LAUSR

OBJECTIVE We evaluated frequencies of T cells with high PD-1 expression (PD-1) before and after long-term effective antiretroviral therapy (ART), and determined if frequencies on-ART correlated positively with measures of HIV persistence and negatively with HIV-specific responses. METHODS We enrolled individuals who started ART during chronic infection and had durable suppression of viremia for ≥4 years (N = 99). We assessed PD-1 T cell frequencies at timepoints pre- and on-ART using flow cytometry, and evaluated how frequencies on-ART are associated with measures of HIV persistence, HIV-specific immune responses, and immune activation levels. RESULTS Pre-ART, PD-1 CD4 T cells correlated positively with viremia and negatively with CD4 T cell count. At year 1 on-ART, %PD-1 CD4 T cells decreased but then remained stable at 4 and 6-15 years on-ART, while %PD-1 CD8 T cells on-ART remained similar to pre-ART. PD-1 CD4 T cells correlated positively with HIV DNA pre- and on-ART, and with CD4 T cell activation on-ART. PD-1 CD4 T cells negatively correlated with HIV Gag- and Env-specific T cell responses but not with CMV- or EBV-specific responses. PD-1 CD8 T cells trended towards a negative correlation with responses to Gag and Env, but not to CMV and EBV. CONCLUSIONS PD-1 T cells persist in blood despite prolonged suppression on ART, correlate with HIV DNA levels, and are associated with lower HIV-specific T cell responses but not CMV- or EBV-specific responses, suggesting that these cells are HIV-specific. The findings support evaluating PD-1 blockade strategies for their effect on HIV persistence and HIV-specific immunity.