Gag-specific CD4 proliferative responses correlate inversely with HIV-1 RNA levels in infected adults,and robust responses are characteristic of long-term nonprogressive infection. However,strong responses are seldom detected in adult subjects with progressive infection and are not generally reconstituted on highly active antiretroviral therapy (HAART). To date,the role of HIV-1-specific Th responses in children has not been thoroughly examined. We characterized Gag-specific CD4 responses among 35 perinatally infected subjects,including 2 children who spontaneously control viremia without antiretroviral therapy,21 children with viral loads (VL) of textless400 on HAART,and 12 viremic children. Gag-specific Th activity was assessed by lymphoproliferative assay,and responses were mapped using overlapping Gag peptides in an IFN-gamma ELISPOT. Robust proliferative responses were detected in the children exhibiting spontaneous control of viremia,and mapping of targeted Gag regions in one such subject identified multiple epitopes. Among children textgreateror=5 years old,14 of 17 subjects with VL of textless400 on HAART demonstrated a significant p24 proliferative response (median p24 stimulation index,20),in contrast with only 1 of 9 viremic children (median p24 stimulation index,2.0; p = 0.0008). However,no subject younger than 5 years of age possessed a significant response,even when viremia was fully suppressed. When compared with adults with VL of textless400 on HAART,Th responses among children with VL of textless400 were both more frequent (p = 0.009) and of greater magnitude (p = 0.002). These data suggest that children may have a greater intrinsic capacity to reconstitute HIV-1-specific immunity than adults,and may be excellent candidates for immune-based therapies.
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