HLA is the Major HIV Controller (MHC)

Upon infection by HIV, there follows a massive but transient increase in viruses in the blood followed by a period of years during which CD4+ T lymphocytes slowly decline. However, after the initial spike, some people have far fewer viruses in their blood and their CD4 counts do not decline. They remain apparently healthy, asymptomatic, for a very long time. These people are called “controllers” because their immune system controls virus replication without medication. The authors of this paper – with an impressive number of collaborators – looked for genetic variations in the controllers that could underlie the differences.

A genome wide association study (GWAS) performed with 1, 974 controllers (cases) and 2,648 progressors revealed a strong link with the HLA (the real human MHC, or major histocompatibility complex) on the short arm of chromosome 6 (figure shown). A weaker correlation with a chemokine receptor CCR5delta32 polymorphism previously identified with HIV resistance was also identified. HLA association is not surprising because practically everything immunological is strongly influenced by the HLA. What the investigators did next, however, was novel, imaginative, and highly illuminating.

From the SNP data, they were able to impute the controllers’ HLA type. Of the hundreds of HLA alleles, controllers tended to possess a remarkably narrow number of particular HLA-B and, to a lesser degree, HLA-A and -C alleles. They identified HLA-B*57:01, B*27:05, B*14/Cw*08:02, B*52, A*25 as protective alleles, and B*35 and Cw*07 as risk alleles. Moreover, they identified specific amino acids within the peptide-binding cleft as key variables in HIV control. These HLA amino acids define the ability of a pathogen to stimulate the cellular immune response.

These results provide a solid, well understood albeit complex mechanistic understanding to HIV progression and control. The next step could identify those HIV peptides that are bound preferentially by the protective and risk allele proteins.

The Major Genetic Determinants of HIV-1 Control Affect HLA Class I Peptide Presentation. The International HIV Controllers Study. Science. 2010 Nov 4.