Probing entry inhibitors' activity on HIV and development of new fusion inhibitors : integrating evolutionary biology with virology

Tese de doutoramento, Farmácia (Microbiologia), Universidade de Lisboa, Faculdade de Farmácia, 2011The general aims of this thesis were: 1) to examine the C2, V3 and C3 envelope regions ofHIV-1 and HIV-2 at the molecular, evolutionary and structural levels; 2) to compare HIV-1and HIV-2 susceptibility to entry inhibitors and assess their potential value in HIV-2therapy; 3) to produce a new fusion inhibitor peptide using evolutionary biology basedstrategies.In the first study (Chapter 2), HIV-1 and HIV-2 were compared at the molecular,evolutionary and structural levels in the C2, V3 and C3 envelope regions. We identifiedsignificant structural and functional constrains to the diversification and evolution of C2,V3 and C3 in the HIV-2 envelope but not in HIV-1. In particular, we found that V3 in HIV-2is less exposed and more conserved than in HIV-1, suggesting fundamental differences inthe biology and infection of these viruses as well as in their susceptibility to entryinhibitors.In the second study (Chapter 3) we measured the baseline susceptibility of HIV-1 and HIV-2primary isolates to different fusion inhibitors and coreceptor antagonists, includingenfuvirtide (T-20) and maraviroc (MVC). MVC inhibited HIV-2 R5 variants at significantlyhigher IC90 concentrations than HIV-1 variants. Moreover, as previously found in HIV-1,susceptibility of HIV-2 R5 variants to MVC was inversely related with CD4+ T cell counts attime of virus isolation. These results suggest that the structure of the envelope complex ofR5 variants changes along the course of infection. More importantly, the results call fornew clinical studies to evaluate the efficacy of MVC in HIV-2 infection and to determine itsbest therapeutic dosage in early and late stage disease. We also provide definitiveevidence demonstrating that T-20 is not useful for HIV-2 therapy.In the final study (Chapter 4), we designed a new HIV fusion inhibitor peptide (P3) basedon the ancestral sequences of the HIV-2 and SIV envelope genes. P3 has an a-helixstructure as demonstrated by circular dichroism. It has broad antiviral activity at thenanomolar range against HIV-1 and HIV-2 primary isolates, including HIV-1 variantsresistant to T-20. Binding ELISA assays and selection of resistant mutants suggest that P3prevents viral fusion by binding to the transmembrane protein in the HR1 region. Thesestudies provide proof of concept that viable antiviral peptides can be constructed usingevolutionary biology strategies. Such strategies should be explored to enhance theproduction of peptide drugs and vaccines.O Vírus da Imunodeficiência Humana do tipo 1 e do tipo 2 (VIH-1 e VIH-2) são os agentes etiológicos do Síndrome de Imunodeficiência Adquirida (SIDA). Embora sejam semelhantes na sua organização estrutural e genómica, estes lentivírus humanos apresentam características antigénicas distintas e partilham uma semelhança genética de apenas 50%. Enquanto o VIH-1 é responsável pela pandemia mundial, a infecção pelo VIH-2 localiza-se sobretudo na África Ocidental, em alguns países europeus como Portugal e França, e na Índia. A infecção pelo VIH-2 tem melhor prognóstico, a progressão para a doença é mais lenta e há melhor controlo imunológico do que na infecção pelo VIH-1. Ao contrário do VIH-1, o arsenal terapêutico actualmente disponível para tratar a infecção por VIH-2 é reduzido. Os fármacos antiretrovirais em uso foram especificamente desenvolvidos para o VIH-1 e, consequentemente, a sua actividade pode ser reduzida ou nula no VIH-2. Este é o caso concreto dos inibidores não nucleosídicos da transcriptase reversa e de alguns inibidores da protease. Neste contexto, os inibidores de entrada poderão ser úteis para tratar a infecção por VIH-2. Contudo, a susceptibilidade dos isolados primários de VIH-2 aos inibidores de entrada é actualmente desconhecida. A susceptibilidade do VIH aos inibidores de entrada é determinada pela qualidade da interacção do vírus