Follicular helper CD4 ^hi T cells (T _FH ) are a major cellular pool for the maintenance of the HIV reservoir. Therefore, the delineation of the follicular (F)/germinal center (GC) immune landscape will significantly advance our understanding of HIV pathogenesis. We have applied multiplex confocal imaging, in combination with the relevant computational tools, to investigate F/GC in situ immune dynamics in viremic (vir-HIV), antiretroviral-treated (cART HIV) People Living With HIV (PLWH) and compare them to reactive, non-infected controls. Lymph nodes (LNs) from viremic and cART PLWH could be further grouped based on their T _FH cell densities in high-T _FH and low-T _FH subgroups. These subgroups were also characterized by different in situ distributions of PD1 ^hi T _FH cells. Furthermore, a significant accumulation of follicular FOXP3 ^hi CD4 ^hi T cells, which were characterized by a low scattering in situ distribution profile and strongly correlated with the cell density of CD8 ^hi T cells, was found in the cART-HIV low-TFH group. An inverse correlation between plasma viral load and LN GrzB ^hi CD8 ^hi T and CD16 ^hi CD15 ^lo cells was found. Our data reveal the complex GC immune landscaping in HIV infection and suggest that follicular FOXP3 ^hi CD4 ^hi T cells could be negative regulators of T _FH cell prevalence in cART-HIV.