title: Epstein-Barr virus-specific cytotoxic T cell responses in HIV-1 infection: different kinetics in patients progressing to opportunistic infection or non-Hodgkin's lymphoma.
abstract: Although the high incidence of EBV-associated diffuse large cell lymphomas (DLCL) in HIV-1 infection is believed to be related to loss of immune control due to HIV-induced immune deficiency, it has been claimed that cytotoxic T lymphocyte (CTL) responses to EBV are longer lasting in HIV-1-infected persons than CTL directed against HIV-1 itself. We approached this apparent paradox by performing the first longitudinal study into the kinetics of EBV and HIV-specific CTL responses in HIV-infected patients progressing either to AIDS with non-Hodgkin's lymphoma (NHL) or AIDS with opportunistic infection (OI). Multiple samples were tested from HIV-1 seroconversion to AIDS-diagnosis. Four out of six patients that were either long-term asymptomatic or progressing to OI showed declining HIV-1 CTL precursor (CTLp) frequencies whereas EBV-CTLp remained stable, suggestive for HIV-1-specific immune exhaustion. In two patients rapidly progressing to AIDS-OI, a parallel decline of HIV-1- and EBV-CTL responses was seen, indicative for total collapse of cellular immunity. In all these six patients EBV-load remained low. However, in four out of five patients that progressed to DLCL, EBV-load was high and increasing several months preceding the NHL. In all five patients, EBV-CTLp decreased before the emergence of the NHL. Thus, our data show that in HIV-1 infection loss of HIV-1-specific T cell immunity is not necessarily paralleled by loss of EBV-specific T cell responses. The occurrence of AIDS-related DLCL is preceded by decreasing EBV-CTLp and increasing EBV load. Failing EBV-control might therefore be an important step in the pathogenesis of AIDS-related DLCL.
authors.affiliation: Department of Hematology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Kersten
authors.forename: M R
authors.initials: MR
authors.lastname: Klein
authors.forename: A M
authors.initials: AM
authors.lastname: Holwerda
authors.forename: F
authors.initials: F
authors.lastname: Miedema
authors.forename: M H
authors.initials: MH
authors.lastname: van Oers
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000276:immunology*; D000328:Adult; D002051:Burkitt Lymphoma / Q000276:immunology; D015497:HIV-1 / Q000276:immunology*; D004854:Herpesvirus 4, Human / Q000276:immunology*; D006801:Humans; D007700:Kinetics; D016483:Lymphoma, AIDS-Related / Q000276:immunology*; D008875:Middle Aged; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology*