While the advent of combination antiretroviral therapy (ART) has significantly improved survival, tuberculosis (TB) remains the leading cause of death in the HIV-infected population. We used Mycobacterium tuberculosis/simian immunodeficiency virus-coinfected (M. tuberculosis/SIV-coinfected) macaques to model M. tuberculosis/HIV coinfection and study the impact of ART on TB reactivation due to HIV infection. Although ART significantly reduced viral loads and increased CD4 + T cell counts in blood and bronchoalveolar lavage (BAL) samples, it did not reduce the relative risk of SIV-induced TB reactivation in ART-treated macaques in the early phase of treatment. CD4 + T cells were poorly restored specifically in the lung interstitium, despite their significant restoration in the alveolar compartment of the lung as well as in the periphery. IDO1 induction in myeloid cells in the inducible bronchus-associated lymphoid tissue (iBALT) likely contributed to dysregulated T cell homing and impaired lung immunity. Thus, although ART was indispensable for controlling viral replication, restoring CD4 + T cells, and preventing opportunistic infection, it appeared inadequate in reversing the clinical signs of TB reactivation during the relatively short duration of ART administered in this study. This finding warrants the modeling of concurrent treatment of TB and HIV to potentially reduce the risk of reactivation of TB due to HIV to inform treatment strategies in patients with M. tuberculosis/HIV coinfection.

Problem The goal of this study was to investigate the phenotype and functional responsiveness of CD4+ and CD8+ T-cells in the upper reproductive tract of healthy premenopausal women. The lower reproductive tract is frequently studied as a site of sexually transmitted infections; however, the upper tract may also be a portal of entry and dissemination for pathogens, including HIV-1. Method of Study Endometrial biopsy, endocervical curettage, cytobrush and blood were collected during mid-luteal phase from 23 healthy women. T-cells were isolated and analyzed by flow cytometry. Results As compared to their counterparts in blood, endometrial and endocervical T-cells had enhanced CCR5 expression, and were enriched for activated, effector memory cells. Endometrial T-cells were more responsive to polyclonal stimuli, producing a broad range of cytokines and chemokines. Conclusions These findings underscore the responsiveness of endometrial T-cells to stimulation, and reveal their activated phenotype. These findings also suggest susceptibility of the upper reproductive tract to HIV-1 infection.

Antigen-specific T cell responses are critical for immune control of M. tuberculosis infection. In response to M. tuberculosis infection, the majority of infected people mount robust CD4 + T cell responses involving Th1 cytokines, such as IFN-γ and TNF-α, which are important for activating macrophages and curtailing M. tuberculosis replication in the lung (6, 7). In addition, IL-17 and Th17 responses have emerged as important for protective immunity against TB (8,9). Animal studies have shown a role for IL-17 in induction of chemokines, recruitment of CD4 + T cells to the site of infection, formation of granulomas, and protection during M. tuberculosis infection and Bacille Calmette-Guérin (BCG) vaccination (10)(11)(12)(13)(14)(15)(16)(17)(18). The role of IL-17 and Th17 responses in human TB is less clear and has been mainly studied by comparing individuals with active TB and healthy controls. Reports from humans vary widely, with studies showing no difference in the levels of IL-17 between the groups (19), while others have seen low levels of IL-17 in patients with TB compared with healthy controls (20,21). Human genetic mutations and polymorphisms in IL-17 have been associated with TB susceptibility (12,22), whereas other studies have shown the association of Th17/IL-17 responses with TB pathogenesis and disease progression (23)(24)(25)(26). Overall, how IL-17, and in particular, M. tuberculosis antigen-specific Th17 cells, function to control M. tuberculosis infection during asymptomatic LTBI in humans remains poorly understood. We have limited knowledge of the onset and maintenance of M. tuberculosis antigen-specific Th1 and Th17 cell responses in the blood and lung compartments during LTBI and of the phenotypes and functions associated with the LTBI state. This is in part because small-animal models do not reproduce key aspects of human LTBI. Moreover, accurately documenting M. tuberculosis exposure, initial infection, and early events following infection in humans is almost impossible. Thus, studies of M. tuberculosis antigen-specific T cells in humans have been largely confined to cross-sectional characterization of peripheral responses in the blood (27)(28)(29)(30)(31). While some studies have examined responses in bronchoalveolar lavage (BAL) (32-34), longitudinal studies in humans comparing M. tuberculosis antigen-specific T cell responses in blood and lung compartments have been lacking. Thus, detailed characterization of the nature and kinetics of M. tuberculosis antigen-specific T cells associated with human-like asymptomatic LTBI is important for identifying correlates of immune control and protection.Nonhuman primate (NHP) macaque models of M. tuberculosis infection recapitulate multiple features of human M. tuberculosis infection, including clinically asymptomatic infection and symptomatic active TB disease (35-42), and are attractive for studying immune parameters associated with control of M. tuberculosis infection in peripheral blood and lung compartments. We have previously established a mode...

