PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of nihpaAbout Author manuscriptsSubmit a manuscriptHHS Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
 
Curr Opin Immunol. Author manuscript; available in PMC 2011 August 1.
Published in final edited form as:
PMCID: PMC3039284
NIHMSID: NIHMS216592

Immune mechanisms of HIV control

Lisa A. Chakrabarti1
Institut Pasteur, Paris, France

Summary

HIV-1 can be contained by the immune system, as demonstrated by the existence of rare individuals who spontaneously control HIV-1 replication in the absence of antiretroviral therapy. Emerging evidence points to the importance of a very active cellular immune response in mediating HIV-1 control. The rapid induction of interferon-dependent HIV restriction factors, the presence of protective MHC class I alleles, and the development of a high avidity T-cell response may all cooperate in limiting HIV replication at an early stage. This review will focus on recent advances in understanding the immune mechanisms of HIV control, and on the lessons that may be drawn for the development of candidate HIV vaccines.

Introduction

HIV-1 infection does not always progress to AIDS. A small number of infected individuals spontaneously control HIV-1 replication in the absence of antiretroviral treatment and maintain a healthy status in the long term. Less than 0.2% of HIV-1 sero-positive patients show stringent HIV control, as defined by a viral load <50 copies HIV-1 RNA/ml for over 10 years, but these rare individuals have a remarkably low risk of progression to AIDS [1]. Patients with spontaneous HIV control have been variously called HIV controllers [2], HIV elite controllers [3], long term non progressors [4], or natural virus suppressors [5]. We will use the term “HIV controller” throughout this review. Importantly, the majority of HIV controllers appear infected with replication competent virus [6], indicating that host factors must play a key role in limiting HIV-1 replication and disease progression. We will review recent advances suggesting that both innate and adaptive immune mechanisms cooperate in establishing HIV control very early in the course of infection.

The early type I IFN response induces an array of antiretroviral restriction factors

One of the earliest antiviral defense mechanism is the induction of interferon (IFN) synthesis. “Danger” sensing systems (Toll-like-receptors [TLR], RIG-I-like-receptors) converge in activating the synthesis of type I IFN (Figure 1A, [7]). IFNs curb viral replication by a variety of mechanisms, including the shut-down of protein synthesis and the degradation of foreign nucleic acids [7]. Once produced, IFNα/β bind to the IFNAR1 receptor of the same or neighboring cells and initiate a signaling cascade resulting in the induction of hundreds of IFN stimulated genes (ISG) that constitute the “antiviral state” (Figure 1A, [8]).

Figure 1
Innate immune mechanisms that may contribute to HIV control

The group of type I IFN inhibits both the early as well as late steps of the HIV-1 life cycle [9], decreases HIV-1 infection of several cell types, and impairs HIV-1 transmission from dendritic cells (DC) to CD4+ T-cells [10]. Systemic administration of IFNα reduces HIV-1 plasma viremia [11] and improves production of antiviral antibodies [12] but multiple studies also indicate that IFN activity against HIV-1 is transient and/or suboptimal. For instance, HIV cell-to-cell transmission is much less susceptible to IFN inhibition than cell-free viral spread [13]. Plasmacytoid DC (pDC) are the main natural INFα producers in vivo [14], but this DC subpopulation appears depleted in chronic HIV infection [15]. Viable HIV-infected CD4+ T-cells are excellent inducers of pDC [16] but the capacity of pDC to produce IFNα is impaired during acute HIV-1 infection, suggesting that these cells have reached a refractory or exhausted state [17]. This early impairment of IFN responses may contribute significantly to HIV dissemination in progressor patients.

Intrinsic retroviral restriction factors such as TRIM5α, APOBEC3 and Tetherin are constitutively expressed but are also strongly up-regulated in response to IFN in a cell-type dependent manner (Table 1, Figure 1, [18,19]). Phylogenetic analyses show that these restriction factors have been under strong positive selection throughout primate evolution, indicative of a continuous evolutionary battle between the host and ancient retroviruses or other parasites [18,19]. HIV-1 has developed means to escape most of the human restriction factors: for instance APOBEC3G and Tetherin activities are counteracted the HIV-1 Vif and Vpu proteins, respectively (Figure 1B/C [18,19]). Tetherin and APOBEC3 molecules prevent viral spread (if left unchecked) while TRIM5α variants with activity against HIV-1 would protect the cell from productive infection (Figure 1B/C/D). HIV restriction factors are highly polymorphic, which may contribute to individual variations in susceptibility to HIV. While single nucleotide polymorphisms in TRIM5α [20], Vif-interacting protein Cullin 5 [21] and APOBEC3G [18], have been linked to CD4+ T-cell loss and/or rapid disease progression, these genetic associations need to be replicated in large-scale genomic studies comprising individuals of different ancestry.

Table 1
List of human restriction factors, their mode of action, the targeted retrovirus as well as the known viral countermeasures.

