Preserved CD4+ T cell helper function and coordinated antiviral immunity in people with HBV/HIV co-infection on long-term therapy

ABSTRACT Background & Aims: People with HBV/HIV co-infection on antiretroviral therapy achieve higher rates of HBV functional cure than those with HBV mono-infection, yet the immunological basis remains poorly characterised. HBV-specific CD4+ T cell responses are critical for viral control and functional cure but have been scarcely examined in HBV/HIV co-infection. Our previous studies in HBV/HIV co-infection demonstrated preserved stem-like CD8+ T cells and NK cell functional responses, but whether CD4+ T cell helper function is similarly maintained is unknown. Methods: We analysed CD4+ T cell responses in 72 participants (HBV n=26, HBV/HIV n=24, HIV n=22) on suppressive antiviral therapy, using multiparameter flow cytometry, virus-specific CD4+ T cell functional assays and proliferation assays. Results: People with HBV/HIV co-infection had significantly higher HBV envelope- and core-specific CD4+ T cell responses, with IL-2 production particularly discriminating between groups. CD4+ T cell responses to CEF (CMV, EBV, and Influenza) were comparable, confirming antigen specificity. Granzyme B-expressing cytotoxic CD4+ T cells and TCF-1+CD127+PD-1+CD4+ T cells were enriched in co-infection. CD4+ and CD8+ T cell responses were more frequently coordinated within donors in co-infection than in mono-infection (envelope 83% vs 50%; core 94% vs 60%), where they were more often uncoupled. IL-2 producing CD4+ T cells correlated with CD8+ T cell responses and the CD4:CD8 ratio in co-infection. HBV-specific proliferative capacity was enhanced in co-infection. Conclusions: People with HBV/HIV co-infection mount functional HBV-specific CD4+ T helper responses that are coordinated with CD8+ T cell immunity at the individual level. Together with our prior findings of preserved NK and CD8+ T cell responses in this cohort, these data identify treated HBV/HIV co-infection as a setting of integrated, rather than compromised, antiviral immunity.