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International audience; Recognition of various HIV proteins by CD8 T cells from HIV-infected children was determined by two functional assays. First, using an Elispot assay, we show that 80% of patients recognized Gag, 77% recognized Pol, 61% recognized Env, 44% recognized Nef and 29% recognized Vif. Frequencies of Gag-, Pol-, and Env-specific IFN-gamma producing CD8 T cells were higher than frequencies of Nef and Vif-specific CD8 T cells. The poor recognition of Nef by ex vivo CD8 T cells was confirmed by CTL assays performed in HAART na? children: 25% of children had positive response against Nef versus 44, 63 and 62% for Env, Gag, and Pol, respectively. Memory Gag-specific CTL were positively correlated with age, whereas Nef-specific CTL were negatively correlated with age. The poor Nef-specific CD8 T cell response in HIV-infected children contrasts with dominance of Nef-specific responses in infected adults.

OBJECTIVE: To assess the rate of progression of lipodystrophy and the associated metabolic disturbances over a 2-year period in children and to assess risk factors associated with lipodystrophy and metabolic disturbances. DESIGN: Multicenter 2-year prospective study with a standardized evaluation. METHODS: One hundred thirty children (median age = 10 years, 64 boys and 66 girls) receiving antiretroviral therapy were recruited in 3 pediatric clinics. Lipodystrophy was defined based on 4 skinfold thickness measurements. Fasting lipids and glucose profile were measured in all children. RESULTS: The proportion of children presenting with lipodystrophy was 24.6%. Nineteen percent of children had high-density lipoprotein values less than 1 mmol/L. Twenty-two percent and 15% of children had values greater than 2 standard deviations for age and gender for cholesterol and triglycerides, respectively. A total of 13.2% showed insulin resistance. A total of 42.7% showed at least 1 of these biologic disturbances. Prospective follow-up showed no progression at all over 2 years, except for a doubling of the number of children with insulin resistance. In multivariate analyses, ethnicity, previous severe clinical condition, duration of HIV infection, and nucleoside reverse transcriptase inhibitor treatment were significantly associated with lipodystrophy. Tanner stage V of puberty, severe clinical symptoms and protease inhibitor treatment were independently associated with the risk of metabolic disturbances. CONCLUSIONS: Puberty seems to be the time when HIV-infected children taking potent antiretroviral therapy are more likely to develop lipodystrophy and metabolic complications, especially in children with a severe underlying HIV infection. Once developed, lipodystrophy and metabolic changes seem to be extremely stable with time.

Several prospective randomized trials in acute myelocytic leukemia (AML) documented a lower relapse rate with autologous bone marrow transplantation (ABMT) than with conventional chemotherapy. However, they also identified some transplant difficulties, such as failure to collect sufficient numbers of stem cells, slow kinetics of engraftment, and a high transplant-related mortality that diminished or negated positive impact on overall survival. Data for ABMT are inconclusive in acute lymphocytic leukemia (ALL) in adults. We retrospectively analyzed patients with acute leukemia autografted with marrow purged with mafosfamide after January 1983 in our institution. The population comprised 229 consecutive patients; 165 with AML [123 in first remission (CR1), 32 in second remission (CR2)]; 61 with ALL (46 in CR1, 4 in CR2); and 3 with undifferentiated acute leukemia. All patients were autografted with marrow purged with mafosfamide. Mafosfamide was given at a constant dose of 50 μg/mL in 103 and adjusted individually to produce a CFU-GM LD 95 (5% residual CFU-GM post purging) in 126. The outcome was analyzed for correlation with patient characteristics, the disease including cytogenetics, and the graft itself. Prognostic factors identified by multivariate analysis were used to derive a prognostic classification. Patients receiving higher doses of marrow submitted to purging (>5.46 × 10 4 CFU-GM/kg) experienced a lower treatment-related mortality (RR = 0.11, p=0.005) and a higher leukemia-free (RR = 0.5, p=0.005) and overall survival (RR = 0.4, p=0.001). Patients receiving 5.46 × 10 4 CFU-GM/kg and doses actually infused post purging of ≤0.02 × 10 4 /kg had a treatment-related mortality of only 2 ± 2%, a leukemia-free survival of 70%, and an overall survival of 77 ± 7% at 10 years. In this study of autotransplantation for acute leukemia using mafosfamide-purged marrow, the stem cell dose used for purging and the intensity of purging were the most important factors predicting outcome.

