Current HIV Research - Volume 1, Issue 3, 2003

New insights into the physiological cell death program in mammalian cells have further confounded the central issue of T lymphocyte destruction during HIV infection. Although infected and uninfected cells die following infection, recent evidence indicates that infected and uninfected cells may have unique pathways controlling death. Two widely accepted models for apoptosis have been described, namely the intrinsic and extrinsic apoptotic pathway. In the extrinsic pathway, ligation of TNF death ligands to their receptors causes oligomerization of the death receptors and recruitment of adaptor proteins typically involving caspase 8 activation. In the intrinsic pathway, apoptotic signals converge on mitochondria to cause activation and subsequent release of cytochrome c, which leads to formation of a multiprotein complex containing Apaf-1, cytochrome c, dATP and procaspase 9. Expression of HIV proteins alters these pathways resulting in enhanced levels of apoptosis. Although HIV infection results in T cell apoptosis, under some circumstances a small fraction of CD4+ T cells and macrophages do not die following infection, indicating that this may be a critical step in the development of viral reservoirs. In addition, monocyte differentiation into macrophages leads to an apoptosis resistant phenotype characterized by upregulation of antiapoptotic molecules and lower levels of proapoptotic molecules. The development of these stable antiretroviral resistant cells represents the major obstacle in achieving a complete sterile cure. However, this provides a unique opportunity to further understand the regulation of apoptosis and may facilitate novel immune based therapies aimed at modifying apoptosis in HIV disease.

How HIV replicates and causes destruction of the thymus, and how to restore thymic function, are among the most important questions of HIV-1 pathogenesis and therapy in adult as well as pediatric patients. The thymus appears to function, albeit at reduced levels, throughout the life of adults, to respond to T cell depletion induced by HIV and to be suppressed by HIV. In this review, we summarize recent findings concerning HIV replication and pathogenesis in the human thymus, focusing on mechanistic insights gleaned from studies in the SCID-hu Thy / Liv mouse and human fetal-thymus organ culture (HF-TOC) models. First, we discuss HIV viral determinants and host factors involved in the replication of HIV in the thymus. Second, we consider evidence that both viral factors and host factors contribute to HIV-induced thymocyte depletion. We thus propose that multiple mechanisms, including depletion and suppression of progenitor cells, paracrine and direct lytic depletion of thymocytes, and altered thymocyte selection are involved in HIV-induced pathology in the thymus. With the SCID-hu Thy / Liv mouse and HF-TOC models, it will be important in the coming years to further clarify the virological, cell biological, and immunological mechanisms of HIV replication and pathogenesis in human thymus, and to correlate their significance in HIV disease progression.

CD8 CTLs are a major effector for protection against cancer as well as many infectious diseases, including HIV / AIDS [2, 8, 11, 31, 35]. CD8 CTL recognize antigenic peptides in the context of class I MHC. CTL functional avidity has been shown to be an important determinant of in vivo efficacy. CTL that can recognize peptide / MHC only at high antigen density are termed low avidity CTL, while those that can recognize their cognate antigen at low densities are termed high avidity CTL [4, 14, 15]. Recent studies have demonstrated that high avidity CTLs are essential for the effective clearance of viral infections [4, 22] and for the elimination of tumor cells [39, 60, 62]. At this time, approaches that can target high avidity cells for expansion in vivo are not well defined; however, new insights are beginning to emerge. A recent study has shown that prime-boost immunization may be an effective method to generate high avidity CTLs that recognize HIV antigens [26]. In addition, we recently found that high levels of costimulation (signal 2) can skew the CTL response toward higher avidity cells [41]. Thus, vectors expressing a triad of costimulatory molecules (TRICOM) or dendritic cells expressing higher levels of costimulatory molecules, can be used to induce high avidity CTL. Finally a critical role for CD4+ T cell help in the generation of high avidity cells has recently been identified (Palmer, manuscript submitted). While high avidity CTLs are superior for viral and tumor clearance, they also have a greater sensitivity to antigen induced cell death. In some types of chronic infections, such as HIV and HCV, as well as in cancer, the host may lose, by clonal exhaustion or other apoptotic mechanisms, the effector cells that are most critical to viral or tumor clearance [21, 38]. In this review, we examine the current knowledge concerning CTL avidity. We discuss the factors that may distinguish high avidity CTLs from low avidity CTLs and describe some of the mechanisms these cells use to clear viral infections. In addition, we study possible immunization strategies that may be used to elicit higher avidity CTLs and describe what is known about the factors that render these cells more susceptible to apoptosis than low avidity CTLs. Finally, we will incorporate these various elements into a general discussion of possible approaches for induction and maintenance of an effective immune response that can result in clearance of tumors or chronic viral infections and the relevance to vaccine development.

