Neurocognitive decline in HIV patients is associated with ongoing T-cell activation in the cerebrospinal fluid.

Objective HIV-associated neurocognitive disorders ( HAND) remain a challenge despite combination antiretroviral therapy ( cART). Immune cell activation has been implicated to play a major role in the development of HAND. Methods In this study, we used multicolor flow cytometry on peripheral blood ( PB) and cerebrospinal fluid ( CSF) samples to determine the expression of HLA- DR and programmed death-1 ( PD-1) on CD4+ and CD8+ T cells in patients with chronic HIV infection. Expression levels were correlated with HI virus load in PB and CSF, classification of HAND and severity of magnetic resonance imaging ( MRI) signal abnormalities. Results In a cohort of 86 HIV patients we found that the grade of neurocognitive impairment and the severity of MRI signal abnormalities correlated with decreasing CD4/ CD8-ratios and increased frequencies of HLA- DR expressing CD4+ and CD8+ T cells reaching the highest values in the CSF samples. Importantly, HLA- DR upregulation was still detectable in virologically suppressed HIV patients. Further, T-cell subpopulation analysis of 40 HIV patients showed a significant shift from naïve to effector memory ( EM) T cells that was negatively correlated with the grade of neurocognitive impairment in the PB samples. Moreover, PD-1 was significantly increased on CD4+ memory T cells with highest levels on EM T cells in HIV patients with mild or severe neurocognitive alterations. Interpretation The CD4/ CD8 ratio, the proportion of EM to naïve T cells and the immune activation profile of CD4+ and CD8+ T cells in PB and CSF might be useful parameters to monitor the efficacy of cART and to identify HIV patients at risk of further neurocognitive deterioration. [ABSTRACT FROM AUTHOR]