymphocyte phenotype and function in Indian patients infected with HIV-1

CD4+CD8+ double positive T cells represent a minor peripheral blood lymphocyte population. CD4+ expression on CD8+ T cells is induced following cellular activation, and as chronic HIV-1 infection is associated with generalized immune activation, double positive T cells studies have become necessary to understand the immunopathology of human immunodeficiency virus (HIV). The frequency of double positive T cells in persons infected with HIV was studied in comparison to uninfected controls. Further, the expression of CD38, HLA-DR, and programmed death (PD)-1 on these cells were ascertained. HIV-1 specific double positive T cells were also studied for their cytokine secretory ability and phenotype. A significantly higher double positive cell population was observed in the patients with advanced HIV disease (CD4+ T cell counts below 200 cells/μl), as compared to patients with CD4+ T cell counts above 500 cells/μl. Double positive T cells from patients with symptomatic HIV disease had a significantly increased activation and exhaustion levels, compared to asymptomatic subjects and to single positive T cells from the same subjects. HIV-1 specific double positive T cells showed further increase in CD38 and PD-1 expression levels. The proportion of CD38 and PD-1 expressing total and HIV-1 specific double positive T cells correlated positively with HIV-1 plasma viremia and negatively with CD4+ T cell counts. HIV infection results in a marked increase of double positive T cell population, and this cell population shows higher level of activation and exhaustion (increased PD-1 expression) compared to the single positive CD4+ and CD8+ T cells.     

使用活化诱导标记法评价HIV-1感染者特异性CD4+T细胞免疫应答的研究

目的:建立一种检测HIV-1特异性CD4⁺T细胞亚群功能的活化诱导标记法(activation-induced markers,AIM),从而更有效地评价HIV-1抗原特异性CD4⁺T细胞免疫应答水平。方法:选取12例未经抗病毒治疗的HIV-1慢性感染者及6例未感染HIV-1的健康人,分别以基于多色流式细胞术的AIM法和细胞内因子染色法(intracellular cytokine staining,ICS)检测抗原特异性T淋巴细胞功能,并探讨两种方法用于评价HIV-1感染者抗原特异性T细胞免疫应答的能力。结果:AIM法检测HIV-1慢性感染者中HIV-1抗原特异性PD-1⁺CD25⁺CD4⁺T、CD69⁺CD200⁺CD4⁺T、CD69⁺ICOS⁺CD4⁺T细胞阳性的比例为11/12、8/12和7/12,检测CD69⁺ICOS⁺CD8⁺T、CD137⁺CD69⁺CD8⁺T、PD-1⁺CD25⁺CD8⁺、OX40⁺PD-1⁺CD8⁺T细胞阳性的比例为8/12、8/12、7/12、7/12。ICS法检测HIV-1抗原特异性IL-2⁺CD4⁺T、IFN-γ⁺CD4⁺T、TNF-α⁺CD4⁺T细胞阳性的占比为2/12、2/12、0;IFN-γ⁺CD8⁺T、TNF-α⁺CD8⁺T、IL-2⁺CD8⁺T细胞阳性的占比为12/12、10/12、5/12。结论:AIM法在评价CD4⁺T细胞功能方面更为敏感,可作为ICS法的补充,两种方法联合使用可更全面地评估抗原特异性T淋巴细胞反应。