NK cells were characterized by their ability to spontaneously kill certain tumor and virus-infected cells. They constitute first line of defense against invading pathogens and usually become activated in viral infections particularly in early phases. Activated NK cells play a crucial role in the induction and amplification of virus-specific immunity by providing IFN-γ and “danger signal”. The functional activities of NK cells are regulated by a balance between the engagement of their inhibitory and activating receptors. In recent years, the discovery of several MHC and non-MHC binding NK receptors has provided important insights regarding NK cell biology and its role in viral infections. These receptors are increasingly being viewed as important regulators of immune response. Like many other viruses, HIV also seems to activate NK cells. However, several studies have reported compromised NK cell functions in HIV-infected individuals. The virus employs several strategies to counter the hosts NK cell response, e.g., a differential downregulation of MHC class I molecules on the surface of infected cells, a dysregulated production of NK cell function-enhancing cytokines, direct inhibitory effects of certain viral proteins on NK cell functions, and changes in the expression of NK cell receptors, etc. The individuals expressing activating NK cell receptors and their cognate MHC ligands have activated NK cells. The development of AIDS is significantly delayed in these individuals after HIV infection. The discovery of NK receptors and their ligands has opened new avenues of developing AIDS vaccine and boosting innate and adaptive antiviral immunity in HIV-infected individuals.

A HIV Vaccine, particularly that based on recombinant proteins and plasmid DNA, is likely to be less reactogenic than traditional vaccines, but also less immunogenic. Therefore, there is an urgent need for the development of new and improved adjuvants and delivery system for combination with HIV vaccine antigens. Adjuvants can be broadly separated into two classes, based on their principal mechanisms of action; “vaccine delivery systems” and “immunostimulatory adjuvants”. Vaccine delivery systems are generally particulate formulations e.g. emulsions, microparticles, iscoms and liposomes, and mainly function to target associated antigens into antigen presenting cells (APC). In contrast, immunostimulatory adjuvants are predominantly derived from pathogens and often represent pathogen associated molecular patterns (PAMP) e.g. LPS, MPL, CpG DNA, which activate cells of the innate immune system. The discovery of more potent adjuvants may allow the development of prophylactic and therapeutic vaccines against HIV. In addition, new adjuvants may also allow vaccines to be delivered mucosally.

Mother-to-child transmission of human immunodeficiency virus type 1 has become rare in developed countries, with the use of highly active antiretroviral treatment, elective cesarean section, and avoidance of breastfeeding. In the developing world, however, these interventions are unfeasible, and costsaving methods for prevention of vertical transmission are vital. Prevention begins with voluntary counseling and testing, improved maternal education and access to prenatal care. Various antiretroviral drugs administered before, during, and for short periods after delivery have decreased vertical transmission. Where safe and compliant formula feeding is difficult, avoidance of mixed feeding may improve infant outcomes. However, post-natal transmission via breast milk remains a major challenge. As we continue to find cost-effective answers to protect infants worldwide, the search for a HIV-1 vaccine continues.

