NK-like and networked CD8+ T cell immunity mediates exceptional HIV control

Abstract

Durable treatment-free remission remains a defining goal for people living with HIV (PLWH). Studies of spontaneous elite controllers have revealed that functional CD8 T cells targeting structurally networked viral epitopes can mediate durable viral suppression1,2. However, rare reservoir-defined exceptional controllers within the spectrum of elite control3-5, characterized by the absence of intact provirus or proviruses confined to transcriptionally repressed genomic regions6, provide a unique opportunity to define mechanisms of cure-like immunity. Here, we integrate functional epitope mapping, single-cell transcriptomics, and infected cell elimination assays to identify networked HIV epitope targeting and a natural killer (NK)-like killer-cell immunoglobulin-like receptor (KIR) CD8 T cell subset as key features of exceptional control. This NK-like subset was selectively enriched within HIV-specific, but not CMV-specific, CD8 T cells from controllers, and was transcriptionally similar to highly cytotoxic subsets within the broader KIR+ CD8+ T cell compartment. Flow cytometry revealed increased frequencies of KIR CD8 T cells in exceptional controllers relative to antiretroviral therapy (ART)-suppressed individuals, and unexpectedly, enrichment of dual KIR+ NKG2A+ CD8 T cells. Functional depletion of KIR CD8 T cells significantly impaired the elimination of autologous HIV-infected CD4 T cells, despite preserved recognition by proliferative networked HIV-specific CD8 T cells. These findings thereby identify an NK-like KIR CD8 T cell state as a previously unrecognized component of exceptional HIV immunity that complements networked epitope targeting, providing a novel framework for immunotherapeutic HIV cure strategies.