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Sci Transl Med. 2019 May 22;11(493). pii: eaau0528. doi: 10.1126/scitranslmed.aau0528.

Augmentation of HIV-specific T cell function by immediate treatment of hyperacute HIV-1 infection.

Author information

1
Africa Health Research Institute, 4036 Durban, South Africa. zndhlovu@mgh.harvard.edu bwalker@mgh.harvard.edu.
2
Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA.
3
Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA.
4
HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, 4013 Durban, South Africa.
5
Institute for Medical Engineering and Science (IMES), MIT, Cambridge, MA 02139, USA.
6
Department of Chemistry and Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139, USA.
7
Broad Institute of MIT and Harvard, Cambridge, MA 02139, USA.
8
Africa Health Research Institute, 4036 Durban, South Africa.
9
Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
10
Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
11
South Africa Medical Research Council, 4091 Durban, South Africa.
12
Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA. zndhlovu@mgh.harvard.edu bwalker@mgh.harvard.edu.

Abstract

Sustained viremia after acute HIV infection is associated with profound CD4+ T cell loss and exhaustion of HIV-specific CD8+ T cell responses. To determine the impact of combination antiretroviral therapy (cART) on these processes, we examined the evolution of immune responses in acutely infected individuals initiating treatment before peak viremia. Immediate treatment of Fiebig stages I and II infection led to a rapid decline in viral load and diminished magnitude of HIV-specific (tetramer+) CD8+ T cell responses compared to untreated donors. There was a strong positive correlation between cumulative viral antigen exposure before full cART-induced suppression and immune responses measured by MHC class I tetramers, IFN-γ ELISPOT, and CD8+ T cell activation. HIV-specific CD8+ T responses of early treated individuals were characterized by increased CD127 and BCL-2 expression, greater in vitro IFN-γ secretion, and enhanced differentiation into effector memory (Tem) cells. Transcriptional analysis of tetramer+ CD8+ T cells from treated persons revealed reduced expression of genes associated with activation and apoptosis, with concurrent up-regulation of prosurvival genes including BCL-2, AXL, and SRC Early treatment also resulted in robust HIV-specific CD4+ T cell responses compared to untreated HIV-infected individuals. Our data show that limiting acute viremia results in enhanced functionality of HIV-specific CD4+ and CD8+ T cells, preserving key antiviral properties of these cells.

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