Delayed virus-specific CD8⁺ cytotoxic T lymphocyte activity in an HIV-infected individual with high CD4⁺ cell counts: Correlations with various parameters of disease progression

This 4-year longitudinal study monitored the temporal association between the HIV-specific cytotoxic T lymphocyte (CTL) response and the control viremia in an individual infected with human immunodeficiency virus type 1 (HIV-1). At the beginning of the study, this asymptomatic individual with a high CD4⁺ cell count showed no HIV-specific cytotoxic activity after polyclonal in vitro restimulation with autologous PHA-blasts, unlike most HIV-seropositive individuals. Anti-HIV CTLs were detected only in the last year of the study, both after in vitro restimulation and directly ex vivo. This was correlated with the inversion of the CD4⁺/CD8⁺ ratio, essentially due to increased numbers of CD8⁺CD28^- T lymphocytes. The HIV-specific cytolytic activity was mediated by this CD28⁺CD28^- subpopulation. The amount of HIV-1 provirus in peripheral blood mononuclear cells (PBMCs) did not change during the study, but the HIV RNA in plasma increased and virus was isolated from PBMCs only at the time when HIV-specific CTL activity was detected. This suggests overall that the HIV-1 replication was low in this individual, with a transient increase that could have reached the threshold for CTL reactivation, and was perhaps controlled thereby.