Immune signatures and biomarkers of viral control in early-treated children with HIV: insights informing intervention.

Abstract

Purpose of review: This review concentrates on the immune signatures in infants with perinatally acquired HIV (PAH) and in later life to assess their utility in predicting the likelihood of HIV remission following discontinuation of antiretroviral therapy.

Recent findings: Distinct immune signatures are identifiable in early treated infants with PAH in whom reservoirs are markedly restricted, with high CD4 + /CD8 + ratios, decreased immune activation and exhaustion, and a rapid transition of CD8 + T cells from naïve to a terminally differentiated state. The natural killer (NK) cell compartments manifest downregulated inhibitory markers and exhibit cytokine producing NK phenotypes. Immune signatures observed in adolescent/adult cohorts with PAH, and associated with reduced or absent replication competent HIV reservoir included HIV-specific T cell proliferative responses and NK cells expressing the activation markers NKG2D and NKp46.

Summary: Immune signatures of functional T cell and NK cell compartments are identifiable in early treated infants and adolescents with PAH, and are associated with limited replication competent reservoirs. Such findings are also observed in post treatment controllers and could be predictors of ART-free remission.