Immune checkpoint inhibitors in people living with HIV: what about anti-HIV effects?

Abstract

Immune checkpoint inhibitors (ICPi) have shown major therapeutic successes when used in various cancers. In the HIV field a double benefit of such ICPi should result from their dual ability to restore in-vitro HIV-specific CD8+ T-cell functions and to enhance HIV production from reservoir cells, thus fulfilling the goals of the ‘shock and kill’ concept proposed as an HIV cure therapeutic strategy. We conducted a systematic review to identify studies reporting the tolerance profile of ICPi and their effects on HIV plasma loads (pVL), CD4+ count, HIV reservoirs (cell-associated HIV-DNA) and/or HIV-specific CD8+ T in PLWH. Thirty-four articles were included for a total 176 participants. 12.1% participants experienced severe adverse events and 49.4% nonsevere adverse events. pVL remained stable in 91.9% participant, showed increases in 5.8% participant, and decreases in 2.3%. CD4+ count remained stable in 60.7% participants, showed increases in 24.6%, and decreases in 14.7%. Regarding ICPi effects on HIV-DNA and HIV-specific immunity, we identified three distinct profiles: profile I, transient pVL increases followed by a boost in HIV-specific CD8+ T cells concomitant to a decrease in HIV-DNA, reported in one participant. Profile II: increase in HIV-specific CD8+ T cells without changes in pVL or HIV-DNA, reported in three participants. III: no effect, reported in five participants. In conclusion, the clinical, virological and immunological safety profiles of ICPi reported in about 200 PLWH appear to be favorable but their still modest results in terms of HIV cure strategy.