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Hidden in plain sight
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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