Rapidly progressive HIV case highlights importance of specific immune response

The near-absence of an HIV-specific cytotoxic lymphocyte (CTL) response in a patient with extremely rapid disease progression emphasizes the importance of a robust HIV-specific immune response in combating the disease, according to a recent report.

Dr. James F. Demarest, from Duke University Medical Center in Durham, North Carolina, and colleagues analysed the immunologic and virologic profile of a 35-year-old black male who progressed from initial HIV infection to death in less than 6 months. The patient was not treated with antiretroviral therapy.

While the patient had an altered humoral response, the most distinctive immunologic feature was the near-absence of detectable HIV-specific CTL responses, the researchers note in the September 20th issue of AIDS Research and Human Retroviruses.

Immune cell analysis revealed a decreased percentage of CD8+ cells expressing CD45R0 and CD28 and an increased percentage of cells expressing CD45RA and CD57.

Limited sequence diversity was noted in primary viral isolates recovered throughout the disease course, the authors state. While cloned viral envelopes demonstrated broad coreceptor usage patterns, there was no evidence that infection occurred through these alternative receptors. The viral isolates maintained an R5 phenotype throughout the course of infection.

“Much emphasis has been placed on the virus and its coreceptor as determinants of disease stability/progression,” the investigators note. The current findings suggest that the ability to mount an HIV-specific immune response during the early stages of infection may be an equally important determinant of disease progression.