com os receptores celulares. O VIH-1 e VIH-2 são substancialmente diferentes a este nível. Por exemplo, o VIH-2 pode ligar-se ao co-receptor CCR5 independentemente do receptor CD4 e da região V3 do invólucro. Por outro lado, as regiões C2, V3 e C3 do VIH-2 são substancialmente diferentes do VIH-1 a nível antigénico. Colectivamente, estes dados indicam que a estrutura e conformação das glicoproteínas de superfície do VIH-1 e VIH-2 são substancialmente diferentes e sugerem que a susceptibilidade e resistência dos dois tipos de vírus aos inibidores de entrada podem também ser diferentes. Os principais objectivos desta tese foram: 1) analisar as características moleculares, estruturais e evolutivas das regiões C2, V3 e C3 no VIH-1 e VIH-2; 2) comparar a susceptibilidade do VIH-1 e VIH-2 aos inibidores de entrada e avaliar o seu potencial terapêutico na infecção por VIH-2; 3) produzir um novo inibidor de fusão para o VIH-2. Para melhor compreender as potenciais diferenças destes dois vírus na resposta aos inibidores de entrada começámos por analisar as características moleculares, estruturais e evolutivas da região V3 e as regiões circundantes C2 e C3, num número significativo de vírus VIH-1 e VIH-2 isolados em Portugal e noutras regiões do globo, com recurso a diferentes metodologias de biologia evolutiva e computacional (Capitulo 2). Apesar da menor variabilidade das 3 regiões no VIH-2, verificámos que a região C3 está sob forte selecção positiva e encontra-se exposta à superfície sugerindo que, tal como no VIH-1, esta região poderá constituir um domínio neutralizante. No entanto, ao contrário do VIH-1, a maioria das mutações adaptativas no VIH-2 são prejudiciais e levam à extinção das linhagens virais pelo que o efeito final é um forte constrangimento à variabilidade das regiões analisadas. Ao contrário do VIH-1, verificámos que a ansa V3 do VIH-2 se encontra oclusa no complexo glicoproteico do invólucro, numa conformação que parece ser estabilizada por interacções que mantém com alguns resíduos da regiões C2 e C3. Estes resultados são consistentes com o facto de a V3 não ser imunodominante no VIH-2, ficando assim mais protegida da resposta imunitária e das eventuais mutações que dela resultam. A forte conservação da V3, da C2 e da C3 também é consistente com a sua potencialmente importante actividade imunosupressora. Em conclusão, este primeiro estudo permitiu caracterizar algumas das características estruturais e funcionais que distinguem as glicoproteínas do invólucro do VIH-1 e do VIH-2 e que estão associadas às diferentes características biológicas e fenotípicas destes dois vírus. Estes dados podem ter impacto na resposta dos dois vírus aos inibidores de entrada (analisado no Capítulo 3) e no desenvolvimento de novas vacinas. No segundo estudo (Capítulo 3) comparámos a actividade antiviral dos antagonistas dos coreceptores (AMD3100, TAK-779 e maraviroc) e dos inibidores de fusão (T-20 e T-1249) entre um grupo de 20 isolados de VIH-2 (19 isolados primários + um isolado laboratorial) e nove isolados de VIH-1 (sete isolados primários + dois isolados laboratoriais). Verificámos que a sensibilidade ao AMD3100 e ao TAK-779 é semelhante no VIH-1 e o VIH-2. No entanto, o perfil da curva dose-resposta do maraviroc (MVC) obtido para os isolados R5 foi diferente nos dois tipos de vírus. No VIH-2 os valores de IC90 foram significativamente mais elevados do que no VIH-1; por outro lado, os declives da curva dose-resposta foram mais baixos no VIH-2 do que no VIH-1. Colectivamente, estes resultados sugerem que poderão ser necessárias concentrações mais elevadas de MVC para tratar os doentes infectados pelo VIH-2. Adicionalmente, encontrámos uma correlação forte e de sentido inverso entre as susceptibilidade do VIH-2 ao MVC e o número de células T CD4+ dos doentes quando os vírus foram isolados. Vírus isolados em doentes em fase de SIDA foram menos susceptíveis ao MVC do que os vírus isolados em doentes com uma contagem de células T CD4+ superior a 200 células/ul. Ao contrário do VIH-1 não encontrámos qualquer correlação entre