Impaired T-cell proliferation among HAART-treated adults with suboptimal CD4 recovery in an African cohort

BMC Immunology

Harriet Mayanja-Kizza¹  Huyen Cao⁴  Moses R Kamya¹  Agnes Kiragga³  Rose Nabatanzi²  Isaac Ssewanyana²  Damalie Nakanjako³ 

[1] Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda;Joint Clinical Research Center, Kampala, Uganda;Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda;California Department of Public Health, Richmond, CA, USA

关键词: HIV/AIDS;    HAART immune responses;    Suboptimal immune recovery;    Immune activation;    T-cell proliferation;   

Others  :  1077785
DOI  :  10.1186/1471-2172-14-26

 received in 2012-12-19, accepted in 2013-06-18,  发布年份 2013

【 摘 要 】

Background

Most HIV-infected subjects exhibit a progressive rise in CD4 T-cell counts after initiation of highly active antiretroviral therapy (HAART). However, a subset of individuals exhibit very poor CD4 T-cell recovery despite effective control of HIV-RNA viraemia. We evaluated CD4 T-cell proliferation among suboptimal responders and its correlation with CD4 T-cell activation.

Methods

The magnitude of CD4 increase (difference between absolute CD4 counts at baseline and absolute CD4 counts at 4 years of ART) was grouped into 4 quartiles for the 211 patients with sustained HIV-RNA viral suppression. Cases of ‘Suboptimal immune responders’ included patients within the lowest quartile [Median CD4 increase 165 (Range −43-298) cells/μl; n=52] and a comparison group of ‘Optimal immune responders’ was defined as patients within the highest quartile of CD4 increase [Median CD4 increase 528 (Range 417–878) cells/μl; n=52]. Frozen PBMC were thawed and analysed from a convenient sample of 39 suboptimal responders and 48 optimal responders after 4 years of suppressive antiretroviral therapy. T-cell activation was measured by proportions of T-cells expressing surface marker CD38 and HLADR (CD4+CD38+HLA-DR+ and CD8+CD38+HLA-DR+ cells). T-cell proliferation was determined by the extent of carboxyfluorescein diacetate succinimidyl ester (CFSE) dye dilution on culture day 5 of PBMCs in the presence of antigen (SEB, PPD, CMVpp65, GagA and GagD). Samples were analyzed on a FACS Calibur flow cytometer and flow data was analyzed using FlowJo and GraphPad.

Results

Overall, CD4 T-cell proliferation on stimulation with SEB, PPD, CMVpp65, Gag A and Gag D.antigens, was lower among suboptimal than optimal responders; this was significant for SEB (CD4+ p=0.003; CD8+ p=0.048) and PPD antigens (CD8+ p=0.038). Among suboptimal responders, T-cell proliferation decreased with increasing immune activation (Negative correlation; slope = −0.13±−0.11) but not among optimal responders.

Conclusion

T-cell immune activation and exhaustion were associated with poor proliferation among suboptimal responders to HAART despite sustained viral suppression. We recommend studies to further understand the mechanisms leading to impaired T-cell function among suboptimal responders as well as the potential role of immune modulation in optimizing CD4 count and functional recovery after HAART.

【 授权许可】

   
2013 Nakanjako et al.; licensee BioMed Central Ltd.

【 图 表 】

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