Vaccine and Gene Therapy Institute, Oregon Health & Science University, Beaverton, Oregon, United States of America.
Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, United States of America.
PLoS Pathog. 2024 Aug 22;20(8):e1012496. doi: 10.1371/journal.ppat.1012496. eCollection 2024 Aug.
Persistence of the rebound-competent viral reservoir (RCVR) within the CD4+ T cell compartment of people living with HIV remains a major barrier to HIV cure. Here, we determined the effects of the pan-lymphocyte-depleting monoclonal antibody (mAb) alemtuzumab on the RCVR in SIVmac239-infected rhesus macaques (RM) receiving antiretroviral therapy (ART). Alemtuzumab administered during chronic ART or at the time of ART initiation induced >95% depletion of circulating CD4+ T cells in peripheral blood and substantial CD4+ T cell depletion in lymph nodes. However, treatment was followed by proliferation and reconstitution of CD4+ T cells in blood, and despite ongoing ART, levels of cell-associated SIV DNA in blood and lymphoid tissues were not substantially different between alemtuzumab-treated and control RM after immune cell reconstitution, irrespective of the time of alemtuzumab treatment. Upon ART cessation, 19 of 22 alemtuzumab-treated RM and 13 of 13 controls rebounded with no difference in the time to rebound between treatment groups. Time to rebound and reactivation rate was associated with plasma viral loads (pVLs) at time of ART initiation, suggesting lymphocyte depletion had no durable impact on the RCVR. However, 3 alemtuzumab-treated RM that had lowest levels of pre-ART viremia, failed to rebound after ART withdrawal, in contrast to controls with similar levels of SIV replication. These observations suggest that alemtuzumab therapy has little to no ability to reduce well-established RCVRs but may facilitate RCVR destabilization when pre-ART virus levels are particularly low.
在感染 HIV 的人群中,CD4+T 细胞内持续存在具有反弹能力的病毒储存库(RCVR)仍然是 HIV 治愈的主要障碍。在这里,我们确定了泛淋巴细胞耗竭单克隆抗体(mAb)阿仑单抗对接受抗逆转录病毒治疗(ART)的 SIVmac239 感染恒河猴(RM)RCVR 的影响。在慢性 ART 期间或在开始 ART 时给予阿仑单抗,会导致外周血循环 CD4+T 细胞和淋巴结中大量 CD4+T 细胞耗竭。然而,治疗后会导致 CD4+T 细胞在血液中增殖和重建,尽管持续进行 ART,但在免疫细胞重建后,阿仑单抗治疗组和对照组 RM 的血液和淋巴组织中细胞相关 SIV DNA 水平没有实质性差异,无论阿仑单抗治疗时间如何。停止 ART 后,22 只接受阿仑单抗治疗的 RM 中有 19 只和 13 只对照 RM 中有 13 只出现反弹,两组之间的反弹时间没有差异。反弹时间和再激活率与开始 ART 时的血浆病毒载量(pVL)相关,表明淋巴细胞耗竭对 RCVR 没有持久影响。然而,3 只接受阿仑单抗治疗的 RM 在 ART 停药后未能反弹,而对照组的 SIV 复制水平相似。这些观察结果表明,阿仑单抗治疗几乎没有能力降低已建立的 RCVR,但当 ART 前病毒水平特别低时,可能会促进 RCVR 失稳。
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