a carga da V3 e a susceptibilidade dos isolados R5 de VIH-2 ao MVC. De um modo geral, os nossos resultados sugerem que são necessários ensaios clínicos para avaliar a efectividade do MVC na infecção pelo VIH-2, determinar a dose terapêutica mais adequada e esclarecer se é necessário fazer um ajuste de dose de acordo com a fase da doença. Adicionalmente, e uma vez que isolados VIH-2 X4 e populações duplas/mistas são totalmente ou parcialmente resistentes ao MVC, é de extrema importância o desenvolvimento de um ensaio de tropismo (genotípico e/ou fenotípico) para o VIH-2 de modo a determinar o tropismo antes do início da terapia com MVC. Sem o conhecimento prévio do tropismo viral, o tratamento com MVC poderá seleccionar espécies X4 minoritárias que estão associadas a maior resistência à neutralização e uma progressão mais rápida da doença. No que diz respeito aos inibidores de fusão, verificámos que o T-20 tem actividade reduzida no VIH-2, confirmando estudos anteriores realizados com dois isolados laboratoriais. Por outro lado, observámos uma elevada susceptibilidade deste vírus ao T- 1249, indicando que os inibidores de fusão são potencialmente eficazes na infecção pelo VIH-2. Assim, o desenvolvimento de um novo inibidor de fusão do VIH-2 foi o objectivo do último estudo desta tese (Capítulo 4). No Capítulo 4, desenvolvemos novos péptidos inibidores de fusão a partir da reconstrução de sequências ancestrais da glicoproteína gp36 do invólucro de VIH-2 e de Vírus de Imunodeficiência dos Símios (VIS). Com esta abordagem inovadora pretendemos incorporar a história evolutiva dos vírus na sequência dos péptidos e desta forma melhorar a tolerância destas moléculas aos polimorfismos naturais da sua região alvo bem como às mutações de resistência seleccionadas na sua presença. Obteve-se um péptido ancestral (P3) constituído por 34 aminoácidos, cuja sequência corresponde às posições homólogas 628 – 661 da proteína Env do isolado VIH-1 HXB2 (ou 623 – 656 do isolado VIH-2 ROD). A sequência do P3 difere em 21 aminoácidos da sequência consenso de VIH-1, 14 aminoácidos da sequência do T-20 e 6 aminoácidos da sequência consenso de VIH-2. Ao contrário da natureza não-estruturada do T-20, o P3 tem uma conformação típica em hélice-a, o que lhe poderá conferir maior a estabilidade contra a degradação proteolítica, bem como maior afinidade para a região alvo. Por outro lado, o P3 foi facilmente solúvel em soluções aquosas o que é uma vantagem num futuro desenvolvimento de uma fórmula farmacêutica. O P3 demonstrou ter uma forte actividade antiviral contra isolados primários e laboratoriais de VIH-1 e VIH-2 (IC50 médio, 11 nM para o HIV-1 e 63.8 nM para o HIV-2), incluindo variantes resistentes ao T-20 (IC50, 0.15 – 11.8 nM). Através da passagem consecutiva de vírus em cultura na presença do péptido, foi seleccionada uma mutação de resistência na região HR1 da gp41 (VIH-1), a qual é responsável pela redução da susceptibilidade do VIH-1 ao P3 em 120x. Nas mesmas condições, e após 60 dias em cultura, não foi possível seleccionar mutações de resistência ao P3 no VIH-2. Estes resultado, em conjugação com a sua forte ligação à glicoproteína transmembranar de um isolado de VIH-2, indicam que, tal como outros péptidos baseados na região HR2 (T-20, T- 1249), o P3 inibe a entrada do VIH pela interacção com a região HR1 da gp41 e sugerem que a barreira genética para a resistência ao P3 é significativamente superior no VIH-2 do que no VIH-1. Neste estudo demonstrámos ainda que o P3 é significativamente menos antigénico do que o T-20 nos doentes infectados pelo VIH-1 o que poderá traduzir-se numa maior duração da eficácia clínica do P3 em comparação com o T-20. Os resultados obtidos com o P3 demonstram pela primeira vez que é possível desenvolver péptidos com actividade antiviral significativa utilizando metodologias de biologia evolutiva, pelo que esta abordagem poderá ser explorada no futuro para a produção de medicamentos peptídicos e, eventualmente, de vacinas

Characterization of the longitudinal HIV-1 quasispecies evolution in HIV-1 infected individuals co-infected with Mycobacterium tuberculosis

