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Volume 6 Supplement 3

AIDS Vaccine 2009

P16-25. HIV specific CTL from elite controllers have a unique survival advantage


Understanding how elite controllers (EC), patients controlling virus without antiretroviral therapy (ART), differ from those with chronic disease is an area of intense investigation. HIV Gag specific (sp) cytotoxic T lymphocytes (CTL) play a dominant role in this control. Unfortunately, most HIV sp CTL are primed for apoptosis. We hypothesize that EC up-regulate survival factors allowing them to resist apoptosis.


We examined pro- and anti-apoptotic factors in HIV Gag specific CTL in EC (viral load (VL) < 50 off ART), successfully treated (ST) (VL < 50 on ART), and untreated viremics (V). Using flow cytometry based assays, we performed cross-sectional and longitudinal analysis of pro-apoptotic (cleaved caspase-3) vs. anti-apoptotic (Bcl-2) markers in HIV specific CD8 T cells examining spontaneous cell death.


VL only partially drives expression of cleaved caspase-3 (CC3). CC3hi HIV sp CTL in EC were not only lower compared to V (2.3 vs. 13%, respectively) but also lower than ST (5.4%) (p < 0.05). Bcl-2 trended towards higher levels in HIV sp CTL of EC and ST compared to V. Combining these makers we found differences in CC3hi/Bcl-2lo HIV sp CTL with the greatest number of HIV sp CTL at risk of apoptosis in viremics (6.5%), followed by ST (2.1%) and EC (0.80%) (p < 0.05). In a longitudinal analysis pre and post ART we found decreases in both CC3hi HIV sp CTL and CC3hi/Bcl-2lo CTL after successful treatment. CC3hi/Bcl-2lo populations represent cells at greatest risk of undergoing apoptosis and this phenotype appears to be only partially reversible with ART.


EC have a survival advantage over patients with chronic disease even when treated with ART. Elucidating pro- and anti-apoptotic factors contributing to the survival of CTL in EC including costimulatory signaling necessary to generate these CTL capable of resisting apoptosis is paramount to development of effective HIV-1 vaccines.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Heath, S., Jiyu, J., Bansal, A. et al. P16-25. HIV specific CTL from elite controllers have a unique survival advantage. Retrovirology 6 (Suppl 3), P254 (2009).

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