Methods: HIV-infected and uninfected subjects with recurrent HSV-2 genital lesions underwent 5 serial biopsies – at the time of an active lesion, at healing of the lesion, and at the same site 2 and 8 weeks after healing of the lesion. Lesional biopsies were primarily taken from the buttock and perirectal areas in both groups. A control biopsy was taken from a distant site, typically the arm. 8mm slides were prepared, fixed and stained for CD4+ and CD8+ T cells. T cells were enumerated and unpaired t tests (without assumption of equal variances) were performed using STATA version 14.0. P-values <0.05 were considered significant.
Results: Of the 8 HIV-infected subjects, 7 were on combination antiretroviral (cART) therapy and only 2 had detectable viremia by PCR. The median peripheral blood CD4+ T cell count was 342 (range 167 – 990). On average, the CD4+ T-cell density in biopsy specimens at the time of the lesion was significantly lower in the HIV-infected than HIV-uninfected subjects (145 and 630 cells/mm2, respectively, p-value <0.01), as well as at healing (70 and 381 cells/mm2, p-value 0.02). The mean CD8+ T-cell count in the tissue among HIV-infected and uninfected subjects at the time of the lesion and healing was not significantly different. The ratio between tissue CD4+ and CD8+ T cells in HIV-infected subjects was 0.10-0.63 at the time of the lesion, as compared to 0.70-4.6 in HIV-uninfected subjects.
Conclusion: Even in individuals with well-treated HIV infection there was an altered T-cell response to local HSV infection, both in the number of tissue-infiltrating CD4+ T cells as well as the balance between CD4+ and CD8+ T-cell subsets.
A. Wald, None
L. Corey, None