One of the earliest and most striking observations made about HIV is the extensive genetic variation that the virus has within individual hosts, particularly in the hypervariable regions of the env gene which is divided into 5 variable regions (V1-V5) and 5 more constant (C1-C5) regions. HIV evolves at any time over the course of an individual’s infection and infected individuals harbours a population of genetically related but non-identical viruses that are under constant change and ready to adapt to changes in their environment. These genetically heterogeneous populations of closely related genomes are called quasispecies [65]. Tuberculosis or tubercle forming disease is an acute and/or chronic bacterial infection that primarily attacks the lungs, but which may also affect the kidneys, bones, lymph nodes, and brain. The disease is caused by Mycobacterium tuberculosis (MTB), a slow growing rod-shaped, acid fast bacterium. It is transmitted from person to person through inhalation of bacteria-carrying air droplets. Worldwide, one person out of three is infected with Mycobacterium tuberculosis – two billion people in total. TB currently holds the seventh place in the global ranking of causes of death [73]. In 2008, there were an estimated 9.4 (range, 8.9–9.9 million) million incident cases (equivalent to 139 cases per 100 000 population) of TB globally [75]. A complex biological interplay occurs between M. tuberculosis and HIV in coinfected host that results in the worsening of both pathologies. HIV promotes progression of M. tuberculosis either by endogenous reactivation or exogenous reinfection [77, 78] and, the course of HIV-1 infection is accelerated subsequent to the development of TB [80]. Active TB is associated with an increase in intra-patient HIV-1 diversity both systemically and at the infected lung sites [64,122]. The sustainability or reversal of the HIV-1 quasispecies heterogeneity after TB treatment is not known. Tetanus toxoid vaccinated HIV-1 infected patients developed a transient increase in HIV-1 heterogeneity which was reversed after few weeks [121]. Emergence of a heterogeneous HIV-1 population within a patient may be one of the mechanisms to escape strong immune or drug pressure [65,128]. The existence of better fitting and/or immune escape HIV-variants can lead to an increase in HIV-1 replication [129,130]. It might be that TB favourably selected HIV-1 variants which are sources for consistent HIV-1 replication. Understanding the mechanisms underlying the impacts of TB on HIV-1 is essential for the development of effective measures to reduce TB related morbidity and mortality in HIV-1 infected individuals. In the present study we studied whether the increase in HIV-1 quasispecies diversity during active TB is reversed or preserved throughout the course of antituberculous chemotherapy. For this purpose Two time point HIV-1 quasispecies were evaluated by comparing HIV-1 infected patients with active tuberculosis (HIV-1/TB) and HIV-1 infected patients without tuberculosis (HIV-1/non TB). Plasma samples were obtained from the Frankfurt HIV cohort and HIV-1 RNA was isolated. C2V5 env was amplified by PCR and molecular cloning was performed. Eight to twenty five clones were sequenced from each patient. Various phylogenetic analyses were performed including tree inferences, intra-patient viral diversity and divergence, selective pressure, co-receptor usage prediction and two time point identity of quasispecies comparison using Mantel’s test. We found out from this study that: 1) Active TB sustains HIV-1 quasispecies diversity for longer period 2. Active TB increases the rate of HIV-1 divergence 3) TB might slow down evolution of X4 variants And we concluded that active TB has an impact on HIV-1 viral diversity and divergence over time. The influence of active TB on longitudinal evolution of HIV- 1 may be predominant for R5 viruses. The use of CCR5-coreceptor inhibitors for HIV-1/TB patients as therapeutic approach needs further