RT Journal Article
SR Electronic
T1 Vulnerability to reservoir reseeding due to high immune activation after allogeneic hematopoietic stem cell transplantation in individuals with HIV-1
JF Science Translational Medicine
FD American Association for the Advancement of Science
SP eaay9355
DO 10.1126/scitranslmed.aay9355
VO 12
IS 542
A1 Eberhard, Johanna M.
A1 Angin, Mathieu
A1 Passaes, Caroline
A1 Salgado, Maria
A1 Monceaux, Valerie
A1 Knops, Elena
A1 Kobbe, Guido
A1 Jensen, Björn
A1 Christopeit, Maximilian
A1 Kröger, Nicolaus
A1 Vandekerckhove, Linos
A1 Badiola, Jon
A1 Bandera, Alessandra
A1 Raj, Kavita
A1 van Lunzen, Jan
A1 Hütter, Gero
A1 Kuball, Jürgen H. E.
A1 Martinez-Laperche, Carolina
A1 Balsalobre, Pascual
A1 Kwon, Mi
A1 Díez-Martín, José L.
A1 Nijhuis, Monique
A1 Wensing, Annemarie
A1 Martinez-Picado, Javier
A1 Schulze zur Wiesch, Julian
A1 Sáez-Cirión, Asier
YR 2020
UL http://stm.sciencemag.org/content/12/542/eaay9355.abstract
AB Some persons living with HIV also have hematologic malignancies, which require treatment by hematopoetic stem cell transplant (HSCT). Eberhard et al. collected clinical, virologic, and immunologic data on 16 such individuals before and after transplant. They observed incomplete T cell reconstitution after HSCT, although there was de novo priming of HIV-specific T cells. A period of high immune activation indicated a window of vulnerability for HIV reservoir re-seeding. These valuable data may hold clues for helping other individuals in a similar situation, and more generally for curing HIV.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.