The clearest implication of a restriction factor in HIV disease progression has emerged from studies of copy number variation in the APOBEC3 locus. A large deletion eliminating the entire coding region of APOBEC3B [22] was found to be associated with an increased risk of HIV-1 acquisition, accelerated progression to AIDS and higher viral setpoints [23]. The homozygous deletion of APOBEC3B occurs commonly in East-Asians, Oceanic and Ameri-Indian populations [22] suggesting that certain populations may be more susceptible to infections with viruses known to be targeted by cytidine deaminases (HIV-1, HBV, HPV, HTLV1). APOBEC3B is expressed constitutively at low level in HIV target cells [24,25], but is, in contrast to APOBEC3G, resistant to Vif-mediated degradation [23]. Higher expression levels of such “HIV resistant” restriction factors, either at baseline or upon IFN induction, could conceivably contribute to HIV control.

HIV particles induce type I IFN responses mainly through the TLR7/8/ pathways [14]. Chronic IFN production may be deleterious for the infected host in the long-term, because it induces death receptors, increases expression of the HIV coreceptor CCR5 [26], and contributes to abnormal immune activation. The activation of the TLR7/IFN pathway by HIV in pDC appears to have a lower threshold in women than in men, which may contribute to higher immune activation levels and faster disease progression in HIV infected women [27]. It is relevant that the IFN response appears swiftly resolved in HIV controllers but not in progressor patients, as demonstrated by ISG expression patterns in whole-genome transcriptome studies [28]. How HIV controllers achieve optimal IFN responses while limiting IFN-dependent immunopathology remains to be elucidated. It is attractive to speculate that early containment of HIV at mucosal transmission sites by ISGs such as TRIM/APOBEC3/Tetherin creates a window of opportunity for the infected host to mount an efficient adaptive immune response (Figure 3).

Figure 3
Very early events in HIV control

Genetic studies suggest that CD8+ T-cells and NK cells are involved in HIV-1 control

HIV control shows a strong genetic association with MHC class I loci on chromosome 6, with alleles HLA B*5701 and B*5703 having the clearest protective effects in Caucasians and Africans, respectively [29]. Whole genome analyses have confirmed the HLA B association and pointed to an independent effect of HLA C, while the HLA-A association remains debated [30]. The HLA class I and CCR5 loci were the only regions to display significant associations with plasma viral load at the genome-wide level, emphasizing the potentially central role of class I restricted CD8 responses in HIV control [30]. The fact that protective HLA class I alleles disproportionately contribute to the initial CD8 response during acute HIV-1 infection further supports a role of CD8+ T-cells in rapidly establishing viral control [31]. The effects of protective MHC class I alleles appear also mediated by their interaction with KIR receptors at the surface of NK cells. The combination of certain HLA class I molecules of the Bw4 serological group with the KIR3DL1 and KIR3DS1 receptors is more protective against HIV disease progression than the class I molecule alone [32]. Importantly, HLA-Bw4 molecules include the B*57 alleles that are markedly overrepresented in HIV controllers.

Remarkable efficiency of effector CD8+ T-cells in HIV Controllers

Initial analyses of CD8 responses in HIV controllers revealed a high degree of heterogeneity in terms of cytokine secretion and differentiation status of HIV specific CD8+ T-cells [3,33]. However, it was noted early on that a hallmark of HIV control was a high proliferative capacity of specific CD8+ T-cells [4]. Consistent with an optimal survival/expansion capacity, HIV-specific CD8+ T-cells were detected at a particularly high frequency in mucosal tissues of HIV controllers [34].

The development of an in vitro “viral suppression” assay, based on the inhibition of HIV-1 replication in activated CD4+ T-cells by autologous CD8+ T-cells, has revealed the remarkable potency of HIV-specific CD8+ T-cells from controllers [35]. CD8+ T-cells from controllers inhibited HIV replication without being pre-activated in vitro, pointing to the presence of a pool of HIV-specific CD8+ T-cells with immediate or rapidly inducible antiviral effector functions. This efficient viral suppression was contact dependent and mediated predominantly by CD8+ T-cells directed against Gag, rather than Env or Nef proteins, [36,37], a finding in agreement with the good prognostic value of high anti-Gag responses measured ex vivo [38]. These studies have spurred the realization that classical ELISPOT assays, which rely on a massive antigenic stimulation by exogenous peptides, may not best reflect in vivo CD8+ T-cell efficacy, and that the development of assays based on antigenic presentation at physiologic doses, such as that occurring in a productively infected CD4+ T-cell, may be more informative. Next generation immunomonitoring assays are now being developed for HIV pathogenesis and vaccination studies.

The basis for CD8+ T-cell efficacy in HIV controllers is not entirely elucidated, but recent findings point to the importance of lytic granule loading. In particular, effector CD8+ T-cells from controllers are distinguished by their capacity to upregulate granzyme B to high levels and to deliver it efficiently to target CD4+ T-cells, a property that correlates with a high cytotoxic activity per effector cell [39]. Multiparametric flow cytometry analyses have also shown that CD8+ T-cells from HIV controllers are more polyfunctional, i.e. capable of secreting multiple cytokines and chemokines (IFN-γ, TNF-α, IL-2, MIP-1ß) as well as degranutating (CD107a surface expression) upon HIV specific stimulation [34,40]. Polyfunctionality is associated with a higher production of individual cytokines per cells, and hence with a more efficient secretion of effector molecules. While polyfunctionality is a proven correlate of the quality of CD8+ T-cell responses, it less clearly distinguishes HIV controllers from progressor patients than viral suppression assays [41]. Hence, it is not yet clear how cytokine/chemokine secretion contribute to viral control. The recent identification of distinct subsets of polyfunctional CD8+ T cells, endowed either with IL-2 secretion or with the capacity to upregulate perforin, may help further refine the correlates of control [42].

