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People Living with HIV (PLHIV) are at an increased risk of pneumococcal pneumonia than HIV-uninfected adults, but the reasons for this are still not well understood. We investigated whether alveolar macrophages (AM) mediated control of pneumococcal infection is impaired in PLHIV compared to HIV-uninfected adults. We assessed anti-bactericidal activity against Streptococcus pneumoniae of primary human AM obtained from PLHIV and HIV-uninfected adults. We found that pneumococcus survived intracellularly in AMs at least 24 hours post ex vivo infection, and this was more frequent in PLHIV than HIV-uninfected adults. Corroborating these findings, in vivo evidence showed that PLHIV had a higher propensity for harboring S. pneumoniae within their AMs than HIV-uninfected adults. Moreover, bacterial intracellular survival in AMs was associated with extracellular propagation of pneumococcal infection. Our data suggest that failure of AMs to eliminate S. pneumoniae intracellularly could contribute to the increased risk of pneumococcal pneumonia in PLHIV., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Nyazika, Sibale, Phiri, De Ste Croix, Jasiunaite, Mkandawire, Malamba, Kankwatira, Manduwa, Ferreira, Nyirenda, Oggioni, Mwandumba and Jambo.)

HIV-infected adults are at an increased risk to lower respiratory tract infections (LRTIs). CD8 + CD161 ++ TCRvα7.2 + T cells are an innate-like T cell subset that are thought to play an important role in early defense against pathogens in the respiratory tract. HIV infection leads to irreversible depletion of these cells in peripheral blood, however, its impact on this subset in the human airway is still unclear. Here, we show presence of CD103 expressing CD8 + CD161 ++ TCRvα7.2 + T cells in the airway that exhibited a distinct cytokine functional profile compared to their CD103 - airway counterparts and those from peripheral blood. These CD103 expressing airway CD8 + CD161 ++ TCRvα7.2 + T cells were selectively depleted in untreated HIV-infected adults compared to healthy controls. Their frequency was positively correlated with frequency of airway CD4 + T cells. Furthermore, the frequency of airway CD8 + CD161 ++ TCRvα7.2 + T cells was also inversely correlated with HIV plasma viral load, while suppressive antiretroviral therapy (ART) resulted in restoration of airway CD8 + CD161 ++ TCRvα7.2 + T cells. Our findings show that CD103 expressing airway CD8 + CD161 ++ TCRvα7.2 + T cells are functionally distinct and are preferentially depleted during untreated asymptomatic HIV infection. Depletion of CD103 expressing airway CD8 + CD161 ++ TCRvα7.2 + T cells, at a major portal of pathogen entry, could partly contribute to the increased propensity for opportunistic LRTIs observed in untreated HIV-infected adults.