PURPOSE

Initiating antiretroviral therapy promptly (rapid ART) is linked to better immune recovery in people with HIV (PWH), although its specific effects on immune dysregulation remain partially understood. We have discovered a "pathological proliferation" phenomenon, marked by T cell over-proliferation and exhaustion in PWH, potentially hindering full immune recovery. The objective of this research is to examine how rapid ART affects T-cell pathological proliferation, immune recovery, and systemic inflammation in PWH.

PATIENTS AND METHODS

In this cross-sectional study (conducted at Beijing Youan Hospital, Capital Medical University, China, from April 1 to September 18, 2022), we recruited 39 PWH, including 23 in the rapid ART group (within 30 days) and 16 in the non-rapid ART group (after 180 days). Fasting venous blood samples were collected in the morning. Immune phenotypes of T cells were analyzed using mass cytometry and Luminex.

RESULTS

The rapid ART group demonstrated a significant decline in Ki67⁺ CD4⁺ and CD8⁺ T cells. Within this group, a higher percentage of naive T (T) cells was observed in CD4⁺ T cells, along with a remarkable reduction in Ki67 expression. Additionally, CD8⁺ T cells in the rapid ART group exhibited an increased presence of T cells while showing a decreased proportion of PD-1/HLA-DR/CD38 high-expressing cells. In addition, the rapid ART group exhibited significantly lower IL-18 levels. T cells (CD31 HLA-DR CD38 CD57 PD-1) and central memory T (T) cells (HLA-DR CD38 PD-1 CD57) that were not suppressed by rapid ART showed significant correlations with baseline CD4 counts, HIV loads, and recent CD4/CD8 ratio.

CONCLUSION

These findings suggest rapid ART may curb pathological T cell proliferation and improved immune recovery in PWH. Despite these benefits, persistent immune activation in some individuals highlights the need for targeted immune monitoring and potential adjunctive interventions to optimize long-term immune health in PWH.