investigation.Eine der ersten und überraschenden Beobachtungen, welche bei der Analyse des HI-Virus gemacht wurden ist seine ausgeprägte Genetische Variabilität besonders die hypervariable Region des env Genes betreffen. Dieses wird in 5 variable Regionen (V1-V5) sowie 5 stärker konservierte Regionen (C1-C5) unterteilt. HIV wandelt sich zu jedem Zeitpunkt im Verlauf der Infektion und jedes infizierte Individuum ist Träger einer Population von genetisch verwandten jedoch nicht identischen Viren, welche sich kontinuierlich verändern und an die Erfordernisse innerhalb der Umgebung anpassen. Diese genetisch heterogenen, jedoch eng verwandten Populationen werden Quasispecies genannt. Tuberkulose ist eine mykobakterielle Infektion, welche sowohl akute als auch chronische Verläufe zeigt. Neben den Lungen als primärem Manifestationsort können auch die Nieren, Knochen und andere Organe befallen sein. Eine von drei Personen weltweit ist mit Mycobacterium tuberculosis infiziert, insgesamt 2 Milliarden Menschen. In HIV/TB Co-Inifzierten Menschen entsteht ein komplexes Zusammenspiel zwischen HIV und M. tuberculosis, welches zu einer Verschlechterung beider Krankheitsbilder führt. HIV führt durch endogene Rekativierung oder exogene Re-Infektion zu einer Progression der Tuberkulose, welche im weiteren Verlauf die Krankheitsprogression von HIV beschleunigt. Sowohl Morbidität als auch Mortalität sind in HIV-1/TB Co-Infizierten Menschen erhöht. Aktive Lungentuberkulose und Miliartuberkulose gehen mit dem Anstieg der Diversifität der HIV Viren innerhalb eines Wirtes einher. Wie lange diese erhöhte Heterogenität der HIV Quasispecies nach der erfolgreichen Behandlung einer Tuberkulose bestehen bleibt ist bisher noch unklar. Das Verständnis des dem Zusammenspiel von HIV und TB zugrundeliegenden Mechanismus ist essentiell für die Entwicklung von effektiven Massnahmen zur Senkung der Morbidität und Mortalität in HIV/TB Co-infizierten Menschen. Die gegenwärtige Forschungsarbeit folgte daher der Frage, ob wärend einer aktiven TB Infektion eine Zunahme der Diversität der HIV-1 Quasispecies zu beobachten ist und ob diese Diversität während einer TB Therapie erhalten bleibt oder sich zurück bildet. Hierfür wurden die HIV-1 Quasispecies zu zwei Zeitpunkten untersucht, wobei Proben von HIV-1 infizierten Patienten mit aktiver Tuberkulose (HIV-1/TB) und HIV infizierte Patienten ohne Tuberkulose (HIV-1/non TB) verglichen wurden. Aus Plasmaproben der Frankfurter HIV Cohorte wurde HIV-1 RNA isoliert. C2V5 env wurde durch PCR amplifiziert und molekular cloniert. Acht bis fünfundzwanzig Clone wurden für jeden Patienten sequenziert. Mehrere phylogenetische Analysen wurden durchgeführt, welche tree inferences, Intra-Patienten- und virale Diversität und Divergenz, Selektionsdruckanalysen, Vorhersage der Co-Rezeptornutzung sowie Zweipunktanalysen der Identität von Quasispecies mit Hilfe des Mantel’s Test miteinschlossen. Die Analysen ergaben die folgenden Ergebnisse: 1) Eine aktive TB erhält die Diversität von HIV-1 Quasispecies über einen längeren Zeitraum. 2. Eine aktive TB verstärkt die HIV -1 Divergenz 3) TB könnte zu einer langsameren Evolution von X4 Varianten führen. Schlussfolgerung: eine aktive TB beeinflusst die Entwicklung der viralen Diversität und Divergenz von HIV-1 im Verlauf der Krankheit. Der Einfluss der aktiven TB auf die longitudinale Evolution von HIV-1 könnte insbesondere R5 Viren betreffen. Der Einsatz von CCR5-Corezeptor Inhibitoren in HIV-1/TB coinifizerten Patienten sollte daher in Langzeitstudien untersucht werden

Differential Trends in the Codon Usage Patterns in HIV-1 Genes

