Vulnerability to reservoir reseeding due to high immune activation after allogeneic hematopoietic stem cell transplantation in individuals with HIV-1

JM Eberhard, M Angin, C Passaes, M Salgado… - Science Translational …, 2020 - science.org
JM Eberhard, M Angin, C Passaes, M Salgado, V Monceaux, E Knops, G Kobbe, B Jensen
Science Translational Medicine, 2020science.org
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only medical
intervention that has led to an HIV cure. Whereas the HIV reservoir sharply decreases after
allo-HSCT, the dynamics of the T cell reconstitution has not been comprehensively
described. We analyzed the activation and differentiation of CD4+ and CD8+ T cells, and the
breadth and quality of HIV-and CMV-specific CD8+ T cell responses in 16 patients with HIV
who underwent allo-HSCT (including five individuals who received cells from CCR5Δ32/Δ32 …
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only medical intervention that has led to an HIV cure. Whereas the HIV reservoir sharply decreases after allo-HSCT, the dynamics of the T cell reconstitution has not been comprehensively described. We analyzed the activation and differentiation of CD4+ and CD8+ T cells, and the breadth and quality of HIV- and CMV-specific CD8+ T cell responses in 16 patients with HIV who underwent allo-HSCT (including five individuals who received cells from CCR5Δ32/Δ32 donors) to treat their underlying hematological malignancy and who remained on antiretroviral therapy (ART). We found that reconstitution of the T cell compartment after allo-HSCT was slow and heterogeneous with an initial expansion of activated CD4+ T cells that preceded the expansion of CD8+ T cells. Although HIV-specific CD8+ T cells disappeared immediately after allo-HSCT, weak HIV-specific CD8+ T cell responses were detectable several weeks after transplant and could still be detected at the time of full T cell chimerism, indicating that de novo priming, and hence antigen exposure, occurred during the time of T cell expansion. These HIV-specific T cells had limited functionality compared with CMV-specific CD8+ T cells and persisted years after allo-HSCT. In conclusion, immune reconstitution was slow, heterogeneous, and incomplete and coincided with de novo detection of weak HIV-specific T cell responses. The initial short phase of high T cell activation, in which HIV antigens were present, may constitute a window of vulnerability for the reseeding of viral reservoirs, emphasizing the importance of maintaining ART directly after allo-HSCT.
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