Impact of Multi-Targeted Antiretroviral Treatment on Gut T Cell Depletion and HIV Reservoir Seeding during Acute HIV Infection

• Published in: PloS one Vol. 7; no. 3; p. e33948
• Main Authors: Ananworanich, Jintanat, Schuetz, Alexandra, Vandergeeten, Claire, Sereti, Irini, de Souza, Mark, Rerknimitr, Rungsun, Dewar, Robin, Marovich, Mary, van Griensven, Frits, Sekaly, Rafick, Pinyakorn, Suteeraporn, Phanuphak, Nittaya, Trichavaroj, Rapee, Rutvisuttinunt, Wiriya, Chomchey, Nitiya, Paris, Robert, Peel, Sheila, Valcour, Victor, Maldarelli, Frank, Chomont, Nicolas, Michael, Nelson, Phanuphak, Praphan, Kim, Jerome H.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 30.03.2012; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Anti-HIV agents; Antiretroviral agents; Antiretroviral drugs; Antiretroviral Therapy, Highly Active; Armed forces; Biological products industry; Biology; Blood; CCR5 protein; CD4 antigen; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes - immunology; CD4-Positive T-Lymphocytes - virology; Collaboration; Cytokines - blood; Deoxyribonucleic acid; Depletion; Development and progression; Disease control; DNA; Drug therapy; Efavirenz; Emtricitabine; Female; Gene therapy; Health aspects; Highly active antiretroviral therapy; HIV; HIV infections; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - virology; HIV-1 - immunology; Human immunodeficiency virus; Humans; Infections; Intestines - immunology; Intestines - virology; Laboratories; Leukocytes, Mononuclear - virology; Lymphocytes; Lymphocytes T; Male; Medical diagnosis; Medical research; Medicine; Peripheral blood mononuclear cells; Public health; R&D; Receptors, CCR5 - metabolism; Remission; Research & development; Restoration; Ribonucleic acid; RNA; T cells; T-Lymphocytes - immunology; Tenofovir; Treatment Outcome; Viral Load; Virus Latency - immunology; Viruses; United States > US; Hawaii; East Asia; California; Thailand; Florida; Maryland; Bangkok Thailand
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0033948

Limited knowledge exists on early HIV events that may inform preventive and therapeutic strategies. This study aims to characterize the earliest immunologic and virologic HIV events following infection and investigates the usage of a novel therapeutic strategy. We prospectively screened 24,430 subjects in Bangkok and identified 40 AHI individuals. Thirty Thais were enrolled (8 Fiebig I, 5 Fiebig II, 15 Fiebig III, 2 Fiebig IV) of whom 15 completed 24 weeks of megaHAART (tenofovir/emtricitabine/efavirenz/raltegravir/maraviroc). Sigmoid biopsies were completed in 24/30 at baseline and 13/15 at week 24. At baseline, the median age was 29 years and 83% were MSM. Most were symptomatic (87%), and were infected with R5-tropic (77%) CRF01_AE (70%). Median CD4 was 406 cells/mm(3). HIV RNA was 5.5 log(10) copies/ml. Median total blood HIV DNA was higher in Fiebig III (550 copy/10(6) PBMC) vs. Fiebig I (8 copy/10(6) PBMC) (p = 0.01) while the median %CD4+CCR5+ gut T cells was lower in Fiebig III (19%) vs. Fiebig I (59%) (p = 0.0008). After 24 weeks of megaHAART, HIV RNA levels of <50 copies were achieved in 14/15 in blood and 13/13 in gut. Total blood HIV DNA at week 0 predicted reservoir size at week 24 (p<0.001). Total HIV DNA declined significantly and was undetectable in 3 of 15 in blood and 3 of 7 in gut. Frequency of CD4+CCR5+ gut T cells increased from 41% at baseline to 64% at week 24 (p>0.050); subjects with less than 40% at baseline had a significant increase in CD4+CCR5+ T cells from baseline to week 24 (14% vs. 71%, p = 0.02). Gut T cell depletion and HIV reservoir seeding increases with progression of AHI. MegaHAART was associated with immune restoration and reduced reservoir size. Our findings could inform research on strategies to achieve HIV drug-free remission.