Importantly, not all HIV controllers show evidence for potent CD8 responses. CD8+ T-cells endowed with HIV suppressive capacity and polyfunctionality appear less frequent in HIV controllers devoid of protective HLA class I alleles [36,43]. It is also intriguing that SIV-infected rhesus macaques with a “controller” phenotype lack signs of potent CD8 antiviral responses [44]. These observations point to either a local containment of HIV/SIV by tissue-associated responses, which would not achieve systemic dissemination, or to novel mechanisms of control.

CD4+ T-cells: more than just sitting targets

HIV controllers show an intact or slightly decreased CD4+ T-cell population which harbors very low levels of HIV proviral DNA, indicative of a limited seeding of the viral reservoir [2]. CD4+ T-cells from controllers are endowed with IL-2 secretion capacity and a particularly high proliferative potential upon HIV-specific stimulation [45,46]. This last property has been ascribed to a resistance of the central memory CD4+ T-cell population to activation-induced apoptosis, through inactivation of the transcription factor FOXO3a [47]. The pool of HIV-specific CD4+ T-cells from controllers do not show signs of immune exhaustion typically seen in progressor patients, such as loss of poly-functionality and increased expression of the negative regulatory molecules CTLA-4 and PD-1 [3,48].

It has been argued that the lack of immune exhaustion is just a reflection of a persistently low antigenemia, and that the properties of HIV controller CD4+ T-cells are a consequence rather than a cause of viral control [49]. However, CD4+ T-cell responses of controllers remain quantitatively and qualitatively different from those of treated patients with similarly undetectable viral loads. Differences are most marked in the frequencies of IFN-γ producing CD4+ T-cells, which are of similar magnitude in HIV controllers and in viremic patients, while they are significantly lower in treated patients and tend to further decrease with treatment duration [46,50]. In contrast, proliferative CD4 responses of patients efficiently treated for over 10 years may indeed recover to levels equivalent to those seen in HIV controllers [50]. Thus, while low antigenemia may account for high proliferative capacity, other characteristics intrinsic to HIV controllers must account for an unusually high effector function.

It is not yet clear whether CD4+ T-cell from controllers can directly contribute to HIV control by killing infected cells. The fact that CD4+ T-cell clones from controller monkeys do inhibit SIV replication in autologous macrophages suggests that this could be the case [51]. CD4+ T-cells are known to have cytotoxic properties in other chronic viral infections. It is also well established that CD4+ T-cell help is required for the persistence of efficient cytotoxic activity mediated by CD8+ T-cells in chronic viral infections [52]. Emerging evidence suggests that IL-21 could be a key mediator of help, since this cytokine produced predominantly by CD4+ T-cells is a potent inductor of cytotoxic granule loading in CD8+ T-cells, and is necessary to viral control in the murine models of chronic infections [52]. Importantly, IL-21 production and IL-21 circulating levels are decreased in progressor patients but not in HIV controllers [53].

High avidity equals quality

Recent evidence suggests that HIV controllers harbor a high avidity memory CD4+ T-cell population directed against Gag [54]. The capacity to recognize minimal amounts of the immunodominant Gag 293–312 peptide results from a high avidity TCR/peptide-MHC interaction, as demonstrated by MHC class II tetramer binding. High avidity TCR are known to confer extensive proliferative potential and progressive immunodominance to CD4+ T-cells [55], consistent with findings in HIV controllers. The capacity to detect minimal amounts of virus may play a key role in HIV control, by keeping the immune system in constant alert and allowing the induction of rapid recall responses. The presence of a high avidity CD4+ T-cell population may also explain why HIV controllers show signs of persisting immune activation, in spite of very low viral loads [46,56]: the pool HIV-specific CD4+ T-cells, being easily triggered, could drive this immune activation through repeated reactivation and cytokine secretion.

HIV-specific CD8+ T-cell responses may also be of high avidity in HIV controllers, though this remains to be formally demonstrated. It is noteworthy that patients carrying the protective HLA B*27 allele frequently develop high avidity responses against the KK10 epitope, and that this response inversely correlates with viral load [57]. A recent study of HIV-specific CD8+ T-cell clones suggests that polyfunctionality and HIV suppressive capacity, which are hallmarks of HIV control, correlate with a high avidity for antigen [58]. A high cytotoxic activity per CD8+ T-cell, another correlate of HIV control, has been linked to a high avidity TCR/MHC-peptide interaction in murine models of viral infections [59].

