Functional impairment of HIV-specific CD8+ T cells precedes aborted control of viremia

Spontaneous control of HIV infection has been repeatedly linked to antiviral CD8+ T cells but is not always permanent. To address mechanisms of durable and aborted control of viremia, we evaluated immunologic and virologic parameters in longitudinal samples from 34 subjects with differential outcomes. Despite sustained recognition of autologous virus, aborted control was preceded by impairment of HIV-specific proliferative and cytolytic T cell effector functions without evidence of canonical T cell exhaustion. During aborted control, HIV-specific CD8+ T cells infiltrated lymphoid follicles but exhibited poor functionality relative to durable control. Longitudinal transcriptomic profiling of HIV-specific CD8+ T cells revealed altered expression of genes related to T cell activation, cytokine-mediated signaling and cell cycle regulation preceding aborted control, including increased expression of the antiproliferative transcription factor KLF2. Our results identify prognostic indicators of aborted HIV control and elucidate functional requirements for durable immune control, which may guide development of new therapies Overall design: Longitudinal RNA-seq of replicate HIV-specific CD8+ T cells preceding aborted or durable control (5 subjects each)