Les thérapeutiques antirétrovirales ont permis d’augmenter la survie des personnes vivant avec le VIH (PVVIH). Cependant, de nombreuses comorbidités non liées au VIH émergent et sont une préoccupation majeure dans la prise en charge des patients. L’activation, l’inflammation et l’immunosénescence pourraient jouer un rôle majeur dans ce processus. De nombreux marqueurs existent pour mesurer ces dysfonctionnements et ils ont souvent été considérés sans prendre en compte leurpossible interdépendance. Les objectifs de cette thèse était i) de proposer une combinaison de ces marqueurs, ii) d’évaluer l’association entre la combinaison de ces marqueurs et la présence des comorbidités, et iii) d’évaluer l’association entre la combinaison de ces marqueurs, et le risque de survenue des comorbidités et de la mortalité chez des PVVIH inclus dans la sous étude CIADIS de la cohorte ANRS CO3 Aquitaine. Nous avons identifié deux scores : le score CIADIS cellulaire et soluble. Le score cellulaire était plutôt associé à la multimorbidité et à la survenue d’une nouvelle comorbidité quelle qu’elle soit. Le profil des dysfonctionnements immunitaires sous-jacent était différent lorsque l’on s’intéressait aux comorbidités séparément. Ces résultats soutiennent l’hypothèse que différents profils d’activation, d’inflammation et de sénescence sous-jacents pourraient être impliqués dans le développement de différentes comorbidités. Nos résultats montrent que des analyses intégrant de nouveaux biomarqueurs pourraient accroître la compréhension des comorbidités. Nous allons continuer de travailler sur l’identification des profils de dysfonctionnements immunitaires pour des comorbidités spécifiques. / Antiretroviral therapies have improved the survival of HIV-infected people. However, many non-HIVrelated comorbidities occur and represent a major concern in patient care. Activation, inflammation and immunosenescence could play a major role in this process. Many markers can measure those dysfunctions and they are often used without accounting for their possible interdependency. The objectives of this thesis were i) proposing a combination of those markers, ii) assessing the association between the combination of markers and the presence of comorbidities and iii) assessing the association between the combination of markers and the risk of occurrence of comorbidities and mortality in HIV-infected patients included in the sub-study CIADIS from cohort ANRS CO3 Aquitaine. We identified two scores: the cellular and the soluble CIADIS scores. The cellular score was mostly to multimorbidity and occurrence of any kind of new comorbidity. The profile of underlying immune dysfunctions was different when looking separately at the comorbidities. These results support the assumption that several underlying profiles of activation, inflammation and senescence could be involved in the development of different comorbidities. Our results show that integrating new biomarkers in analyses could improve the understanding of comorbidities. We will continue to work on the identification of profiles of immune dysfunctions for some specific comorbidity.

Given the shared risk factors for transmission, co-infection of hepatitis B virus (HBV) with hepatitis C virus (HCV) and/or human immunodeficiency virus (HIV) is quite common, and may lead to increases in morbidity and mortality. As such, HBV vaccine is recommended as the primary means to prevent HBV super-infection in HCV- and/or HIV-infected individuals. However, vaccine response (sero-conversion with a hepatitis B surface antibody titer >10 IU/L) in this setting is often blunted, with poor response rates to standard HBV vaccinations in virally infected individuals when compared with the healthy subjects. This phenomenon also occurs to other vaccines in adults, such as pneumococcal and influenza vaccines, in other immunocompromised hosts who are really at risk for opportunistic infections, such as individuals with hemodialysis, transplant, and malignancy. In this review, we summarize the underlying mechanisms involving vaccine failure in these conditions, focusing on immune exhaustion and immune senescence - two distinct signaling pathways regulating cell function and fate. We raise the possibility that blocking these negative signaling pathways might improve success rates of immunizations in the setting of chronic viral infection.

Given the shared risk factors for transmission, co-infection of hepatitis B virus (HBV) with hepatitis C virus (HCV) and/or human immunodeficiency virus (HIV) is quite common, and may lead to increases in morbidity and mortality. As such, HBV vaccine is recommended as the primary means to prevent HBV super-infection in HCV- and/or HIV-infected individuals. However, vaccine response (sero-conversion with a hepatitis B surface antibody titer >10 IU/L) in this setting is often blunted, with poor response rates to standard HBV vaccinations in virally infected individuals when compared with the healthy subjects. This phenomenon also occurs to other vaccines in adults, such as pneumococcal and influenza vaccines, in other immunocompromised hosts who are really at risk for opportunistic infections, such as individuals with hemodialysis, transplant, and malignancy. In this review, we summarize the underlying mechanisms involving vaccine failure in these conditions, focusing on immune exhaustion and immune senescence - two distinct signaling pathways regulating cell function and fate. We raise the possibility that blocking these negative signaling pathways might improve success rates of immunizations in the setting of chronic viral infection.