PURPOSE Vaccine-induced neutralizing antibodies (nAbs) play a critical role in protection from SARS CoV-2. Patients with B-cell malignancies including myeloma are at increased risk of COVID-19–related mortality and exhibit variable serologic response to the vaccine. The capacity of vaccine-induced antibodies in these patients to neutralize SARS CoV-2 or its variants is not known. METHODS Sera from 238 patients with multiple myeloma (MM) undergoing SARS CoV-2 vaccination were analyzed. Antibodies against the SARS CoV-2 spike receptor-binding domain (RBD) and viral nucleocapsid were measured to detect serologic response to vaccine and environmental exposure to the virus. The capacity of antibodies to neutralize virus was quantified using pseudovirus neutralization assay and live virus neutralization against the initial SARS CoV-2 strain and the B1.617.2 (Delta) variant. RESULTS Vaccine-induced nAbs are detectable at much lower rates (54%) than estimated in previous seroconversion studies in MM, which did not monitor viral neutralization. In 33% of patients, vaccine-induced antispike RBD antibodies lack detectable neutralizing capacity, including against the B1.617.2 variant. Induction of nAbs is affected by race, disease, and treatment-related factors. Patients receiving mRNA1273 vaccine (Moderna) achieved significantly greater induction of nAbs compared with those receiving BNT162b2 (Pfizer; 67% v 48%, P = .006). CONCLUSION These data show that vaccine-induced antibodies in several patients with MM lack detectable virus-neutralizing activity. Vaccine-mediated induction of nAbs is affected by race, disease, vaccine, and treatment characteristics. These data have several implications for the emerging application of booster vaccines in immunocompromised hosts.

Depot-medroxyprogesterone acetate is a commonly used injectable contraceptive that has been associated with an increased risk of HIV acquisition. This study compares effects of depot-medroxyprogesterone acetate on immune parameters from several reproductive tract compartments relevant to HIV-1 susceptibility in upper reproductive tract samples from 15 depot-medroxyprogesterone acetate users and 27 women not on hormonal contraceptives. Compared to samples from unexposed women in the mid-luteal phase, depot-medroxyprogesterone acetate use was associated with: increased endocervical concentrations of MCP1 and IFNalpha2; decreased endocervical concentrations of IL1beta and IL6; increased proportions of endometrial CD4+ and CD8+ cells expressing the activation marker HLADR; increased density of endometrial macrophages; and decreased density of endometrial regulatory T-cells. Unlike previous reports with samples from the vagina, we did not observe increased expression of the HIV co-receptor CCR5 on CD4+ T-cells in the endocervix or endometrium. Our results indicate important differences in anatomic compartments regarding mechanisms by which depot-medroxyprogesterone acetate could be associated with increased risk of HIV acquisition, including increased recruitment of macrophages to the endometrium, decreased levels of pro-inflammatory cytokines in the endocervix possibly leading to enhanced susceptibility to viral infection, and activation of endometrial T-cells.

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ProblemThere is little information regarding the impact of the intrauterine device on immune parameters of the upper female reproductive tract related to risk of HIV acquisition.Method of StudyWe collected cervical and endometrial samples from women using the hormonal intrauterine device to study its effects on endocervical cytokines/chemokine concentrations, phenotypic markers of T cells, responses of endometrial T cells to activation, and alterations of endometrial cellular infiltrates.ResultsHormonal intrauterine device use was associated with: increased concentrations of inflammatory cytokines/chemokines (endocervix); increased coexpression of CXCR4 and CCR5 (endocervix and endometrium); increased coexpression of CD38 and HLADR (endocervix and endometrium); increased intracellular IL-10 production after T-cell stimulation (endometrium); and increased density of T cells, most notably regulatory T cells (endometrium).ConclusionHormonal intrauterine device use resulted in both inflammatory and immunosuppressive alterations. Further research is needed to determine the significance of these changes for HIV risk.

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