Disease progression in Human Immunodeficiency Virus type 1 infected viraemic controllers
Publisher
Metadata
Show full item recordAbstract
Background: The mechanism of CD4+ T-cell decline in Human Immunodeficiency Virus-1 (HIV-1) infection
is unclear, but the association with plasma HIV-1 RNA-load suggests viral replication is
involved. Viraemic controller patients with low HIV-1 RNA-loads (<2000 copies/ml) typically
maintain good CD4+ T-cell counts (>450 CD4+ T-cells/mm3). However, within a cohort of 86
viraemic controllers, a subgroup (18 ‘discord controllers’) was identified with low CD4+ T-cell
counts (<450 CD4+ T-cells/mm3) which present clinical uncertainty. The underlying
mechanism accounting for CD4+ T-cell decline in the face of low or undetectable HIV-1 RNAloads
is unknown. The objective of the work described in this thesis was to investigate the
virological and host immune system dynamics in discord controllers compared with typical
controllers.
Method
Epidemiological features, HIV-1 subtype, cellular HIV-1 DNA-load, T-cell populations
(CD4+/CD8+ naïve/ central-memory/ effector-memory subsets; CD45RA/RO ± CD62L) and Tcell
activation markers (CD38, HLA-DR) were examined for discord controllers and typical
controllers as well as progressors with HIV-1 RNA-load >10000 copies/ml, <450 CD4+ Tcells/
mm3.
Results
Discord controllers and typical controllers were similar, based on epidemiological features and
viral subtype distribution. They resembled progressors, showing high HIV-1 DNA-load,
depletion of naïve CD4+ T-cells and higher activation in all CD4+ T-cell subsets. However, the
CD8+ T-cell compartment in discord controllers was similar to typical controllers with
preserved naïve CD8+ T-cells and low level CD8+ T-cells activation.
Conclusion
The data presented in this thesis is consistent with a relationship between CD4+ T-cell
activation, HIV-1 DNA-load and disease progression but not HIV-1 RNA-load. This suggests
that in viraemic controllers, HIV-1 DNA-load may be a better marker of viral replication and
disease progression than HIV-1 RNA-load. Furthermore, low level CD8+ T-cell activation
correlate with low plasma HIV-1 RNA-load but not with HIV-1 DNA-load.
Authors
Groves, Katherine ClaireCollections
- Theses [3705]