Host-pathogen interactions underlie one of the most complex evolutionary phenomena resulting in continual adaptive genetic changes, where pathogens exploit the host's molecular resources for growth and survival, while hosts try to eliminate the pathogen. Deciphering the molecular basis of host–pathogen interactions is useful in understanding the factors governing pathogen evolution and disease propagation. In host-pathogen context, a balance between mutation, selection, and genetic drift is known to maintain codon bias in both organisms. Studies revealing determinants of the bias and its dynamics are central to the understanding of host-pathogen evolution. We considered the Human Immunodeficiency Virus (HIV) type 1 and its human host to search for evolutionary signatures in the viral genome. Positive selection is known to dominate intra-host evolution of HIV-1, whereas high genetic variability underlies the belief that neutral processes drive inter-host differences. In this study, we analyze the codon usage patterns of HIV-1 genomes across all subtypes and clades sequenced over a period of 23 years. We show presence of unique temporal correlations in the codon bias of three HIV-1 genes illustrating differential adaptation of the HIV-1 genes towards the host preferred codons. Our results point towards gene-specific translational selection to be an important force driving the evolution of HIV-1 at the population level

Patterns and rates of viral evolution in HIV-1 subtype B infected females and males.

Biological sex differences affect the course of HIV infection, with untreated women having lower viral loads compared to their male counterparts but, for a given viral load, women have a higher rate of progression to AIDS. However, the vast majority of data on viral evolution, a process that is clearly impacted by host immunity and could be impacted by sex differences, has been derived from men. We conducted an intensive analysis of HIV-1 gag and env-gp120 evolution taken over the first 6-11 years of infection from 8 Women's Interagency HIV Study (WIHS) participants who had not received combination antiretroviral therapy (ART). This was compared to similar data previously collected from men, with both groups infected with HIV-1 subtype B. Early virus populations in men and women were generally homogenous with no differences in diversity between sexes. No differences in ensuing nucleotide substitution rates were found between the female and male cohorts studied herein. As previously reported for men, time to peak diversity in env-gp120 in women was positively associated with time to CD4+ cell count below 200 (P = 0.017), and the number of predicted N-linked glycosylation sites generally increased over time, followed by a plateau or decline, with the majority of changes localized to the V1-V2 region. These findings strongly suggest that the sex differences in HIV-1 disease progression attributed to immune system composition and sensitivities are not revealed by, nor do they impact, global patterns of viral evolution, the latter of which proceeds similarly in women and men

Analysis of the impact of codon choice on gene expression of HIV-1

The degeneracy of the genetic code with its 61 codons encoding for only 20 amino acids is the basis for a phenomenon known as codon usage bias. That means that different organisms show differences in the frequency of occurrence of synonymous codons. Despite the necessity of HIV to use the host’s translational machinery for viral gene expression, the virus exhibits an adenine-rich nucleotide composition which differs clearly from the GC-rich coding regions of humans. Changing the nucleotide composition by choosing synonymous codons at certain positions might therefore impact viral replication by affecting viral gene expression. Previous studies of our group showed that adapting the gag gene to human codon usage (huGag) led not only to a significantly increased protein production but also caused independency of Rev, an accessory protein of HIV that exports intron-containing viral mRNAs. The aim of this work was to gain insight into the effects of codon adaptation, especially regarding length and position, and the associated impact on gag expression. For this, subgenomic gag reporter constructs were generated that systematically varied the humanized part of the gene. Those constructs were then transfected into HEK293T cells. Gag expression was investigated on protein level by p24 ELISA as well as on RNA level by qPCR. Furthermore, transcription