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Changes in immunological and virological parameters in HIV-1 infected subjects following leukapheresis
M R Boulassel1, G Spurll, D Rouleau
1Immunodeficiency Service, Royal Victoria Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada.
Insights
Leukapheresis is a safe procedure for HIV-1 patients, yielding sufficient blood mononuclear cells (PBMC) for therapeutic immunization. It temporarily boosts CD4(+) cell counts without increasing viral load.
Area of Science:
- Immunology
- Virology
- Cellular Biology
Background:
- Therapeutic immunization for HIV-1 requires substantial numbers of peripheral blood mononuclear cells (PBMC).
- Assessing the safety and immunological impact of leukapheresis is crucial for patient management in HIV-1 research.
Purpose of the Study:
- To evaluate the clinical safety and immunological effects of leukapheresis in individuals with HIV-1.
- To determine if leukapheresis impacts viral load or specific immune cell populations in HIV-1 infected subjects.
Main Methods:
- Leukapheresis was performed using a Fenwal CS3000 cell separator on 29 HIV-1 infected subjects with CD4(+) counts >200 x 10(6)/l.
- Clinical tolerance, safety, and changes in immunological parameters (including CD4(+) and CD8(+) cell counts) were monitored for 90 days post-procedure.
- Virological parameters (viral load) were assessed at multiple time points before and after leukapheresis.
Main Results:
- Leukapheresis was well-tolerated with no observed side effects within 90 days.
- A significant, transient increase in absolute CD4(+) cell counts and percentage was observed 1 hour post-procedure.
- No significant changes in white blood cells, lymphocytes, monocytes, CD8(+), CD34(+), or naive/memory CD4(+) cell counts were detected.
- Viral load remained stable in both treated and untreated subjects throughout the study period.
Conclusions:
- Leukapheresis is a safe and effective method for collecting PBMC in HIV-1 infected individuals with adequate CD4(+) cell counts.
- The procedure induces a temporary increase in CD4(+) cell counts without adversely affecting viral replication.
- This method supports the feasibility of using leukapheresis for immune response assessments in HIV-1 therapeutic immunization strategies.
Abstract:
In order to assess immune responses during HIV-1 therapeutic immunization, a large number of blood mononuclear cells (PBMC) are needed. Clinical tolerance and safety, as well as changes in immunological and virological parameters, were assessed, following leukapheresis in HIV-1 infected subjects with CD4(+) cell count >200 x 10(6)/l. PBMC were collected using a Fenwal CS3000 cell separator in 29 subjects with mean CD4(+) cell counts of 503 x 10(6)/l (range 172-1,119) and viral load of 2.5 log(10) copies/ml (range <1.7-5.4). Twenty-four (83%) subjects were on antiretroviral therapy while 5 (17%) were untreated. The blood volume processed was 7 L over a period of 3 hours. A mean value (+/- standard error) of 82 +/- 26 x 10(9)/l lymphocytes was collected by a single apheresis in a mean volume of 200 +/- 1.8 ml, containing 9.0 +/- 1.3 x 10(9)/l CD4(+) and 10.2 +/- 1.3 x 10(9)/l CD8(+) cells. The leukapheresis procedures were well tolerated and no immediate or delayed side effects were observed within 90 days of follow-up. No changes from blood pre-leukapheresis values were detected for white blood cells, lymphocytes, monocytes, CD8(+), CD34(+), naive and memory CD4(+) cell counts immediately after, 1 h, 7 days, or within 90 days after leukapheresis. However, absolute CD4(+) cell counts and percentage significantly increased from pre-leukapheresis values after 1 h (530 +/- 43 vs. 700 +/- 75 cell x 10(6)/l; 32.6 +/- 1.6 vs. 36.9 +/- 1.9%; P < 0.001 for both paired t-tests) before returning to pre-leukapheresis levels on day 7. No significant changes in viral load from pre-leukapheresis levels in treated or untreated subjects were detected at any time points. We conclude that leukapheresis in HIV-1 infected subjects with CD4(+) cell counts >200 x 10(6)/l is safe and induces a transient increase in the absolute and percentage of CD4(+) cell count without enhancing viral replication.