Progressor patients show a loss of high avidity CD8 responses after primary infection, suggesting that high quality CD8+ T-cells become rapidly exhausted when viremia persists [60]. This finding is consistent with the higher susceptibility of high avidity T-cells to overstimulation. Further studies are needed to understand how HIV controller avoid excessive clonal turnover and maintain a high avidity response in the long term. An initially higher precursor frequency of high avidity T cells may avoid their exhaustion, through a very rapid containment of viral replication. In this respect, it is intriguing that shared clonotypes, which are frequently associated to a high precursor frequency, are predominant among CD8+ T-cells of vaccinated monkeys that resist SIV challenge [61]

Taken together, it is remarkable that the defining features of the antiviral T-cell response in HIV controllers, including high proliferative potential, polyfunctionality, and high cytotoxic capacity, are all known attributes of high avidity T-cells (Figure 2). Importantly, high avidity T-cells have been associated with the control of chronic viral infections in mice, monkeys, and humans [59,62,63]. Improving the avidity of T-cell responses, for instance by adjuvant combinations [64], should thus become a key objective of future HIV vaccination studies.

Figure 2
Consequence of a high avidity CD4+ T-cell response against HIV

Conclusions

Retrospective analysis of primary HIV-1 infection cohorts show that the HIV controller status can be established within months of the initial infection event, and that the viral replication peak is reduced, though not absent, in future controllers [65,66]. These findings emphasize the role of very early events in determining the outcome of the competition between HIV-1 replication and the host response. Signs of immunosuppression, such as dysfunctional non-proliferating T-cells, can be detected during primary infection in progressor patients, indicating that the host response has already been undermined at this early stage. In contrast, any parameter that may delay viral replication or accelerate the development of the antiviral response early on may favor the acquisition of a controller status. For instance, a reduced susceptibility of target cells due limited CCR5 expression, a pre-existing antiviral state due to a concomitant infection, a favorable combination of HIV restriction factors, or a high precursor frequency of high avidity T-cells clonotypes may all play a role in containing viral spread and in protecting the CD4+ T cell pool (Figure 3).

In conclusion, studies of HIV controllers have started yielding a wealth of information on the components of an efficient response against HIV. Genetic studies have revealed a role for NK cells in HIV control, and have pointed to the possible involvement of innate restriction factors. Recent evidence for a high antibody-dependent cell-mediated cytotoxic activity in controllers' sera suggests that humoral response parameters should be further explored [67]. Last and importantly, multiple studies have highlighted the key role of cellular immunity, and have helped identify correlates of control that should prove instrumental in evaluating future candidate HIV vaccines.

Acknowledgements

We regret the fact that we were unable to cite many of the relevant original articles because of space limitations. We thank Ana Fernandez Sesma, Florence Buseyne and Asier Saez-Cirion for critical reading of the manuscript.

The authors receive funding from the National Institutes of Health/ National Institute of Allergy and Infectious Diseases (R01AI064001, R01AI089246, VS), the Alexandrine and Alexander L. Sinsheimer Fund (VS), the Clinical and Translational Science Award to Mount Sinai School of Medicine (UL1RR029887, VS), the Agence Nationale de Recherche sur le SIDA et les Hépatites Virales (ANRS EP36, LC), Sidaction (LC), and the Pasteur Institute (LC).

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

References and recommended reading

Papers of particular interest, published within the period of review, have been highlighted as:

