Impact of multi-targeted antiretroviral treatment on gut t cell depletion and hiv reservoir seeding during acute hiv infection

Jintanat Ananworanich*, Alexandra Schuetz, Claire Vandergeeten, Irini Sereti, de Souza Mark, Rungsun Rerknimitr, Robin Dewar, Mary Marovich, van Griensven Frits, Rafick Sekaly, Suteeraporn Pinyakorn, Nittaya Phanuphak, Rapee Trichavaroj, Wiriya Rutvisuttinunt, Nitiya Chomchey, Robert Paris, Sheila Peel, Victor Valcour, Frank Maldarelli, Nicolas ChomontNelson Michael, Praphan Phanuphak, Jerome H. Kim

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

253 Scopus citations


Background: Limited knowledge exists on early HIV events that may inform preventive and therapeutic strategies. This study aims to characterize the earliest immunologic and virologic HIV events following infection and investigates the usage of a novel therapeutic strategy. Methods and Findings: We prospectively screened 24,430 subjects in Bangkok and identified 40 AHI individuals. Thirty Thais were enrolled (8 Fiebig I, 5 Fiebig II, 15 Fiebig III, 2 Fiebig IV) of whom 15 completed 24 weeks of megaHAART (tenofovir/emtricitabine/efavirenz/raltegravir/maraviroc). Sigmoid biopsies were completed in 24/30 at baseline and 13/15 at week 24. At baseline, the median age was 29 years and 83% were MSM. Most were symptomatic (87%), and were infected with R5-tropic (77%) CRF01_AE (70%). Median CD4 was 406 cells/mm3. HIV RNA was 5.5 log10 copies/ml. Median total blood HIV DNA was higher in Fiebig III (550 copy/106 PBMC) vs. Fiebig I (8 copy/106 PBMC) (p = 0.01) while the median %CD4+CCR5+ gut T cells was lower in Fiebig III (19%) vs. Fiebig I (59%) (p = 0.0008). After 24 weeks of megaHAART, HIV RNA levels of &50 copies were achieved in 14/15 in blood and 13/13 in gut. Total blood HIV DNA at week 0 predicted reservoir size at week 24 (p&0.001). Total HIV DNA declined significantly and was undetectable in 3 of 15 in blood and 3 of 7 in gut. Frequency of CD4+CCR5+ gut T cells increased from 41% at baseline to 64% at week 24 (p>0.050); subjects with less than 40% at baseline had a significant increase in CD4+CCR5+ T cells from baseline to week 24 (14% vs. 71%, p = 0.02). Conclusions: Gut T cell depletion and HIV reservoir seeding increases with progression of AHI. MegaHAART was associated with immune restoration and reduced reservoir size. Our findings could inform research on strategies to achieve HIV drug-free remission.

Original languageEnglish
Article numbere33948
JournalPLoS ONE
Issue number3
StatePublished - 30 Mar 2012
Externally publishedYes


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