Mit zunehmendem Alter verringert sich die Fähigkeit des menschlichen Organismus Infektionen erfolgreich zu bekämpfen und, z.B. nach Impfung, einen protektiven Schutz aufzubauen. Es wird vermutet, dass die Alterung des Immunsystems eine Rolle dabei spielt. Wichtige Ergebnisse liefern dazu vor allem tierexperimentelle Studien, welche jedoch die Komplexität menschlicher Immunität nur bedingt abbilden. Nur ansatzweise erforscht ist der Einfluss immunologischer Alterungsprozesse auf die primäre Immunantwort im Menschen. Um ein besseres Verständnis über primäre Immunantworten im Alter zu erlangen, haben wir junge (n=11, Med=26 Jahre) und ältere (n=12, Med=60 Jahre) Erwachsene mit einem viralen Erreger experimentell infiziert und die akute Immunreaktion und Entwicklung langlebiger Protektion eingehend untersucht. Dafür verwendeten wir den attenuierten Lebendimpfstoff gegen Gelbfieber, der ein hervorragendes Modelsystem darstellt um anti-virale Primärantworten im Menschen zu erforschen. Wir konnten zeigen, dass ältere Impflinge weniger Gelbfiebervirus-(GFV)-neutralisierende Antikörper produzierten, schwächere GFV-spezifische CD8+ T-Zellantworten erzeugten und quantitativ als auch qualitativ veränderte GFV-spezifische CD4+ T-Zellantworten generierten. Zudem wiesen ältere Impflinge häufiger eine vergleichsweise späte Virämie auf. Unsere systembiologische Untersuchungen zeigten, dass die niedrige Zahl von frisch aus dem Thymus ausgewanderten naiven CD4+ T Zellen, sogenannten CD4+ Recent thymic emigrants, sowie der Mangel an dendritischen Zellen vor bzw. am Beginn der Infektion ausschlaggebend für die schlechtere Immunreaktion und niedrigere Langzeit-Immunität bei Älteren war. Daraus schließen wir, dass in älteren Menschen die Verfügbarkeit eines breiten Repertoires naiver CD4+ T-Zellen und eine effektive Induktion des angeborenen Immunsystems in der frühen Phase einer primären Infektion kritisch für die akute Abwehr viraler Erreger und die Ausbildung protektiver Immunität ist. / The immunological competence to fight infections and to generate protective immunity, for example upon vaccination, progressively declines with advancing age. Although the aged immune system has been extensively studied at steady state and in aged animal models, there is only rudimentary understanding on how aging affects the immune response to a primary infection in humans. Involving complex individual systemic immune properties, such investigations have been very challenging particularly with the given restrictions of experimental infections in humans. In our study, we explored age-related changes in human immunity during experimental, primary immunization with live-attenuated yellow fever (YF) vaccine. In 11 young (median age: 26 years) and 12 elderly (median age: 60 years) vaccinees, we assessed individual viral burden and compared humoral and cellular immunity by advanced flow cytometric analysis over the entire course of the acute infection and up to 3 years after it. We discovered that aged subjects developed fewer neutralizing antibodies, mounted diminished YF-specific CD8+ T-cell responses and showed quantitatively and qualitatively altered YF-specific CD4+ T-cell immunity. A comparatively late peak in YF viremia suggested impaired infection control and viral clearance in the elderly. Among numerous immune signatures, low in vivo numbers of naive CD4+ recent thymic emigrants (CD4+ RTE) prior immunization and peripheral dendritic cells (DCs) in the early phase of the innate response phase were indicative for reduced acute responsiveness and altered long-term persistence of human cellular immunity to YF vaccination in the elderly. Thus, we reveal by this study that essential elements of immune responses such as CD4+ RTEs and DCs affect productive immunity in the elderly, explaining conclusively diminished responsiveness to vaccination with neo-antigens and infection with de novo pathogens in aged people.