ArticleJCI insight2019
Identification of rare HIV-1-infected patients with extreme CD4+ T cell decline despite ART-mediated viral suppression.
Article in JCI insight, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
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Who cites it
23 citing papers in PubMed, 41 citations in OpenAlex.
- Systemic translocation ofJournal of virology · 2026Article
- Persistent immune dysfunction during suppressive antiretroviral therapy: implications for analytical treatment interruption trials for chronic HIV infections in sub-Saharan Africa.Frontiers in immunology · 2026Review
- Persistent activation of monocytes/macrophages and cell senescence in SIV-infected macaques on ART.Frontiers in immunology · 2026Article
- Persistent Activation of Monocytes/Macrophages and Cell Senescence in SIV-Infected Macaques on ART.bioRxiv : the preprint server for biology · 2025Article
- Immune cell subset profiling and metabolic dysregulation define the divergent immune microenvironments in HIV immunological non-responders.Clinical and translational medicine · 2025Article
- Impact of Anti-CD4 Autoantibodies on Immune Reconstitution in People With Advanced HIV.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Article
- How to properly define immunological nonresponse to antiretroviral therapy in people living with HIV? an integrative review.Frontiers in immunology · 2025Review
- Implications of accumulation of clonally expanded and senescent CD4Emerging microbes & infections · 2024Article
- Deficiency of Caspase-1 Attenuates HIV-1-Associated Atherogenesis in Mice.International journal of molecular sciences · 2023Article
- Impacts of plasma microbial lipopolysaccharide translocation on B cell perturbations and anti-CD4 autoantibody production in people with HIV on suppressive antiretroviral therapy.Cell & bioscience · 2023Article
- Increased Microbial Translocation is a Prognostic Biomarker of Different Immune Responses to ART in People Living with HIV.Infection and drug resistance · 2023Article
- HIV-1 activates oxidative phosphorylation in infected CD4 T cells in a human tonsil explant model.Frontiers in immunology · 2023Article
- Autoantibodies in immunodeficiency syndromes: The Janus faces of immune dysregulation.Blood reviews · 2022Review
- CD56International journal of general medicine · 2022Article
- A link between IL-23 and anti-CD4 autoantibody production in antiretroviral-treated HIV-infected individuals.Journal of virology · 2021Article
- NLRP3 inflammasome induces CD4+ T cell loss in chronically HIV-1-infected patients.The Journal of clinical investigation · 2021Article
- Residual immune dysfunction under antiretroviral therapy.Seminars in immunology · 2021Review
- Association of Low CD4/CD8 Ratio With Adverse Cardiac Mechanics in Lymphopenic HIV-Infected Adults.Journal of acquired immune deficiency syndromes (1999) · 2020Article
- Prevalence and pathogenicity of autoantibodies in patients with idiopathic CD4 lymphopenia.The Journal of clinical investigation · 2020Article
- Incomplete immune reconstitution in HIV/AIDS patients on antiretroviral therapy: Challenges of immunological non-responders.Journal of leukocyte biology · 2020Review
Corrections and comments
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Authors and funding
20 authors at 8 institutions in 3 countries.
Funding
Abstract
backgroundThe goal of antiretroviral therapy (ART) is to suppress HIV-1 replication and reconstitute CD4+ T cells. Here, we report on HIV-infected individuals who had a paradoxical decline in CD4+ T cells despite ART-mediated suppression of plasma HIV-1 load (pVL). We defined such an immunological outcome as extreme immune decline (EXID).
methodsEXID's clinical and immunological characteristics were compared to immunological responders (IRs), immunological nonresponders (INRs), healthy controls (HCs), and idiopathic CD4+ lymphopenia (ICL) patients. T cell immunophenotyping and assembly/activation of inflammasomes were evaluated by flow cytometry. PBMC transcriptome analysis and genetic screening for pathogenic variants were performed. Levels of cytokines/chemokines were measured by electrochemiluminescence. Luciferase immunoprecipitation system and NK-mediated antibody-dependent cellular cytotoxicity (ADCC) assays were used to identify anti-lymphocyte autoantibodies.
resultsEXIDs were infected with non-B HIV-1 subtypes and after 192 weeks of consistent ART-mediated pVL suppression had a median CD4+ decrease of 157 cells/μl, compared with CD4+ increases of 193 cells/μl and 427 cells/μl in INR and IR, respectively. EXID had reduced naive CD4+ T cells, but similar proportions of cycling CD4+ T cells and HLA-DR+CD38+CD8+ T cells compared with IR and INR. Levels of inflammatory cytokines were also similar in EXID and INR, but the IL-7 axis was profoundly perturbed compared with HC, IR, INR, and ICL. Genes involved in T cell and monocyte/macrophage function, autophagy, and cell migration were differentially expressed in EXID. Two of the 5 EXIDs had autoantibodies causing ADCC, while 2 different EXIDs had an increased inflammasome/caspase-1 activation despite consistently ART-suppressed pVL.
conclusionsEXID is a distinct immunological outcome compared with previously described INR. Anti-CD4+ T cell autoantibodies and aberrant inflammasome/caspase-1 activation despite suppressed HIV-1 viremia are among the mechanisms responsible for EXID.
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