Pediatric Adolescent Virus Eradiation (PAVE) Martin Delaney Collaboratory

Paediatric patients may be optimal candidates for HIV cure and vaccine strategies. They are known to generate more frequent and potent broadly neutralizing antibodies to HIV than their adult counterparts. (1,2,3) This is partially due to an enrichment of follicular helper T-cells (TFH) in children, however, the landscape of the secondary lymphoid organ in children is very different from adults in ways that are underexplored and important. From an HIV reservoir standpoint, the secondary lymphoid organ is a key sanctuary site in which the actions of CD8+ T cells and NK cells in eliminating HIV are curtailed both by changes in the activation state of these cell types and by their exclusion from germinal centers, where a majority of ongoing HIV replication occurs in ARV controlled HIV infection. (Figures 1) Addressing the viral reservoir in germinal centers of lymphoid tissue is a key part of the strategy to achieving long term post-treatment control (PTC). Notably, studies of lymphoid tissue sanctuary sites have been limited to date due to a lack of access to these tissues from HIV infected individuals.