Therapeutic approaches seeking to limit the exposure to antiretroviral drugs while retaining the benefits of continuous therapy have become an active area of investigation in HIV therapy research. Although early attempts to use interruptions of therapy as auto-vaccination strategies have shown little success, much has been discovered in regards to immunological correlates of viral control in acute and chronic infection, viral evolution, and the safety of single or multiple therapy interruptions in different patient sub-groups (acutely infected, chronically infected, and multi-drug resistant). Here we review safety data and candidate factors that may contribute to the striking differences observed between patients that undergo similar treatment interruption strategies but achieve different outcomes in controlling HIV replication. Differences between acute and chronic infection in the viral component (e.g. diversity of the viral pool) and the host immune system (e.g. low avidity CTL memory response), which may not be reversed by ART, may determine the potential for suppressive immune response upon therapy interruption. Consistent with goals of limiting toxicity and cost of antiretroviral drug regimens, safety outcomes to date indicate that intermittent therapy strategies may safely continue to be investigated in early and chronically infected patients. Based on ongoing research, we identify the topics to be targeted in future studies.

Human immunodeficiency virus type 1 (HIV-1) is the etiologic agent of AIDS. Following entry into the host cell, the viral RNA is reverse transcribed into DNA and subsequently integrated into the host genome as a chromatin template. Chromatin structure may be responsible for silencing retroviral gene expression. Transcriptional activation occurs after ATP-dependent chromatin remodeling complexes alter chromatin structure and positioning of nucleosomes. Histone acetyltransferases (HATs), histone deacetylases (HDACs), kinases, and methyltransferases (HMTs), covalently modify nucleosomes by adding or removing chemical moieties in the N-terminal tails of histones. Recent advances have indicated that HIV-1 encoded proteins interact with chromatin remodeling complexes and histone modifying enzymes, implying that chromatin remodeling plays an important role in the HIV-1 life cycle. Nucleosomes are positioned on the HIV-1 LTR and are barriers to transcription. Following cellular activation, these nucleosomes are modified and repositioned allowing for activation of viral gene expression. Tat recruits various HATs to the HIV-1 promoter region and can also be acetylated by some of these enzymes. Unmodified Tat is involved in binding to the CBP / p300 and cdk9 / cyclin T complexes and facilitates transcription initiation. Acetylated Tat dissociates from the TAR RNA structure and recruits bromodomain-containing chromatin modifying complexes such as p / CAF and SWI / SNF to facilitate transcription elongation. This review summarizes our current knowledge and understanding of chromatin remodeling complexes and their regulation of HIV-1 replication, and highlights the important contributions HIV-1 research has made to further our understanding of the transcription process.

Recent evidence of the evolutionary adaptation of HIV-1 to the specific immune system is reviewed. Longitudinal studies of patients show that a neutralizing antibody (NAb) response specific to autologous virus is detectable within 1-2 months of infection and that viral variants resistant to neutralization arise and spread in the viral population within the subsequent three months, and that this general pattern is repeated. There is strong evidence that amino acid replacements in gp120 glycan-binding motifs affect viral sensitivity to neutralization and are selected by NAbs. Longitudinal studies of humans have also provided good evidence of amino acid replacements in cytotoxic T lymphocyte (CTL) epitopes that allow the virus to escape detection by CTLs. But, the clearest evidence of adaptation to CTL surveillance at the molecular level comes from experiments with SIV-infected rhesus macaques. These show unequivocally that amino acid replacements in CTL epitopes are the result of positive selection and that these escape mutants have a lower class I major histocompatibility complex (MHC) binding affinity or are less likely to be recognized by CTLs than nonescape variants. To improve our ability to predict HIVs evolutionary responses to selection by the specific immune system it is suggested that future work focus on the details of the adaptive response to antibody surveillance, the temporal dynamics of specific immune responses, the relative importance of antibody and CTL selection, and the effects of superinfection, viral recombination, and viral protein functional constraints on immune escape.