Exploring the impact of vertically acquired HIV infection on the quality of humoral immunity in early adulthood . (360G-Wellcome-088317_Z_09_Z)

Perinatally-acquired HIV infection is a global concern, yet little is known about how HIV affects immune system development and whether timely use of ART is critical to minimise lasting HIV-mediated damage. Although T cells are the primary target of HIV, significant disruption to humoral immunity is described in horizontally infected adults. Some changes are reversed on control of viral load/recovery of CD4+ count with ART; however the generation and maintenance of long lived memory B cell respo nses remain impaired. Availability of an increasing cohort of vertically infected young adults provides me with the opportunity to study, for the first time, the impact of perinatally-acquired HIV infection on the development of adaptive immunity and how these patients differ immunologically from adults who acquired infection in the context of a mature immune system and from healthy controls. A comprehensive analysis of B cell lineage development, turnover and the quality of natural immun ity to the colonising bacteria pneumococcus, will be made in a cross sectional study incorporating the three patient cohorts. Subjects will then be immunised with pneumococcal vaccine and the quality and persistence of memory responses analysed. This information will be used ultimately to inform clinical management of perinatally infected patients.