Immune reconstitution in lymphoid tissue following potent antiretroviral therapy

Abstract

During untreated HIV-1 infection, a chronic state of immune activation and inflammation develops at the lymphoid tissue sites of viral replication. The early effect of potent combination drug therapy is a reduction in peripheral viral burden and a reduction in the production of inflammatory and type 1 cytokines. Further along in treatment there are trends toward normalization in the frequencies of CD8⁸ T-cells, CD4⁺ CD45RA⁺ cells, as well as CD4⁺ CD45R0⁺ cells. Finally, the CD1a⁺ dendritic cell network is re-established and germinal centers are reformed. Although this restoration of the lymphoid dynamic form is coupled to a reconstitution of peripheral blood T-cell function in vitro and by skin testing, sterilizing immunity to HIV-1 does not develop. Furthermore there is no heightened development of cytotoxic CD8⁺ T-cell function at the site of HIV-1 latency. This is evidenced by a massive recrudescence of HIV-1 viral replication within lymphoid tissue when therapy is stopped. The development of supplemental therapies, which reconstitute anti-HIV-1 immunity, will be required. Specific defects in anti-HIV-1 activity which occur in lymphoid tissue during infection include a downregulation of perform expression by cytotoxic T-cells, the down regulation of the TCR signal transducing chain CD3ζ, and inadequate CD4⁺ T-cell help within the tissue compartment of immune regeneration.