Ex vivo interferon (IFN)- gamma -producing CD8 T cells specific for human immunodeficiency virus (HIV) Env, Gag, and Pol antigens were measured in the peripheral blood of 55 children not receiving highly active antiretroviral therapy (HAART) and 70 children receiving HAART. In children not receiving HAART, the frequency of HIV-specific IFN- gamma -producing CD8 T cells was positively correlated with age and was not associated with plasma viral load or CD4 T cell levels. In children receiving HAART, the frequency of HIV-specific IFN- gamma -producing CD8 T cells was directly correlated with plasma viral load, and its association with age remained significant. In conclusion, the frequency of HIV-specific IFN- gamma -producing CD8 T cells in children is primarily determined by both age and plasma viral load.

The evolution of the HIV-specific CD8+ T cell response in patients receiving potent combination therapy has been well documented in adult patients. However, no study reported whether baseline HIV-specific CD8+ T cell response is linked to treatment outcome. The aims of this study were to investigate both the impact of baseline memory cytotoxic T lymphocytes (CTL) on treatment outcome and the effect of potent therapy on memory HIV-specific CTL in HIV-1-infected pediatric patients. The study group comprised 30 children who started a first-line combination treatment including at least three drugs from two different classes and were longitudinally followed during treatment. Their memory HIV-specific responses were measured at baseline and during treatment, as well as their plasma viremia and CD4+ levels. The intensity of memory Gag-specific CTL and the breadth of the CTL response at the beginning of treatment were significantly correlated with lower plasma viral load during treatment, independently of baseline plasma viral load, CD4+ counts, and age. Children with partially controlled viral replication had enhanced Gag-specific CTL compared to their baseline value. This improvement of antiviral responses during treatment was not observed when viral replication was either fully suppressed or uncontrolled. In conclusion, our results show that higher baseline HIV-specific CTL are linked to lower viremia under combination therapy. This result adds further support to the hypothesis that cooperation between the antiviral immune response and antiviral drugs could be helpful for therapeutic management of HIV-infected patients.

International audience; In the pediatric human immunodeficiency virus type-1 (HIV-1) infection, the presence of cytotoxic T lymphocytes (CTL) is associated with a slow progression to AIDS. The secretion of cytokines by CTLs may be critical in the control of viral infection. We used the combination of cell surface and intracellular staining to study the functionality of tetramer binding CD8+ T cells recognizing two HIV-1 immunodominant epitopes, in peripheral blood mononuclear cells from HIV-1-infected children. A fraction of tetramer positive CD8+ T cells produce cytokines (IFN-gamma, TNF-alpha) or chemokines (CCL4, CCL5) after ex vivo stimulation with the cognate peptide. There was a negative correlation between the plasma viral load and the percentage of CD8+ Tetramer Gag+ T cells secreting IFN-gamma. This is the first report in the context of pediatric HIV-1 infection showing that only a fraction of HIV-1-specific CD8+ T cells have the capacity to produce cytokines and chemokines implicated in their antiviral functions.

The role of antiretroviral therapy in acceleration of atherosclerosis in HIV-infected adults is controversial, partly because of the confounding effects of the involvement of classic cardiovascular risk factors.To study vascular function in HIV-infected children.Cross-sectional study of 49 HIV-infected children (34 receiving antiretroviral therapy and 15 never treated) and if 24 age- and sex-matched controls.Automatic, computerized, ultrasonic procedure evaluation of geometric and mechanical properties of the common carotid artery, and of the endothelium-dependent dilation and endothelium-independent dilation.Relative systolodiastolic variations in diameter of the carotid artery in HIV-infected children were significantly lower than those in controls, but there was no significant difference in intima-media thickness. Cross-sectional compliance and distensibility were also significantly lower. Wall stiffness, assessed as the incremental elastic modulus, was larger in HIV-infected children. Endothelium-dependent dilation was lower in HIV-infected children but non-endothelium-dependent dilation was similar to that in controls. We did not find differences for any of the vascular variables between HIV-infected children receiving antiretroviral therapy and those never treated. All arterial variables were similar in children with and without dyslipidemia.HIV-infected children had a vascular dysfunction in the absence of cardiovascular risk factors. In this short series, no additional detrimental effects were observed after a mean of 5 years of antiretroviral therapy.

