1. Conflict of Interest
No conflicts of interest to declare.

2. Evaluation of memory CD8+ T cell responses in individuals initiating cART during hyperacute HIV-1 infection
Thandeka Nkosi
HIV Pathogenesis Programme
Nelson R Mandela School of Medicine
University of KwaZulu-Natal
Durban, South Africa

3. KwaZulu-Natal and Durban, South Africa
Gauteng
Northern
Province
Mpumalanga
North West
Free State
KwaZulu
Natal
Northern Cape
Durban
Eastern Cape
Western Cape

4. HIV-1 incidence in 18-35 year old women in this community 9.1%
HIV in pregnant women in rural South Africa
( )
HIV-1 incidence in year old women in this community
9.1%
Age Group
(Years)
HIV Prevalence
(N=4818)
≤16
11.5%
17-18
21.3%
19-20
30.4%
21-22
39.4%
23-24
49.5%
>25
51.9%
Source: Abdool Karim Q, 2014

5. FRESH (Females Rising through Education, Support and Health)
Subjects:
Uninfected year old women at high risk of HIV infection
Methods:
Provide a twice weekly empowerment, life skills, job readiness and HIV prevention education curriculum with the goal of preventing HIV infections and placing all women in employment after one year
Test twice weekly for HIV RNA by finger prick, with the goal of identifying hyperacute infections
Test and treat

6. Acute infections detected (N = 56)
As of June 17, 2017:
14 untreated, 79% Fiebig I
42 treated early, 84.2% Fiebig I
Incidence 8.5 (95% CI= ) per 100 p/y

7. Typical treated and untreated acute HIV-1 infection
Treatment: TDF/FTC/EFZ

8. Early ART blunts peak viremia in Fiebig I treated patients

9. Impact of early ART on CD8+ T cell responses
Investigate if very early ART suppresses development of immune responses OR
Early ART initiation,
help to preserve CD8+ T cell immune responses

10. Persistent HIV-specific CD8+ T cell response following early cART initiation
Tetramer
CD8

11. Some patients started on cART in Fiebig I do not make detectable HIV-specific tetramer CD8+ T cell responses P2
Tetramer
CD8

12. Some patients started on cART in Fiebig I do not have proliferative responses
CFSE
CD8

13. Majority of Fiebig I treated subjects make detectable HIV-specific CD8+T cell responses
Assays used:
Tetramer staining
ELISPOT Assay
CFSE Proliferation Assay

14. Increased CD127 expression on CD8+ T cells during early treated hyperacute HIV infection

15. HIV-specific CD8+ T cells in early treated subjects are more functionally competent
Untreated
IFN-gamma
CD8
Tetramer

16. Conclusions
Hyperacute infection can be identified at the center of the HIV epidemic in Durban, South Africa
A large proportion of individuals treated in Fiebig I have detectable anti-HIV immune responses
Understanding of immune responses in early treated people may be useful for future intervention studies

17. Acknowledgements Dr Zaza Ndhlovu Prof Thumbi Ndung’u Prof Bruce Walker
Nikoshia Shen
Karyn Pretorious
Funsho Ogunshola
Faatima Laher
Omolara Baiyegunhi
Nasreen Ismail
HPP staff and students
Study Participants