T cell responses in Kenyan infants: impact on HIV-1 evolution during infection and an assessment of vaccine-induced memory responses in HIV-exposed uninfected infants

The past 10 years has seen mother to child transmission (MTCT) of HIV-1 shift from being one of the predominant forces in the global epidemic to a phenomenon that is largely preventable and envisioned as being on the path to elimination. This thesis is based on two cohorts of Kenyan infants recruited before and after the development of effective antiretroviral interventions to prevent MTCT. Two main lines of enquiry are pursued with the aim to contribute to improved health outcomes of infants affected by HIV-1. The first seeks to further our understanding of the capacity of the infant cytotoxic T lymphocyte (CTL) response to influence viral evolutionary dynamics in early infection. Chapter 3 presents a modern phylogenetic analysis of longitudinal viral sequences derived from infants following in utero or peripartum infection. The results indicate that despite high levels of viral replication, infant CTL selection pressure plays a significant role in shaping early viral evolution. The second stems from an accumulating body of evidence that suggests that infants born to HIV-1 infected mothers who themselves are free from infection, termed HIV-1 exposed uninfected (HEU) infants, nevertheless face significantly higher rates of infectious disease- associated morbidity and mortality than HIV-1 unexposed infants. This study therefore sought to characterise the immunological status of HEU infants with particular emphasis on the phenotypic and functional properties of the T cell compartment. Chapter 4 presents the immunological characterisation of a cohort of healthy Kenyan infants recruited as a control population at two time points in early life. Chapter 5 present a cross-sectional comparison of HEU and control infant cohorts. The results suggest a level of altered immunological reactivity with respect to the T helper type 1 (Th1) response to polyclonal stimulation. In addition a compromised memory Th1 response was observed following polyclonal stimulation and following stimulation with Bacillus Calmette-Guerin and tetanus toxoid vaccine antigens.This thesis is not currently available in ORA