• of special interest

•• of outstanding interest

1. Grabar S, Selinger-Leneman H, Abgrall S, Pialoux G, Weiss L, Costagliola D. Prevalence and comparative characteristics of long-term nonprogressors and HIV controller patients in the French Hospital Database on HIV. AIDS. 2009;23:1163–1169. [PubMed]
2. Saez-Cirion A, Pancino G, Sinet M, Venet A, Lambotte O. HIV controllers: how do they tame the virus? Trends Immunol. 2007;28:532–540. [PubMed]
3. Deeks SG, Walker BD. Human immunodeficiency virus controllers: mechanisms of durable virus control in the absence of antiretroviral therapy. Immunity. 2007;27:406–416. [PubMed]
4. Migueles SA, Laborico AC, Shupert WL, Sabbaghian MS, Rabin R, Hallahan CW, Van Baarle D, Kostense S, Miedema F, McLaughlin M, et al. HIV-specific CD8+ T cell proliferation is coupled to perforin expression and is maintained in nonprogressors. Nat Immunol. 2002;3:1061–1068. [PubMed]
5. Sajadi MM, Heredia A, Le N, Constantine NT, Redfield RR. HIV-1 natural viral suppressors: control of viral replication in the absence of therapy. AIDS. 2007;21:517–519. [PubMed]
6. Blankson JN. Effector mechanisms in HIV-1 infected elite controllers: highly active immune responses? Antiviral Res. 85:295–302. [PMC free article] [PubMed]
7. Kumagai Y, Takeuchi O, Akira S. Pathogen recognition by innate receptors. J Infect Chemother. 2008;14:86–92. [PubMed]
8. Baum A, Garcia-Sastre A. Induction of type I interferon by RNA viruses: cellular receptors and their substrates. Amino Acids. 2009 [PMC free article] [PubMed] •• This review provides a comprehensive and timely overview of the interferon system, its receptors and its targets.
9. Meylan PR, Guatelli JC, Munis JR, Richman DD, Kornbluth RS. Mechanisms for the inhibition of HIV replication by interferons-alpha, -beta, and -gamma in primary human macrophages. Virology. 1993;193:138–148. [PubMed]
10. Thibault S, Fromentin R, Tardif MR, Tremblay MJ. TLR2 and TLR4 triggering exerts contrasting effects with regard to HIV-1 infection of human dendritic cells and subsequent virus transfer to CD4+ T cells. Retrovirology. 2009;6:42. [PMC free article] [PubMed]
11. Tavel JA, Huang CY, Shen J, Metcalf JA, Dewar R, Shah A, Vasudevachari MB, Follmann DA, Herpin B, Davey RT, et al. Interferon-alpha Produces Significant Decreases in HIV Load. J Interferon Cytokine Res. 2010 [PMC free article] [PubMed]
12. Adalid-Peralta L, Godot V, Colin C, Krzysiek R, Tran T, Poignard P, Venet A, Hosmalin A, Lebon P, Rouzioux C, et al. Stimulation of the primary anti-HIV antibody response by IFN-alpha in patients with acute HIV-1 infection. J Leukoc Biol. 2008;83:1060–1067. [PubMed]
13. Vendrame D, Sourisseau M, Perrin V, Schwartz O, Mammano F. Partial inhibition of human immunodeficiency virus replication by type I interferons: impact of cell-to-cell viral transfer. J Virol. 2009;83:10527–10537. [PMC free article] [PubMed]
14. Borrow P, Bhardwaj N. Innate immune responses in primary HIV-1 infection. Curr Opin HIV AIDS. 2008;3:36–44. [PMC free article] [PubMed]
15. Soumelis V, Scott I, Gheyas F, Bouhour D, Cozon G, Cotte L, Huang L, Levy JA, Liu YJ. Depletion of circulating natural type 1 interferon-producing cells in HIV-infected AIDS patients. Blood. 2001;98:906–912. [PubMed]
16. Schmidt B, Ashlock BM, Foster H, Fujimura SH, Levy JA. HIV-infected cells are major inducers of plasmacytoid dendritic cell interferon production, maturation, and migration. Virology. 2005;343:256–266. [PubMed] •• The authors demonstrate that HIV infected cells are more potent inducers of pDCs maturation and IFN production than cell-free virus.
17. Hosmalin A, Lebon P. Type I interferon production in HIV-infected patients. J Leukoc Biol. 2006;80:984–993. [PubMed]
18. Ross SR. Are viruses inhibited by APOBEC3 molecules from their host species? PLoS Pathog. 2009;5:e1000347. [PMC free article] [PubMed] •• This review discusses the impact APOBEC3 molecules on retroviral restriction in a species specific context with an emphasis on host genetic diversity.
19. Neil S, Bieniasz P. Human immunodeficiency virus, restriction factors, and interferon. J Interferon Cytokine Res. 2009;29:569–580. [PMC free article] [PubMed] •• This review provides an overview of current knowledge on HIV restriction factors and on the molecular mechanisms underlying their mode of action.
20. van Manen D, Rits MA, Beugeling C, van Dort K, Schuitemaker H, Kootstra NA. The effect of Trim5 polymorphisms on the clinical course of HIV-1 infection. PLoS Pathog. 2008;4:e18. [PubMed]
21. An P, Duggal P, Wang LH, O'Brien SJ, Donfield S, Goedert JJ, Phair J, Buchbinder S, Kirk GD, Winkler CA. Polymorphisms of CUL5 are associated with CD4+ T cell loss in HIV-1 infected individuals. PLoS Genet. 2007;3:e19. [PMC free article] [PubMed]
22. Kidd JM, Newman TL, Tuzun E, Kaul R, Eichler EE. Population Stratification of a Common APOBEC Gene Deletion Polymorphism. PLoS Genet. 2007;3:e63. [PubMed]
23. An P, Johnson R, Phair J, Kirk GD, Yu XF, Donfield S, Buchbinder S, Goedert JJ, Winkler CA. APOBEC3B Deletion and Risk of HIV-1 Acquisition. J Infect Dis. 2009 [PMC free article] [PubMed]
24. Refsland EW, Stenglein MD, Shindo K, Albin JS, Brown WL, Harris RS. Quantitative profiling of the full APOBEC3 mRNA repertoire in lymphocytes and tissues: implications for HIV-1 restriction. Nucleic Acids Res. 2010 [PMC free article] [PubMed]
25. Koning FA, Newman EN, Kim EY, Kunstman KJ, Wolinsky SM, Malim MH. Defining APOBEC3 Expression Patterns in Human Tissues and Hematopoietic Cell Subsets. J Virol. 2009 [PMC free article] [PubMed]
26. Stoddart CA, Keir ME, McCune JM. IFN-alpha-induced upregulation of CCR5 leads to expanded HIV tropism in vivo. PLoS Pathog. 2010;6:e1000766. [PMC free article] [PubMed]
27. Meier A, Chang JJ, Chan ES, Pollard RB, Sidhu HK, Kulkarni S, Wen TF, Lindsay RJ, Orellana L, Mildvan D, et al. Sex differences in the Toll-like receptor-mediated response of plasmacytoid dendritic cells to HIV-1. Nat Med. 2009;15:955–959. [PMC free article] [PubMed] •• This study reveals that the TLR7/IFN pathway is more easily triggered by HIV in pDCs from women than men, which may account for higher levels of chronic immune activation in HIV-infected women.
28. Rotger M, Dang KK, Fellay J, Heinzen EL, Feng S, Descombes P, Shianna KV, Ge D, Gunthard HF, Goldstein DB, et al. Genome-Wide mRNA Expression Correlates of Viral Control in CD4+ T-Cells from HIV-1-Infected Individuals. PLoS Pathog. 2010;6:e1000781. [PMC free article] [PubMed] •• The authors characterize transcriptome profiles in CD4+ T-cells of chronically HIV infected patients with different viral set-points. This large study shows an association between HIV plasma viremia and increased induction of antiviral defense genes suggesting that, in the chronic phase of infection, ISGs fail to control HIV infection.
29. Pelak K, Goldstein DB, Walley NM, Fellay J, Ge D, Shianna KV, Gumbs C, Gao X, Maia JM, Cronin KD, et al. Host Determinants of HIV-1 Control in African Americans. J Infect Dis. 2010;201:1141–1149. [PMC free article] [PubMed]
30. Fellay J, Ge D, Shianna KV, Colombo S, Ledergerber B, Cirulli ET, Urban TJ, Zhang K, Gumbs CE, Smith JP, et al. Common genetic variation and the control of HIV-1 in humans. PLoS Genet. 2009;5:e1000791. [PMC free article] [PubMed]
31. Altfeld M, Kalife ET, Qi Y, Streeck H, Lichterfeld M, Johnston MN, Burgett N, Swartz ME, Yang A, Alter G, et al. HLA Alleles Associated with Delayed Progression to AIDS Contribute Strongly to the Initial CD8(+) T Cell Response against HIV-1. PLoS Med. 2006;3:e403. [PMC free article] [PubMed]
32. Carrington M, Martin MP, van Bergen J. KIR-HLA intercourse in HIV disease. Trends Microbiol. 2008;16:620–627. [PMC free article] [PubMed]
33. Pereyra F, Addo MM, Kaufmann DE, Liu Y, Miura T, Rathod A, Baker B, Trocha A, Rosenberg R, Mackey E, et al. Genetic and immunologic heterogeneity among persons who control HIV infection in the absence of therapy. J Infect Dis. 2008;197:563–571. [PubMed]
34. Ferre AL, Hunt PW, Critchfield JW, Young DH, Morris MM, Garcia JC, Pollard RB, Yee HF, Jr., Martin JN, Deeks SG, et al. Mucosal immune responses to HIV-1 in elite controllers: a potential correlate of immune control. Blood. 2009;113:3978–3989. [PubMed] •• This study shows that HIV controllers have particularly strong and poly-functional CD8 responses in the rectal mucosa, with a frequency of HIV-specific CD8+ T cells that can reach above 10%.
35. Saez-Cirion A, Lacabaratz C, Lambotte O, Versmisse P, Urrutia A, Boufassa F, Barre-Sinoussi F, Delfraissy JF, Sinet M, Pancino G, et al. HIV controllers exhibit potent CD8 T cell capacity to suppress HIV infection ex vivo and peculiar cytotoxic T lymphocyte activation phenotype. Proc Natl Acad Sci U S A. 2007;104:6776–6781. [PubMed] •• This paper provides evidence for highly efficient CD8+ T-cells in HIV controllers, based on a coculture assay where CD8+ T-cells inhibit HIV replication in autologous CD4+ T-cells. These findings have spurred the development of novel immunomonitoring assays for HIV vaccine studies.
36. Saez-Cirion A, Sinet M, Shin SY, Urrutia A, Versmisse P, Lacabaratz C, Boufassa F, Avettand-Fenoel V, Rouzioux C, Delfraissy JF, et al. Heterogeneity in HIV suppression by CD8 T cells from HIV controllers: association with Gag-specific CD8 T cell responses. J Immunol. 2009;182:7828–7837. [PubMed]
