CD4⁺T Cell Depletion in an Untreated HIV Type 1–Infected Human Leukocyte Antigen–B*5801–Positive Patient with an Undetectable Viral Load

Abstract

We report a case of a patient infected with human immunodeficiency virus type 1 (HIV-1) for 20 years who has experienced CD4(+) T cell depletion in spite of maintaining undetectable viral loads. Our data suggest that immune activation can cause CD4(+) T cell depletion even when HIV-1 replication appears to be controlled by host factors.

Persistent Low‐Level Viremia in HIV‐1 Elite Controllers and Relationship to Immunologic Parameters

“…Elite controllers are characterized by stable high absolute CD4+ T cells [2], but CD4+ T cell decline and progression to AIDS has been reported in isolated cases [16]. To determine the impact of low-level viremia on the absolute CD4+ T cell counts, we calculated the slope of change over time.…”

Evidence of dysregulation of dendritic cells in primary HIV infection

“…Immune activation and disease progression has been demonstrated with somewhat higher levels of CD38 ϩ HLADR ϩ CD4 ϩ and CD8 ϩ T cells than uninfected subjects, 35 and some controllers exhibit declining CD4 ϩ T-cell counts over time. 36 Therefore, even clinically undetectable viral levels affect host immune responses. The reduction in DC numbers of all patient populations we observed, regardless of innate or ART-induced control of viremia, suggests that even residual levels of virus may be sufficient to directly or indirectly cause tissue homing of peripheral DCs, DC destruction, and/or decreased DC differentiation from progenitors.…”

Control of HIV-1 in Elite Suppressors despite Ongoing Replication and Evolution in Plasma Virus

“…While elevated lipopolysaccharide (LPS) levels seen in some ES (2,9,21) suggest ongoing viral replication in the gastrointestinal tract, there have been no studies directly supporting this hypothesis. Studies analyzing viral clones obtained from lymphoid tissue in ES are needed to address this critical issue.…”