Human immunodeficiency virus (HIV)-specific CD8+-T-cell responses are critical in restricting viral replication and altering the course of HIV infection (38, 48). Ex vivo cytotoxic T lymphocytes (CTL) are much less frequent in vertically infected children than in adults (9, 10, 41, 42, 46, 60). In contrast, after in vitro culture, memory CTL can be readily detected in HIV-infected children, with magnitude, breadth, and specificity similar to those observed in adults (9, 10, 41, 46). These memory CTL can be detected during the first weeks or months of life (10, 41, 56, 75), and the presence of HIV-specific CTL is associated with slower evolution toward disease (10). Complete suppression of viral replication following combined therapy is less frequent in children than in adults (40, 51, 52), and the kinetics of viral decrease is slower (49). However, children have a more active thymus function than adults (19, 44), which allows better lymphocyte regeneration following combined therapy (13, 69). In children treated with combined therapy before 3 months of age, and with undetectable viral load, neither HIV-specific antibodies nor HIV-specific CD4 or CD8 cells were detected (43). This contrasts with the beneficial effect of early treatment on preservation of HIV-specific T-cell immunity in adults (8, 50). New immunotherapeutic interventions are being developed for adults (8, 50). These treatments are of great interest for children due to observance problems and because complete viral suppression is more difficult to obtain in children than in adults. Therefore, it is crucial to characterize the dynamics of HIV-specific T cells in pediatric HIV infection. On encountering viral antigen, naive CD8+ T cells proliferate and differentiate into effector cells able to lyse infected cells and to secrete cytokines. As virus is cleared, most activated effector cells undergo apoptosis, but some survive and enter the memory pool that persists for long periods (76). Most memory cells are in a resting state, unable to secrete cytokine or to lyse infected cells, until reactivation on reexposure to viral antigen (61). During persistent infection, continuous stimulation of T cells may lead to dysfunction, anergy, or clonal exhaustion. In the absence of CD4+ T cells, exhaustion and anergization of CD8+ T cells is more rapid (78). The complex interplay between the antigen load, virus-specific CD8+-T-cell dynamics and function, and the immune status of the infected host has been illustrated by a number of studies of HIV-infected adults. In untreated chronically HIV-infected patients, CTL numbers are inversely correlated with the plasma viral load (5, 24, 25, 34, 54, 58). On the other hand, reduction of HIV replication by potent antiretroviral therapy is associated with a decline in HIV-specific CD8+ T cells (11, 55). Evidence that a fraction of HIV-specific CD8+ T cells are not functional was recently obtained (22, 31). Furthermore, loss of gamma-interferon (IFN-γ)-producing cells with persistence of tetramer binding cells was observed in subjects progressing to AIDS (32). CTL derived from the memory pool after in vitro expansion are easily detected by the standard 51Cr release assay in most HIV-infected children (9). In contrast, ex vivo-activated effector cytolytic cells are infrequently detected immediately after isolation (9). Cytokine synthesis following short-term ex vivo stimulation with the antigen can be measured using assays that are more sensitive than the chromium release assay and could be used to quantify the effector subset of HIV-specific CD8+ T cells (3, 18). Cytokine production can be measured at the single-cell level using the enzyme-linked immunospot (ELISPOT) technique, allowing direct calculation of T-cell frequencies (15). This technique is very sensitive and has been found to reliably detect CD8+ T cells in various human diseases (35, 63, 64, 74), including HIV infection (16, 36). The aim of the present work was to evaluate the use of the ELISPOT assay for the ex vivo study of HIV-specific CD8+ T cells from HIV-infected children. We chose to focus our initial effort on two immunodominant HLA-A∗0201-restricted HIV epitopes that are frequently recognized by infected children, as we showed previously using tetramers (66). In this cross-sectional study, HLA-A∗0201-positive HIV-infected children were systematically tested for the presence of HIV-specific CD8+ T cells using the ELISPOT assay. The frequencies of HIV-specific IFN-γ-producing CD8+ T cells were compared to the frequencies of HIV-specific CD8+ T cells measured by tetramer labeling, and relationships with biological parameters of HIV infection were investigated. The results from the ELISPOT and the tetramer assays were well correlated, but a comparison of the results from both assays suggests that a significant fraction of CD8+ T cells were unable to produce IFN-γ. Most importantly, the frequencies of ex vivo-activated HIV-specific CD8+-T-cell-mediated IFN-γ production were positively correlated with plasma HIV RNA, showing that this subset of antiviral CD8+ T cells is dependent upon continuous antigenic stimulation.