{"doi":"10.1093/cid/ciae562","title":"Impact of Anti-CD4 Autoantibodies on Immune Reconstitution in People With Advanced HIV","abstract":"BACKGROUND: Despite suppressive antiretroviral therapy (ART), 15%-30% of people with human immunodeficiency virus (HIV) experience a limited recovery of CD4 T cells. Although autoantibodies against the CD4 receptor have previously been identified in people with HIV (PWH), little is known about their longitudinal impact on CD4 T-cell reconstitution. METHODS: Anti-CD4 autoantibodies were evaluated by the fluid-phase luciferase immunoprecipitation systems immunoassay in ART-naive people with advanced HIV (CD4 count ≤100 cells/µL), PWH with CD4 count >200 cells/µL, long-term nonprogressors, people with idiopathic CD4 lymphopenia, people with autoimmune lymphoproliferative syndrome, and healthy volunteers without HIV. In the participants with advanced HIV, we assessed the association of anti-CD4 autoantibodies at ART initiation with CD4 recovery over a median follow-up of 192 weeks. RESULTS: Anti-CD4 autoantibodies were identified in 29% (61/210) of ART-naive participants with advanced HIV but were absent in people without HIV. Female PWH showed a 4-fold higher prevalence (P < .001) of anti-CD4 autoantibodies compared to males. After ART initiation, people with advanced HIV with anti-CD4 autoantibodies exhibited an overall slower rate of CD4 reconstitution (5.8 vs 6.6 cells/µL/month, P = .007) and lower week 192 CD4 count (268 vs 355 cells/µL, P = .037). Incidental, clinically indicated immunosuppressive therapy in these participants was associated with an improved rate of CD4 reconstitution (P = .0019) and higher week 192 CD4 count (551 vs 268 cells/µL, P = .019). CONCLUSIONS: People with advanced HIV harboring anti-CD4 autoantibodies at ART initiation demonstrated a slower rate and extent of CD4 reconstitution after 4 years. Incidental immunosuppressive therapy was associated with increased CD4 counts in these participants.","journal":"Clinical Infectious Diseases","year":2024,"id":446162,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":7,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.968,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":332535,"name":"Andrea Lisco","orcid":"0000-0002-1475-356X","position":1,"is_corresponding":false},{"id":431963,"name":"Maura Manion","orcid":"0000-0003-0991-0011","position":2,"is_corresponding":false},{"id":342096,"name":"Elizabeth Laidlaw","orcid":"0000-0001-8241-6859","position":3,"is_corresponding":false},{"id":727841,"name":"Frances Galindo","orcid":null,"position":4,"is_corresponding":false},{"id":343335,"name":"Megan Anderson","orcid":null,"position":5,"is_corresponding":false},{"id":343214,"name":"Gregg Roby","orcid":null,"position":6,"is_corresponding":false},{"id":341773,"name":"Virginia Sheikh","orcid":"0000-0003-2006-7440","position":7,"is_corresponding":false},{"id":427784,"name":"Stephen A. Migueles","orcid":"0000-0002-6062-8022","position":8,"is_corresponding":false},{"id":427792,"name":"April Poole","orcid":"0000-0003-0767-4334","position":9,"is_corresponding":false},{"id":342090,"name":"Ainhoa Pérez‐Díez","orcid":"0000-0001-8948-554X","position":10,"is_corresponding":false},{"id":434284,"name":"Xiangdong Liu","orcid":"0000-0002-9816-688X","position":11,"is_corresponding":false},{"id":280640,"name":"V. Koneti Rao","orcid":"0000-0002-7881-6902","position":12,"is_corresponding":false},{"id":104193,"name":"Peter D. Burbelo","orcid":"0000-0003-1717-048X","position":13,"is_corresponding":false},{"id":241760,"name":"Irini Sereti","orcid":"0000-0002-0076-0224","position":14,"is_corresponding":false},{"id":863585,"name":"Brian Epling","orcid":"0000-0002-7434-942X","position":0,"is_corresponding":true}],"reference_count":29,"raw_metadata":null,"created_at":"2026-07-19T02:01:50.465308Z","pmid":"39692471","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}