title: Tuberculosis-associated immune restoration syndrome in HIV-1-infected patients involves tuberculin-specific CD4 Th1 cells and KIR-negative gammadelta T cells.
abstract: Tuberculosis (TB)-associated immune restoration syndrome (IRS) is a frequent event (10 to 30%) in HIV-1-infected patients receiving antiretroviral treatment and is associated with an increased number of IFN-gamma-producing tuberculin-specific cells. To further understand the immune mechanisms of TB-IRS and to identify predictive factors, we prospectively analyzed the Th1 and TCRgammadelta T cells known to be involved in mycobacterial defenses and dendritic cells at baseline and after antiretroviral and TB treatment in 24 HIV-1(+) patients, 11 with and 13 without IRS. At baseline, these two groups differed by significantly lower proportions of TCRgammadelta and Vdelta2(+) T cells displaying the inhibitory receptors CD94/NKG2 and CD158ah,b in IRS patients. The two groups did not differ in the baseline characteristics of CD8 or CD4 T cells or TLR-2 expression on monocytes or myeloid/plasmacytoid dendritic cells. During IRS, the increase in tuberculin-specific IFN-gamma-producing cells involved only highly activated effector memory multifunctional (IFN-gamma(+)TNF-alpha(+)IL-2(-)) CD4 T cells, whereas activated HLA-DR(+) CD4(+) T cells also increased during IRS. In contrast, dendritic cells decreased significantly during IRS and there were no changes in TLR-2 expression. Finally, the Vdelta2(+) T cells, mostly killer Ig-related receptor (KIR) (CD94/NKG2(-) and CD158(-)), significantly peaked during IRS but not in non-IRS patients. In conclusion, IRS is associated with an increase in the number of activated tuberculin-specific effector memory CD4 T cells and of KIR(-)Vdelta2(+) TCRgammadelta(+) T cells. Higher proportions of Vdelta2(+)TCRgammadelta(+) T cells lacking KIR expression are present as baseline and distinguish patients who will develop IRS from those who will not.
authors.affiliation: Laboratory of Cellular Immunology, INSERM, Pitie-Salpetriere Hospital, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Bourgarit
authors.forename: Guislaine
authors.initials: G
authors.lastname: Carcelain
authors.forename: Assia
authors.initials: A
authors.lastname: Samri
authors.forename: Christophe
authors.initials: C
authors.lastname: Parizot
authors.forename: Matthieu
authors.initials: M
authors.lastname: Lafaurie
authors.forename: Sophie
authors.initials: S
authors.lastname: Abgrall
authors.forename: Veronique
authors.initials: V
authors.lastname: Delcey
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.forename: Daniel
authors.initials: D
authors.lastname: Sereni
authors.forename: Brigitte
authors.initials: B
authors.lastname: Autran
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D016022:Case-Control Studies; D002452:Cell Count; D003713:Dendritic Cells; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000276:immunology*; D016130:Immunophenotyping; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016692:Receptors, Antigen, T-Cell, gamma-delta; D054340:Receptors, KIR; D013601:T-Lymphocytes / Q000276:immunology* / Q000382:microbiology; D018417:Th1 Cells / Q000276:immunology; D014373:Tuberculin / Q000276:immunology*; D014376:Tuberculosis / Q000276:immunology*
chemical_list: D016692:Receptors, Antigen, T-Cell, gamma-delta; D054340:Receptors, KIR; C521523:T-cell receptor Vdelta2, human; D014373:Tuberculin