37. Julg B, Williams KL, Reddy S, Bishop K, Qi Y, Carrington M, Goulder PJ, Ndung'u T, Walker BD. Enhanced anti-HIV functional activity associated with Gag-specific CD8 T-cell responses. J Virol. 2010 [PMC free article] [PubMed]
38. Kiepiela P, Ngumbela K, Thobakgale C, Ramduth D, Honeyborne I, Moodley E, Reddy S, de Pierres C, Mncube Z, Mkhwanazi N, et al. CD8+ T-cell responses to different HIV proteins have discordant associations with viral load. Nat Med. 2007;13:46–53. [PubMed]
39. Migueles SA, Osborne CM, Royce C, Compton AA, Joshi RP, Weeks KA, Rood JE, Berkley AM, Sacha JB, Cogliano-Shutta NA, et al. Lytic granule loading of CD8+ T cells is required for HIV-infected cell elimination associated with immune control. Immunity. 2008;29:1009–1021. [PMC free article] [PubMed]
40. Betts MR, Nason MC, West SM, De Rosa SC, Migueles SA, Abraham J, Lederman MM, Benito JM, Goepfert PA, Connors M, et al. HIV nonprogressors preferentially maintain highly functional HIV-specific CD8+ T cells. Blood. 2006;107:4781–4789. [PubMed]
41. Migueles SA, Weeks KA, Nou E, Berkley AM, Rood JE, Osborne CM, Hallahan CW, Cogliano-Shutta NA, Metcalf JA, McLaughlin M, et al. Defective human immunodeficiency virus-specific CD8+ T-cell polyfunctionality, proliferation, and cytotoxicity are not restored by antiretroviral therapy. J Virol. 2009;83:11876–11889. [PMC free article] [PubMed] •• This paper shows that HIV specific CD8+ T cells from controllers have a higher cytotoxic capacity per cell, a property which correlates with the accumulation of lytic molecules such as granzyme B within cytotoxic granules.
42. Makedonas G, Hutnick N, Haney D, Amick AC, Gardner J, Cosma G, Hersperger AR, Dolfi D, Wherry EJ, Ferrari G, et al. Perforin and IL-2 upregulation define qualitative differences among highly functional virus-specific human CD8 T cells. PLoS Pathog. 6:e1000798. [PMC free article] [PubMed]
43. Emu B, Sinclair E, Hatano H, Ferre A, Shacklett B, Martin JN, McCune JM, Deeks SG. HLA class I-restricted T-cell responses may contribute to the control of human immunodeficiency virus infection, but such responses are not always necessary for long-term virus control. J Virol. 2008;82:5398–5407. [PMC free article] [PubMed]
44. Vojnov L, Reed JS, Weisgrau KL, Rakasz EG, Loffredo JT, Piaskowski SM, Sacha JB, Kolar HL, Wilson NA, Johnson RP, et al. Effective simian immunodeficiency virus-specific CD8+ T cells lack an easily detectable, shared characteristic. J Virol. 2010;84:753–764. [PMC free article] [PubMed]
45. Younes SA, Yassine-Diab B, Dumont AR, Boulassel MR, Grossman Z, Routy JP, Sekaly RP. HIV-1 viremia prevents the establishment of interleukin 2-producing HIV-specific memory CD4+ T cells endowed with proliferative capacity. J Exp Med. 2003;198:1909–1922. [PMC free article] [PubMed]
46. Potter SJ, Lacabaratz C, Lambotte O, Perez-Patrigeon S, Vingert B, Sinet M, Colle JH, Urrutia A, Scott-Algara D, Boufassa F, et al. Preserved central memory and activated effector memory CD4+ T-cell subsets in human immunodeficiency virus controllers: an ANRS EP36 study. J Virol. 2007;81:13904–13915. [PMC free article] [PubMed]
47. van Grevenynghe J, Procopio FA, He Z, Chomont N, Riou C, Zhang Y, Gimmig S, Boucher G, Wilkinson P, Shi Y, et al. Transcription factor FOXO3a controls the persistence of memory CD4(+) T cells during HIV infection. Nat Med. 2008;14:266–274. [PubMed]
48. Kaufmann DE, Kavanagh DG, Pereyra F, Zaunders JJ, Mackey EW, Miura T, Palmer S, Brockman M, Rathod A, Piechocka-Trocha A, et al. Upregulation of CTLA-4 by HIV-specific CD4+ T cells correlates with disease progression and defines a reversible immune dysfunction. Nat Immunol. 2007;8:1246–1254. [PubMed] •• In this study, the negative costimulatory molecule CTLA-4 was upregulated at the surface of HIV-specific CD4+ T-cells in all categories of HIV infected patients except in HIV controllers, suggesting that these rare patients escape HIV-induced immune dysregulation.
49. Tilton JC, Luskin MR, Johnson AJ, Manion M, Hallahan CW, Metcalf JA, McLaughlin M, Davey RT, Jr., Connors M. Changes in paracrine interleukin-2 requirement, CCR7 expression, frequency, and cytokine secretion of human immunodeficiency virus-specific CD4+ T cells are a consequence of antigen load. J Virol. 2007;81:2713–2725. [PMC free article] [PubMed]
50. Guihot A, Tubiana R, Breton G, Marcelin AG, Samri A, Assoumou L, Goncalves E, Bricaire F, Costagliola D, Calvez V, et al. Immune and virological benefits of 10 years of permanent viral control with antiretroviral therapy. AIDS. 2010;24:614–617. [PubMed]
51. Sacha JB, Giraldo-Vela JP, Buechler MB, Martins MA, Maness NJ, Chung C, Wallace LT, Leon EJ, Friedrich TC, Wilson NA, et al. Gag- and Nef-specific CD4+ T cells recognize and inhibit SIV replication in infected macrophages early after infection. Proc Natl Acad Sci U S A. 2009;106:9791–9796. [PubMed]
52. Yi JS, Cox MA, Zajac AJ. T-cell exhaustion: characteristics, causes and conversion. Immunology. 2010 [PubMed]
53. Iannello A, Boulassel MR, Samarani S, Debbeche O, Tremblay C, Toma E, Routy JP, Ahmad A. Dynamics and consequences of IL-21 production in HIV-infected individuals: a longitudinal and cross-sectional study. J Immunol. 184:114–126. [PubMed]
54. Vingert B, Perez-Patrigeon S, Jeannin P, Lambotte O, Boufassa F, Lemaitre F, Kwok WW, Theodorou I, Delfraissy JF, Theze J, et al. HIV Controller CD4+ T Cells Respond to Minimal Amounts of Gag Antigen Due to High TCR Avidity. PLoS Pathog. 2010;6:e1000780. [PMC free article] [PubMed] •• This the first report of the presence of a high avidity memory CD4+ T-cell population in HIV controller.
55. Williams MA, Ravkov EV, Bevan MJ. Rapid culling of the CD4+ T cell repertoire in the transition from effector to memory. Immunity. 2008;28:533–545. [PMC free article] [PubMed]
56. Hunt PW, Brenchley J, Sinclair E, McCune JM, Roland M, Page-Shafer K, Hsue P, Emu B, Krone M, Lampiris H, et al. Relationship between T cell activation and CD4+ T cell count in HIV-seropositive individuals with undetectable plasma HIV RNA levels in the absence of therapy. J Infect Dis. 2008;197:126–133. [PMC free article] [PubMed]
57. Almeida JR, Price DA, Papagno L, Arkoub ZA, Sauce D, Bornstein E, Asher TE, Samri A, Schnuriger A, Theodorou I, et al. Superior control of HIV-1 replication by CD8+ T cells is reflected by their avidity, polyfunctionality, and clonal turnover. J Exp Med. 2007;204:2473–2485. [PMC free article] [PubMed] •• This study found an inverse correlation between viral load and functional avidity of the CD8+ T-cell response directed against an immunodominant Gag epitope in HLA B*27 patients, suggesting that functional avidity may be a determinant of HIV control.
58. Almeida JR, Sauce D, Price DA, Papagno L, Shin SY, Moris A, Larsen M, Pancino G, Douek DC, Autran B, et al. Antigen sensitivity is a major determinant of CD8+ T-cell polyfunctionality and HIV-suppressive activity. Blood. 2009;113:6351–6360. [PubMed]
59. Alexander-Miller MA. High-avidity CD8+ T cells: optimal soldiers in the war against viruses and tumors. Immunol Res. 2005;31:13–24. [PubMed]
60. Lichterfeld M, Yu XG, Mui SK, Williams KL, Trocha A, Brockman MA, Allgaier RL, Waring MT, Koibuchi T, Johnston MN, et al. Selective depletion of high-avidity human immunodeficiency virus type 1 (HIV-1)-specific CD8+ T cells after early HIV-1 infection. J Virol. 2007;81:4199–4214. [PMC free article] [PubMed]
61. Price DA, Asher TE, Wilson NA, Nason MC, Brenchley JM, Metzler IS, Venturi V, Gostick E, Chattopadhyay PK, Roederer M, et al. Public clonotype usage identifies protective Gag-specific CD8+ T cell responses in SIV infection. J Exp Med. 2009;206:923–936. [PMC free article] [PubMed]
62. Belyakov IM, Kuznetsov VA, Kelsall B, Klinman D, Moniuszko M, Lemon M, Markham PD, Pal R, Clements JD, Lewis MG, et al. Impact of vaccine-induced mucosal high-avidity CD8+ CTLs in delay of AIDS viral dissemination from mucosa. Blood. 2006;107:3258–3264. [PubMed]
63. Neveu B, Debeaupuis E, Echasserieau K, le Moullac-Vaidye B, Gassin M, Jegou L, Decalf J, Albert M, Ferry N, Gournay J, et al. Selection of high-avidity CD8 T cells correlates with control of hepatitis C virus infection. Hepatology. 2008;48:713–722. [PubMed]
64. Zhu Q, Egelston C, Gagnon S, Sui Y, Belyakov IM, Klinman DM, Berzofsky JA. Using 3 TLR ligands as a combination adjuvant induces qualitative changes in T cell responses needed for antiviral protection in mice. J Clin Invest. 2010;120:607–616. [PMC free article] [PubMed]
65. Goujard C, Chaix ML, Lambotte O, Deveau C, Sinet M, Guergnon J, Courgnaud V, Rouzioux C, Delfraissy JF, Venet A, et al. Spontaneous control of viral replication during primary HIV infection: when is “HIV controller” status established? Clin Infect Dis. 2009;49:982–986. [PubMed]
66. Okulicz JF, Marconi VC, Landrum ML, Wegner S, Weintrob A, Ganesan A, Hale B, Crum-Cianflone N, Delmar J, Barthel V, et al. Clinical outcomes of elite controllers, viremic controllers, and long-term nonprogressors in the US Department of Defense HIV natural history study. J Infect Dis. 2009;200:1714–1723. [PubMed]
67. Lambotte O, Ferrari G, Moog C, Yates NL, Liao HX, Parks RJ, Hicks CB, Owzar K, Tomaras GD, Montefiori DC, et al. Heterogeneous neutralizing antibody and antibody-dependent cell cytotoxicity responses in HIV-1 elite controllers. AIDS. 2009;23:897–906. [PMC free article] [PubMed]