BackgroundHIV p24 is an extracellular HIV antigen that is involved in viral replication. Falling p24 antibody responses are associated with clinical disease progression, whereas their preservation with non-progression implies that stimulation of p24 antibody production by immunisation might delay progression. This was the basis of the discontinued p24 vaccine. We identified a therapy-naive man aged 61 years from Sydney, Australia, infected in 1988 through his partner. He received the HIV-p24-virus like particle (VLP) vaccine and a 3 week course of azidothymidin monotherapy in 1993, and continued to show vigorous p24 antigen responses with more than 4% p24-specific CD4+ T cells, coupled with undetectable plasma viraemia, until December, 2011. The patient has since remained therapy naive, with plasma viraemia below detectable levels. The patient is heterozygous for CCR5Δ32 and has an HLA type A1, 2; B8, 44; DR4, 15. In 2011, a transitory viral spike (163 HIV RNA copies per mL plasma) was recorded, which without antiretroviral drug treatment reverted to undetectable virus (<20 HIV copies per mL) in 3 weeks. We aimed to define the immune-protective correlates of p24 vaccination in this individual by retrospective analysis of cellular responses to p24 antigen in CD4+ and CD8+ T cells, and CD14+ monocytes, in terms of the concentrations of 270 cytokines and chemokines during viraemia and aviraemia. MethodsWe used whole peripheral blood mononuclear cells from the two phases, stimulated them with p24 antigen, and then separated them by magnetic beads as stimulated and unstimulated CD4+ and CD8+ T cells, and monocyte fractions. Cellular proteins were extracted, quantified, and analysed with a cytokine antibody array. Differentially expressed proteins were analysed with online bioinformatic tools, and statistics evaluated with the student t test and three k-way analyses. FindingsEncompassing all three cell types, we found statistically significant coordinated upregulation with high fold-changes of fractalkine, ITAC, IGFBP-2, cathepsin-S, and CCL14a in the aviraemic phase. TECK and TRAIL-R4 were downregulated in the viraemic phase and upregulated in the aviraemic phase. Fractalkine, which showed high fold-changes across cell types during the aviraemic phase and no expression during viraemia, plays a vital part in promotion of cell survival during homeostatic and inflammatory conditions. The upregulation of fractalkine in all three cell types (14-fold in CD4+ T cells, 12-fold in monocytes, and five-fold in CD8+ T cells) during aviraemia might be associated with a protective effect. Interestingly, downregulation of TRAIL-R3/R4 and TECK/CCL25 coincided with plasma viraemia and their upregulation with aviraemia, suggesting that dysfunction in antiapoptotic chemokines might be a mechanism contributing to loss of immune function during HIV infection, and that an effective T-cell-derived immune response can be mounted without T-cell exhaustion. Decrease in TECK expression is associated with increased apoptosis in lymphoid tissues in macaques infected with simian immunodeficiency virus. InterpretationBecause the p24 VLP vaccine failed to induce antibody titres, the possible beneficial effect of p24 vaccine in this individual could be attributed to broad and coordinated cellular responses mounted by all three cell types in tandem in modulating viraemic and aviraemic phases. This study highlights that induction of HIV-1-specific helper cells might be important in immunotherapeutic interventions and HIV vaccine development. FundingWe acknowledge the support of a National Health and Medical Research Council Development grant to NKS.