Natural HIV control in a HIV/HCV co-infected patient with a severe leukopenia: A case report

Abstract

A 63-years old male was diagnosed for HIV (HIV-RNA undetectable and CD4 T cell count 191/mmc) and HCV active infection (HCV-RNA: 101027 cp/ ml, genotype 1a) in May 2018. In September 2018, the patient presented a bacterial pneumonia with fever, severe leukopenia and thrombocytopenia. HIV-RNA persisted lower than 30 cp/ml and CD4 T cell count was 101/mmc. The severe leukopenia was associated with a general low growth capability of bone marrow derived hematopoietic progenitors and with a low frequency of multipotent lymphoid precursors, suggesting a possible impairment of leukocyte replenishment. T cells were few and dramatically skewed toward an effector profile, suggesting a strongly engaged immune system. Finally, a very high frequency of HIV-specific T cells (3.5 %) showing a polyfunctional profile was found: 70% of HIV specific T cells are able to simultaneously mediate 4 different functions (IFN- γ , TNF- α MIP-1 β , CD107a). In conclusion, we presented a case of one HIV-HCV co-infected patient who, despite an effective immune response able to control HIV replication, showed a progressive disease. The high frequency of polyfunctional CD8 T cells together with a threadbare immune system and with an impaired hematopoiesis may explain the disease progression in the absence of HIV replication.