Spontaneous virologic suppression in HIV controllers is independent of delayed-type hypersensitivity test responsiveness

• Type of Material: Article
• Authors: Jason F. Okulicz, Uniformed Services University of the Health Sciences; Greg A. Grandits, University of Minnesota; Matthew J. Dolan, Henry M. Jackson Foundation; Vincent Marconi, Emory University; Glenn Wortmann, Walter Reed National Military Medical Center; Michael L. Landrum, Uniformed Services University of the Health Sciences
• Language: English
• Date: 2012-04-02
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2012 Okulicz et al; licensee BioMed Central Ltd.
• License: Creative Commons Attribution 2.0 Generic
• Final Published Version (URL): http://www.aidsrestherapy.com/content/9/1/10
• Title of Journal or Parent Work: AIDS Research and Therapy
• ISSN: 1742-6405
• Volume: 9
• Issue: 10
• Start Page: 1
• End Page: 5
• Grant/Funding Information: Support for this work (IDCRP-000-05) was provided by the Infectious Disease Clinical Research Program (IDCRP), a Department of Defense (DoD) program executed through the Uniformed Services University of the Health Sciences. This project has been funded in whole, or in part, with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), under Inter-Agency Agreement Y1-AI-5072.
• Research Categories: Health Sciences, Public Health; Biology, Biostatistics

Abstract

Background Delayed-type hypersensitivity (DTH) testing, an in vivo assessment of cell-mediated immunity, is a predictor of HIV disease progression beyond CD4 cell count. We investigated whether preserved DTH responsiveness was characteristic of HIV controllers compared to non-controllers and individuals on suppressive HAART. Findings DTH testing consisted of ≥ 3 recall antigens applied approximately every 6 months. DTH responses were classified by the number of positive skin tests: anergic (0), partial anergic (1), or non-anergic (≥ 2). HIV controllers were compared to treatment naïve non-controllers (n = 3822) and a subgroup of non-controllers with VL < 400 copies/mL on their initial HAART regimen (n = 491). The proportion of non-anergic results at first DTH testing was similar for HIV controllers compared to non-controllers (81.9% vs. 77.6%; P = 0.22), but tended to be greater in HIV controllers compared to the HAART subgroup (81.9% vs. 74.5%; P = 0.07). Complete anergy was observed in 14 (10.1%) HIV controllers with CD4 counts ≥ 400 cells/uL. For longitudinal testing, the average percentage of non-anergic DTH determinations per participant was higher in HIV controllers compared to non-controllers (81.2 ± 31.9% vs. 70.7 ± 36.8%; P = 0.0002), however this difference was eliminated with stratification by CD4 count: 200-399 (83.4 ± 35.6% vs. 71.9 ± 40.9%; P = 0.15) and > 400 cells/uL (81.2 ± 31.5% vs. 80.4 ± 32.7%; P = 0.76). Conclusions Spontaneous virologic control was not associated with DTH responsiveness, and several HIV controllers were anergic despite having elevated CD4 counts. These findings suggest that cellular immunity assessed by DTH is not a principal factor contributing to spontaneous virologic suppression in HIV controllers.