c Interleukin-21 (IL-21) can be produced by CD8 T cells from HIV-1-infected individuals and those with autoimmune disease, but the mechanism remains poorly understood. Here we demonstrate that IL-21-producing CD8 T cells are not associated with CD4 depletion and are absent in patients with idiopathic CD4 lymphocytopenia. Instead, IL-21 production by CD8 T cells was associated with high levels of activation, suggesting that these cells emerge as a consequence of excessive chronic immune activation rather than CD4 lymphopenia.A s a product of CD4 T cells, interleukin-21 (IL-21) has emerged as a key factor for control of chronic viral infections (1-8). Accumulating evidence suggests that CD8 T cells secrete IL-21, and populations of these cells have been described in HIV-1 infection and autoimmunity (9-13). We have demonstrated that HIV-1-specific IL-21-producing CD8 T cells are enriched in HIV-1 elite controllers, whereas polyclonally stimulated IL-21-producing CD8 T cells are increased in patients who lack viral control (12).The basis for the apparent division of IL-21 competency between CD4 and CD8 T cell subsets is unclear, but one possibility is that CD4-negative T cells may acquire CD4 T-helper function (14)(15)(16)(17)(18)(19)(20). Given that CD4 T cell depletion is a hallmark of HIV-1 infection, such a compensatory mechanism could allow for CD8 T cells to acquire IL-21 competency and helper function. On the other hand, CD8 T cell production of IL-21 could also be seen with immune perturbations such as seen in HIV-1 infection and autoimmunity, diseases associated with this unusual cellular phenotype (9-13).We sought to define IL-21-competent CD8 T cells and determine their relation to conventional CD4 T cells. Cryopreserved peripheral blood mononuclear cells (PBMCs) from 30 chronically HIV-1-infected individuals off antiretroviral therapy (ART) (median plasma viral load [pVL], 18,282 copies/ml; median CD4 count, 581 cells/mm 3 ) and 19 HIV-1-seronegative subjects were thawed, activated with phorbol 12,13-dibutyrate and ionomycin (PDBu and ionomycin), and stained as previously described (12). The institutional review boards (IRBs) of the University of Alabama at Birmingham (UAB) and National Institute of Allergy and Infectious Diseases (NIAID) approved this study, and written informed consent was obtained from study participants. ϩ CD8 Ϫ , CD4 ϩ CD8 ϩ , and CD4 Ϫ CD8 ϩ IL-21-producing T cells in HIV-1-infected subjects.