Treatment-dependent loss of polyfunctional CD8+ T-cell responses in HIV-infected kidney transplant recipients is associated with herpesvirus reactivation

Am J Transplant. 2009 Apr;9(4):794-803. doi: 10.1111/j.1600-6143.2008.02539.x.

Abstract

Antiretroviral-therapy has dramatically changed the course of HIV infection and HIV-infected (HIV(+)) individuals are becoming more frequently eligible for solid-organ transplantation. However, only scarce data are available on how immunosuppressive (IS) strategies relate to transplantation outcome and immune function. We determined the impact of transplantation and immune-depleting treatment on CD4+ T-cell counts, HIV-, EBV-, and Cytomegalovirus (CMV)-viral loads and virus-specific T-cell immunity in a 1-year prospective cohort of 27 HIV(+) kidney transplant recipients. While the results show an increasing breadth and magnitude of the herpesvirus-specific cytotoxic T-cell (CTL) response over-time, they also revealed a significant depletion of polyfunctional virus-specific CTL in individuals receiving thymoglobulin as a lymphocyte-depleting treatment. The disappearance of polyfunctional CTL was accompanied by virologic EBV-reactivation events, directly linking the absence of specific polyfunctional CTL to viral reactivation. The data provide first insights into the immune-reserve in HIV+ infected transplant recipients and highlight new immunological effects of thymoglobulin treatment. Long-term studies will be needed to assess the clinical risk associated with thymoglobulin treatment, in particular with regards to EBV-associated lymphoproliferative diseases.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acyclovir / therapeutic use
  • Adult
  • Aged
  • Antiviral Agents / therapeutic use
  • CD4 Lymphocyte Count
  • CD4-Positive T-Lymphocytes / immunology
  • CD8-Positive T-Lymphocytes / immunology*
  • Cell Survival
  • Cytomegalovirus / genetics
  • Flow Cytometry
  • Ganciclovir / therapeutic use
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • HLA-A Antigens / immunology
  • HLA-B Antigens / immunology
  • HLA-DR Antigens / immunology
  • Herpesviridae / drug effects
  • Herpesviridae / genetics
  • Herpesviridae / physiology*
  • Herpesvirus 4, Human / drug effects
  • Herpesvirus 4, Human / genetics
  • Humans
  • Kidney Transplantation / immunology*
  • Kidney Transplantation / pathology
  • Middle Aged
  • Patient Selection
  • T-Lymphocytes, Cytotoxic / immunology*
  • T-Lymphocytes, Cytotoxic / pathology
  • Viral Load
  • Virus Activation / immunology
  • Virus Activation / physiology*

Substances

  • Antiviral Agents
  • HLA-A Antigens
  • HLA-B Antigens
  • HLA-DR Antigens
  • Ganciclovir
  • Acyclovir