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Sex-Based Differences in HIV-1 Reservoir Activity and Residual Immune Activation.

Scully EP, et al. J Infect Dis. 2018.


Plasma HIV-1 RNA levels in women are lower early in untreated HIV-1 infection compared to men, but women have higher T-cell activation and faster disease progression when adjusted for viral load. It is not known whether these sex differences persist during effective antiretroviral therapy (ART), or whether they would be relevant for the evaluation and implementation of HIV-1 cure strategies. We prospectively enrolled a cohort of reproductive age women and matched men on suppressive ART and measured markers of HIV-1 persistence, residual virus activity, and immune activation. The frequency of CD4 + T-cells harboring HIV-1 DNA was comparable between the sexes, but there was higher cell-associated HIV-1 RNA, higher plasma HIV-1 (single copy assay), higher T-cell activation and PD-1 expression in men compared to women. These sex-related differences in immune phenotype and HIV-1 persistence on ART have significant implications for the design and measurement of curative interventions.


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