The majority of HIV infected individuals fail to produce protective antibodies and have diminished responses to immunization–. We report that even though there is an expansion of T follicular helper (Tfh) cells in HIV infected individuals, these are unable to provide adequate B cell help. A higher frequency of PD-L1+ germinal center (GC) B cells from lymph nodes of HIV infected individuals suggested a potential role for PD-1/PD-L1 interaction in regulating Tfh cell function. In fact, engagement of PD-1 on Tfh cells led to a reduction in cell proliferation, activation, ICOS expression and IL-21 cytokine secretion. Importantly, blocking PD-1 signaling enhanced HIV-specific immunoglobulin production in vitro. We further show that at least part of this defect involves IL-21 as addition of this cytokine rescued antibody responses and plasma cell generation. Our results suggest that deregulation of Tfh-mediated B cell help diminishes B cell responses during HIV infection and may be related to PD-1 triggering on Tfh cells. These results show, for the first time, a role for Tfh cell function in HIV pathogenesis and suggest that an alteration in their function could have a significant impact on the outcome and control of HIV infection, future infections and vaccinations.
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