HIV-1-Specific Interleukin-21 + CD4 + T Cell Responses Contribute to Durable Viral Control through the Modulation of HIV-Specific CD8 + T Cell Function

Abstract

Functional defects in cytotoxic CD8⁺ T cell responses arise in chronic human viral infections, but the mechanisms involved are not well understood. In mice, CD4 cell-mediated interleukin-21 (IL-21) production is necessary for the maintenance of CD8⁺ T cell function and control of persistent viral infections. To investigate the potential role of IL-21 in a chronic human viral infection, we studied the rare subset of HIV-1 controllers, who are able to spontaneously control HIV-1 replication without treatment. HIV-specific triggering of IL-21 by CD4⁺ T cells was significantly enriched in these persons (P = 0.0007), while isolated loss of IL-21-secreting CD4⁺ T cells was characteristic for subjects with persistent viremia and progressive disease. IL-21 responses were mediated by recognition of discrete epitopes largely in the Gag protein, and expansion of IL-21⁺ CD4⁺ T cells in acute infection resulted in lower viral set points (P = 0.002). Moreover, IL-21 production by CD4⁺ T cells of HIV controllers enhanced perforin production by HIV-1-specific CD8⁺ T cells from chronic progressors even in late stages of disease, and HIV-1-specific effector CD8⁺ T cells showed an enhanced ability to efficiently inhibit viral replication in vitro after IL-21 binding. These data suggest that HIV-1-specific IL-21⁺ CD4⁺ T cell responses might contribute to the control of viral replication in humans and are likely to be of great importance for vaccine design.