Objectives
AIDS is caused by CD4+ T-cell depletion. While combination antiretroviral therapy can restore blood T-cell numbers, the clonal diversity of the reconstituting cells, critical for immunocompetence, is not well defined.
Methods
We performed an extensive analysis of parameters of thymic function in HIV-1 infected (n=39) and control (n=28) subjects ranging from 13 to 23 years of age. CD4+ T-cells including naïve (CD27+ CD45RA+) and recent thymic emigrant (RTE) (CD31+/CD45RA+) cells, were quantified by flow cytometry. Deep sequencing was used to examine T cell receptor (TCR) sequence diversity in sorted RTE CD4+ T-cells.
Results
Infected subjects had reduced CD4+ T-cell levels with predominant depletion of the memory subset and preservation of naïve cells. RTE CD4+ T-cell levels were normal in most infected individuals, and enhanced thymopoiesis was indicated by higher proportions of CD4+ T-cells containing TCR recombination excision circles. Memory CD4+ T-cell depletion was highly associated with CD8+ T-cell activation in HIV-1-infected persons and plasma IL-7 levels were correlated with naïve CD4+ T-cells, suggesting activation-driven loss and compensatory enhancement of thymopoiesis. Deep sequencing of CD4+ T-cell receptor sequences in well-compensated infected persons demonstrated supranormal diversity, providing additional evidence of enhanced thymic output.
Conclusions
Despite up to two decades of infection, many individuals have remarkable thymic reserve to compensate for ongoing CD4+ T cell loss, although there is ongoing viral replication and immune activation despite cART. The longer-term sustainability of this physiology remains to be determined.