Administration of a Toll-like receptor 9 agonist decreases the proviral reservoir in virologically suppressed HIV-infected patients

PLoS One. 2013 Apr 26;8(4):e62074. doi: 10.1371/journal.pone.0062074. Print 2013.

Abstract

Toll-like receptor (TLR) agonists can reactivate HIV from latently infected cells in vitro. We aimed to investigate the TLR-9 agonist, CPG 7909's in vivo effect on the proviral HIV reservoir and HIV-specific immunity. This was a post-hoc analysis of a double-blind randomized controlled vaccine trial. HIV-infected adults were randomized 1:1 to receive pneumococcal vaccines with or without 1 mg CPG 7909 as adjuvant at 0, 3 and 9 months. In patients on suppressive antiretroviral therapy we quantified proviral DNA at 0, 3, 4, 9, and 10 months (31 subjects in the CPG group and 37 in the placebo-adjuvant group). Furthermore, we measured HIV-specific antibodies, characterized T cell phenotypes and HIV-specific T cell immunity. We observed a mean reduction in proviral DNA in the CPG group of 12.6% (95% CI: -23.6-0.0) following each immunization whereas proviral DNA in the placebo-adjuvant group remained largely unchanged (6.7% increase; 95% CI: -4.2-19.0 after each immunization, p = 0.02). Among participants with additional cryo-preserved PBMCs, HIV-specific CD8+ T cell immunity as indicated by increased expression of degranulation marker CD107a and macrophage inflammatory protein 1β (MIP1β) tended to be up-regulated following immunization with CPG 7909 compared with placebo as adjuvant. Further, increasing proportion of HIV-specific CD107a and MIP1β-expressing CD8+ T cells were strongly correlated with decreasing proviral load. No changes were observed in T cell phenotype distribution, HIV-specific CD4+ T cell immunity, or HIV-specific antibodies. TLR9-adjuvanted pneumococcal vaccination decreased proviral load. Reductions in proviral load correlated with increasing levels of HIV specific CD8+ T cells. Further investigation into the potential effect of TLR9 agonists on HIV latency is warranted.

Publication types

  • Clinical Trial, Phase I
  • Clinical Trial, Phase II
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • CD4-Positive T-Lymphocytes / drug effects
  • CD4-Positive T-Lymphocytes / immunology
  • CD4-Positive T-Lymphocytes / virology
  • CD8-Positive T-Lymphocytes / drug effects
  • CD8-Positive T-Lymphocytes / immunology
  • CD8-Positive T-Lymphocytes / virology
  • Cell Compartmentation / drug effects
  • Disease Reservoirs / virology*
  • HIV Antibodies / biosynthesis
  • HIV Infections / drug therapy
  • HIV Infections / immunology*
  • HIV Infections / virology*
  • Humans
  • Immunity / drug effects
  • Immunologic Memory / drug effects
  • Middle Aged
  • Oligodeoxyribonucleotides / administration & dosage*
  • Oligodeoxyribonucleotides / pharmacology*
  • Oligodeoxyribonucleotides / therapeutic use
  • Phenotype
  • Proviruses / drug effects*
  • Species Specificity
  • Toll-Like Receptor 9 / agonists*
  • Toll-Like Receptor 9 / metabolism
  • Viral Load / drug effects

Substances

  • HIV Antibodies
  • Oligodeoxyribonucleotides
  • ProMune
  • Toll-Like Receptor 9

Grants and funding

AW is supported by a scholarship from the Danish Medical Research Council. TAR is supported by a fellowship from Aarhus University. The completion of the study was further supported by The AIDS Foundation, Familien Hede Nielsens Fond, Læge Søren Segel og Hustru Johannes Forskningsfond, Ulla og Mogens Folmer Andersens Fond and Torben og Alice Frimodts Fond. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.