Differential immunophenotype and proviral composition in young adults with perinatally acquired HIV: Are special cure strategies needed?

Objective: To characterize the immune functionality and phenotype and the proviral composition of a cohort of young adults with perinatally-acquired HIV (p-YA) from Argentina.

Design: Cross-sectional study of 18 p-YA, 15 young adults with non-perinatally acquired HIV matched by age with p-YA and 14 adults with non-perinatally acquired HIV, matched by time from HIV diagnosis with p-YA, all from Argentina.

Methods: Immune memory/effector phenotype, exhaustion, activation, PTK-7 and Ki-67 expression were evaluated by flow cytometry on NK and T-cells. Total, intact and defective proviral (TP, IP and DP) HIV-DNA were measured in CD4 T-cells by IPDA. Soluble markers were determined by ELISA.

Results: p-YA displayed lower expression of PD-1, higher levels of CD38+ CD4 T-cells and increased levels of naïve T-cells than control groups. Also, a trend of lower levels of IP HIV-DNA normalized to CD4 T-cell counts and to the proportion of naïve T-cells was found in p-YA.

Conclusion: The higher frequency of naïve CD4 T-cells in p-YA cannot be explained by elevated thymic activity nor by a higher T-cell proliferation rate. This imbalance could have been generated early in life and persisted during adulthood. Naïve CD4 T-cells may not serve as a major viral reservoir in p-YA. Also, the lower PD-1+ CD4 T-cell count suggests that p-YA did not present higher levels of exhaustion. These findings suggest that acquiring HIV perinatally may imply different challenges for proviral eradication.