efficiency as well as RNA stability were analyzed using nuclear run-on and actinomycin D assays. It was observed that increasing the length of the humanized sequence starting from the 5’ end directly correlated with p24 and gag mRNA levels. Contrary to that, such a correlation was lacking for constructs humanized progressively in 3’ to 5’ direction. It became apparent that humanization of the 5’ end of gag is necessary for enhanced protein production and Rev-independent expression. In addition, it was found that a short sequence, surrounding the nucleotides 61-75 of gag in the 5’-part of the gene contains a specific inhibitory motif which affects transcription rate as well as RNA stability. Moreover, the expression pattern of the different variants was analyzed under the control of a heterologous CMV promoter as well as an LTR promoter of HIV-1. For both systems, comparable expression patterns were observed. By PCR analysis of reverse transcribed RNA from transfected cells, as well as northern blot analysis, the generation of cryptic splicing variants was excluded. Further, a second reporter gene was used in order to investigate whether the function of the identified inhibitory motif could be transferred. For this, a quasi-lentiviral system was used to express egfp after its adaptation to human and HI-viral codon usage. It became apparent that the inhibitory effect of the identified motif was only transferable when it was embedded in a larger part of wild-type gag. The influence of the inhibitory motif on HIV gag expression as well as the missing inhibitory effect on egfp could be based on characteristics of the mRNA secondary structures. For gag, but not for egfp variants, presence of the motif had a clearly destabilizing effect in mRNA folding predictions, which might influence protein binding of the RNA degradation machinery. In future experiments an examination of this hypothesis would be eligible and helpful to gain further insight in the connection between altered codon usage and gene expression

Evolution of subtype C HIV-1 Env in a slowly progressing Zambian infant

BACKGROUND: Given the high prevalence of mother to child infection, the development of a better understanding of African subtype C HIV-1 transmission and natural evolution is of significant importance. In this study, we genotypically and phenotypically characterized subtype C viruses isolated over a 67-month follow-up period from an in utero-infected Zambian infant. Changes in genotype and phenotype were correlated to alterations of the host humoral immune response. RESULTS: A comparison of baseline maternal and infant samples indicated that the infant sequences are monophyletic and contain a fraction of the diversity observed in the mother. This finding suggests that selective transmission occurred from mother to child. Peaks in infant HIV-1 Env genetic diversity and divergence were noted at 48 months, but were not correlated with changes in co-receptor usage or syncytia phenotype. Phylogenetic analyses revealed an accumulation of mutations over time, as well as the reappearance of ancestral lineages. In the infant C2-V4 region of Env, neither the median number of putative N-glycosylation sites or median sequence length showed consistent increases over time. The infant possessed neutralizing antibodies at birth, but these decreased in effectiveness or quantity with time. De novo humoral responses were detected in the child after 12 months, and corresponded with an increase in Env diversity. CONCLUSION: Our study demonstrates a correlation between HIV-1 Env evolution and the humoral immune response. There was an increase in genetic diversification in the infant viral sequences after 12 months, which coincided with increases in neutralizing antibody titers. In addition, episodes of viral growth and successive immune reactions in the first 5–6 years were observed in this slow progressor infant with delayed onset of AIDS. Whether this pattern is typical of slow progressing subtype C HIV-1 infected infant needs to be further substantiated