Mechanisms of residual immune activation in HIV-1 infected human lymphoid tissue ex vivo.

OBJECTIVE HIV-1 infection triggers immune activation, as reflected by the upregulation of various cytokines. This immune activation remains elevated despite antiretroviral therapy (ART) and leads to early age-related diseases. Here, we addressed the mechanisms of sustained immune activation in HIV-1-infected human lymphoid tissues ex vivo. DESIGN/METHOD We investigated several potential causes of immunoactivation, including (i) a proinflammatory effect of ART drugs themselves; (ii) an early HIV-1-triggered cytokine storm, which could in turn trigger a sustained cytokine dysregulation; (iii) herpesvirus reactivation; (iv) HIV-1 protein release; and (v) production of defective virions and extracellular vesicles (EVs). Tissue immune activation was evaluated from measurements of cytokines in culture medium using multiplexed immunoassays. RESULTS Neither ART itself, nor simulated cytokine storms, nor exogenously added HIV-1 proteins triggered a sustained cytokine upregulation. In contrast, defective (replicative-incompetent) virions and EVs induced sustained cytokine upregulation, as did infectious virus. Tissue immune activation was accompanied by reactivation of CMV. CONCLUSIONS The system of ex vivo human lymphoid tissue allowed investigation, under laboratory-controlled conditions, of possible mechanisms involved in persistent immune activation in HIV-1 patients under ART. Mechanisms of this immunoactivation identified in ex vivo tissues may indicate potential therapeutic targets for restoration of immune system homeostasis in HIV-1-infected patients.