Perturbation of CD4⁺ and CD8⁺ T-cell repertoires during progression to AIDS and regulation of the CD4⁺ repertoire during antiviral therapy

The T-cell antigen receptor (TCR) repertoire was studied longitudinally by analyzing the varying lengths of the beta chain CDR3 hypervariable region during the course of HIV-1 infection and following combination antiretroviral therapy. Drastic restrictions in CD8⁺ T-cell repertoire usage were found at all stages of natural progression and persisted during the first six months of treatment. In contrast, significant CD4⁺ T-cell repertoire perturbations were not found in early stages of infection but correlated with progression to AIDS. Out of ten patients presenting with pretreatment perturbations, normalization of the CD4⁺ repertoire was observed in eight good responders, but not in two cases of unsuccessful therapy. These results indicate that, besides CD4⁺ cell count rise, an efficient control of HIV replication may allow qualitative modifications of the CD4⁺ repertoire balance.