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Platelets from HIV-infected individuals on antiretroviral drug therapy with poor CD4+ T cell recovery can harbor replication-competent HIV despite viral suppression

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Science Translational Medicine  18 Mar 2020:
Vol. 12, Issue 535, eaat6263
DOI: 10.1126/scitranslmed.aat6263

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Human platelets carry out several immune functions as well as hemostasis and interact with infectious pathogens including HIV in vitro. Real et al. now report that platelets from HIV-infected individuals can harbor replication-competent HIV, despite successful viral suppression by antiretroviral drug therapy (ART). Moreover, in their study, >80% of virally suppressed HIV-infected individuals with platelets containing HIV showed poor restoration of immune status even 1 year after ART treatment initiation. Platelets carrying HIV may provide an alternative pathway for HIV dissemination in HIV-infected individuals on ART with viral suppression and poor CD4+ T cell recovery.

Abstract

In addition to hemostasis, human platelets have several immune functions and interact with infectious pathogens including HIV in vitro. Here, we report that platelets from HIV-infected individuals on combined antiretroviral drug therapy (ART) with low blood CD4+ T cell counts (<350 cells/μl) contained replication-competent HIV despite viral suppression. In vitro, human platelets harboring HIV propagated the virus to macrophages, a process that could be prevented with the biologic abciximab, an anti–integrin αIIb/β3 Fab. Furthermore, in our cohort, 88% of HIV-infected individuals on ART with viral suppression and with platelets containing HIV were poor immunological responders with CD4+ T cell counts remaining below <350 cells/μl for more than one year. Our study suggests that platelets may be transient carriers of HIV and may provide an alternative pathway for HIV dissemination in HIV-infected individuals on ART with viral suppression and poor CD4+ T cell recovery.

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