Recently, selleck chemicals llc a blinded study utilizing a highly sensitive in vitro expansion method of detecting CTL responses failed to identify HIV-specific T cell responses in the HESN partners among HIV-discordant couples from Zambia [36]. Among HESN individuals with detectible T cell responses to HIV-1 antigens, the breadth and magnitude of the HIV-specific responses has often been significantly lower than comparable responses observed in HIV-1-infected individuals [25,37], due probably to the clear differences in antigen exposure between these subjects. Work from several groups

showing that pre-existing CTL responses against HIV-1 do not ensure a sustained resistance against infection in some persistently exposed HESN subjects who later seroconvert [38–40] further dampened interest in the potential role of T cells in sterilizing immunity. Currently, the potential role of antigen-specific T cell responses to HIV-1 in natural resistance from infection remains debated, and it is

currently unknown if HIV-1-specific T cell responses represent an active mechanism of protection or merely a marker of exposure to the virus, as suggested recently [41]. The fact that 30–60% of HESN subjects lack detectable T cell responses to HIV-1 (reviewed elegantly by Piacentini et al. and Miyazawa et al. in complementary analyses of HESN studies to date [42,43]) suggests that the presence of adaptive anti-HIV T cell responses has not been a unifying Liothyronine Sodium functional attribute of HESNs. Rather, the collective evidence supports the notion that non-T cell-mediated immune

Buparlisib concentration responses may also be involved in protection from HIV-1 in a subset of HESN subjects. Similar to adaptive T cell responses, HIV-specific IgA responses have been identified in the mucosa and sera of high-risk HIV-exposed seronegative subjects from multiple HESN cohorts [5,44–48]. HIV-specific IgA responses have also been documented in the absence of infection following oral exposure to HIV-1 through unprotected oral sex [49,50] and breast feeding [51]. Although there have been cohorts where no HIV-specific IgA has been evidenced [52], most HESN cohorts with documented mucosal exposure have evidenced detectable levels of HIV-specific IgA (see Table 2) [42,43]. Various reports have shown that HIV-specific IgA can neutralize HIV in ex-vivo assays [47,53], with most neutralizing epitopes found in gp41 and gp120 [53]. HIV-specific IgA from HESN subjects has also been shown to inhibit transcytosis across epithelial barriers, suggesting a functional mechanism of action in protection against HIV-1 infection [54,55]. In addition to direct neutralization of viral particles, HIV-specific IgA responses may also trigger antibody-dependent cellular cytotoxicity (ADCC) of infected target cells in conjunction with innate immune cells bearing the IgA-specific Fc receptor, CD89 [56,57].