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- W2024784737 abstract "HIV-1 elicits a vigorous T cell-mediated immune response, which evolves shortly after viral infection and continuously persists during the entire subsequent disease process [1]. Evidence for an active antiviral activity of these virus-specific T cells is largely based on three distinct observations: (a) the rapid evolution of viral sequence diversifications in targeted CD8 T cell epitopes during acute [2–6] and, to a lesser degree, in chronic infection [7]; (b) the significant impact that HLA class I alleles, which restrict CD8 T cell epitopes, have on the speed of HIV-1 disease progression [8,9]; and (c) the accelerated SIV disease progression that occurs in infected rhesus macaques following the artificial depletion of CD8 T cells [10,11]. Yet, the mere presence of HIV-1-specific CD4 and CD8 T cells alone does apparently not confer protective immunity against the virus. Indeed, sizable quantities of HIV-1-specific interferon-γ-secreting CD4 and CD8 T cells can be detected both in individuals with clinical AIDS and in those with long-term non-progressive infection, as determined using Elispot assays or multiparameter flow cytometry [12,13]. In addition, HIV-1-specific T cells in persons with progressive and with long-term non-progressive infection do not differ with regard to a number of additional effector functions, such as secretion of tumor necrosis factor-α and macrophage inflammatory protein-1β or the capacity for antigen-specific degranulation of cytotoxic enzymes [14]. Although the definitive identification of the correlates of protective T cell immunity in HIV-1 infection is still pending, a series of recent studies have evidenced distinct functional patterns of CD4 and CD8 T cell responses associated with effective control of HIV replication [15–17]. In particular, protective immune responses are associated with the presence of virus-specific interleukin-2 (IL-2)-secreting CD4 and CD8 T cells and with antigen-specific CD4 and CD8 T cell proliferation. The in vitro proliferative capacity of HIV-1-specific CD4 and CD8 T cells has gained substantial attention as an effector function that appears to be closely correlated to the in vivo dynamics of viral replication. For instance, strong lymphoproliferative HIV-1-specific CD4 T cell responses are detectable in acute infection but tend to decline during the subsequent disease process, despite the preservation of HIV-1-specific CD4 T cells able to secrete interferon-γ [18–20]. A similar pattern was recently described for HIV-1-specific CD8 T cells, which also appear to have prominent in vitro proliferative activities in acute infection but not in chronic progressive infection [21]. Strong lymphoproliferative CD4 [18] and CD8 T [22] cell responses are typically present in individuals with long-term non-progressive infection who are able to maintain spontaneous control of HIV-1 replication in the absence of antiretroviral therapy. The proliferative activity of HIV-1-specific CD8 T cells is largely dependent on autocrine or paracrine secretion of IL-2 by HIV-1-specific CD4 T cells [21]. Interestingly, the ability of HIV-1-specific CD4 T cells to secrete IL-2 seems to be similarly preserved in acute infection and in chronic long-term non-progressive HIV-1 infection but not in chronic progressive infection, even after treatment with highly active antiretroviral therapy (HAART) [19,23]. However, antigen-specific CD8 T cells may proliferate in the absence of CD4 T cell help (G. Pantaleo, personal communication). This CD4-cell-independent CD8 T cell proliferation is dependent on an autocrine and paracrine secretion of IL-2 by a subset of HIV-1-specific CD8 T cells able to secret IL-2 in long-term non-progressors or in subjects who are able to control HIV replication after treatment interruption. Antigen-specific IL-2-secreting CD8 T cells and CD4-cell-independent CD8 T cell proliferation are consistently observed in conditions of effective control of virus replication, such as infections with cytomegalovirus, Epstein–Barr virus and influenza. The key question arising from these data is whether the loss of antigen-specific IL-2-secreting CD4 and CD8 T cells and of proliferative HIV-1-specific CD4 and CD8 T cell responses following acute infection is causally responsible for the loss of HIV-1 immune control during the subsequent disease process, or whether it is simply a result of ongoing viral replication and immune activation. In the current edition of AIDS, Jansen et al. present interesting observations that may help to dissect the above issue. The authors have performed a detailed analysis of HIV-1-specific CD4 T cell effector functions in five individuals who were identified in acute infection, started on HAART and then subjected to a series of consecutive treatment interruptions. In three of the individuals, discontinuation of treatment resulted in rapid viral rebound, while one of the patients was able to maintain low levels of viral replication in the absence of antiretroviral therapy over a period of about 1 year. In apparent contrast to previously described data, proliferative HIV-1-specific T cell responses were maintained in four of these individuals, including the three patients who rapidly experienced viral rebound following treatment cessation, while proliferative T cell responses tended to decline in the one individual who spontaneously controlled HIV-1 replication after therapy discontinuation. Based on these observations, the authors propose a bell-shaped relation between HIV-1 plasma viremia and proliferative HIV-1-specific T cell responses: According to this model, low-level viremia stimulates the emergence of lymphoproliferative HIV-specific T cell responses; however, the continuous expansion of these antigen-specific T cells ultimately reaches a limit at which no additional proliferation of HIV-1-specific T cells can be achieved. Once this turning point is attained, HIV-1 viremia no longer stimulates HIV-1-specific lymphoproliferative T cells but actively impairs the generation and maintenance of HIV-1-specific T cell proliferation. Therefore, depending on the resources of the immune system, viral replication could either lead to the stimulation or the impairment of HIV-1-specific T cell proliferation. Studies investigating virus-specific responses of both CD4 and CD8 T cells in larger cohorts of individuals will be needed to validate this concept. Despite these recent advances in the delineation of functional patterns of protective CD4 and CD8 T cell responses, it is unclear whether immune-based intervention strategies are able to induce functional HIV-1-specific CD4 and CD8 T cell responses that are associated with effective virus control and whether these T cell responses may prevent progression of HIV-1 disease in patients with chronic infection. A number of studies have demonstrated that HIV-1-specific IL-2-secreting CD4 T cells and proliferation can be restored in chronically infected individuals treated successfully with HAART [21,24]. Randomized controlled clinical trials are now needed to evaluate if the in vivo induction of these functional patterns of HIV-1-specific CD4 and CD8 T cell responses are clinically relevant." @default.
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- W2024784737 title "Loss of HIV-1-specific T cell proliferation in chronic HIV-1 infection: cause or consequence of viral replication?" @default.
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- W2024784737 doi "https://doi.org/10.1097/01.aids.0000176224.56108.fb" @default.
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