Pathological Role of Anti-CD4 Antibodies in HIV-Infected Immunologic Nonresponders Receiving Virus-Suppressive Antiretroviral Therapy

Increased mortality and morbidity occur among human immunodeficiency virus (HIV)-infected patients in whom CD4(+) T-cell counts do not increase despite viral suppression with antiretroviral therapy (ART). Here we identified an underlying mechanism. Significantly elevated plasma levels of anti-CD4 immunoglobulin G (IgG) were found in HIV-positive immunologic nonresponders (ie, HIV-positive individuals with CD4(+) T-cell counts of 350 cells/mu L), compared with levels in HIV-positive immunologic responders (ie, HIV-positive individuals with CD4(+) T-cell counts of 500 cells/mu L) and healthy controls. Higher plasma level of anti-CD4 IgG correlated with blunted CD4(+) T-cell recovery. Furthermore, purified anti-CD4 IgG from HIV-positive immunologic nonresponders induced natural killer (NK) cell-dependent CD4(+) T-cell cytolysis and apoptosis through antibody-dependent cell-mediated cytotoxicity (ADCC) in vitro. We also found that anti-CD4 IgG-mediated ADCC exerts greater apoptosis of naive CD4(+) T cells relative to memory CD4(+) T cells. Consistently, increased frequencies of CD107a(+) NK cells and profound decreases of naive CD4(+) T cells were observed in immunologic nonresponders as compared to responders and healthy controls ex vivo. These data indicate that autoreactive anti-CD4 IgG may play an important role in blunted CD4(+) T-cell reconstitution despite effective ART.