Preserving HIV-specific T cell responses: does timing of antiretroviral therapy help?

• Published in: Current opinion in HIV & AIDS Vol. 10; no. 1; pp. 55 - 60
• Main Authors: Macatangay, Bernard J.C, Rinaldo, Charles R
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins, Inc 01-01-2015
• Subjects: AIDS/HIV; Anti-Retroviral Agents - administration & dosage; Anti-Retroviral Agents - pharmacology; CD4-CD8 Ratio; CD8-Positive T-Lymphocytes - drug effects; CD8-Positive T-Lymphocytes - immunology; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - virology; HIV-1 - immunology; Humans
• ISSN: 1746-630X; 1746-6318
• DOI: 10.1097/COH.0000000000000124

PURPOSE OF REVIEWHIV-specific T cell responses are likely to have an important role in HIV cure strategies that aim for long-lasting viral control without antiretroviral therapy (ART). An important issue in enhancing virus-specific T cell responses is whether timing of ART can influence their magnitude and breadth.
RECENT FINDINGSEarly ART is associated with lower T cell activation, preservation of T cell numbers, smaller DNA and RNA reservoir size, and, in a single study (VISCONTI), control of plasma viremia after treatment interruption. The prevention of T cell destruction by early ART is associated with relatively low anti-HIV CD8 T cell responses but stronger CD4 T helper function. The relatively lower CD8T cell response, which is presumably due to rapid lowering of HIV antigen burden after early ART, appears sufficient to control residual viral replication as well as viral rebound upon treatment interruption.
SUMMARYAvailable evidence of starting ART during acute or early HIV infection has shown benefit in both virologic and immunologic parameters despite the lower HIV-specific CD8 T cell responses observed. Encouraging as this is, more extensive data are necessary to evaluate its role in combination with immunotherapeutic and latency activation strategies that are being assessed in various HIV cure-related studies.