HIV-1 can disseminate between susceptible cells by two mechanisms: cell-free
infection following fluid-phase diffusion of virions and by highly-efficient
direct cell-to-cell transmission at immune cell contacts. The contribution of
this hybrid spreading mechanism, which is also a characteristic of some
important computer worm outbreaks, to HIV-1 progression in vivo remains
unknown. Here we present a new mathematical model that explicitly incorporates
the ability of HIV-1 to use hybrid spreading mechanisms and evaluate the
consequences for HIV-1 pathogenenesis. The model captures the major phases of
the HIV-1 infection course of a cohort of treatment naive patients and also
accurately predicts the results of the Short Pulse Anti-Retroviral Therapy at
Seroconversion (SPARTAC) trial. Using this model we find that hybrid spreading
is critical to seed and establish infection, and that cell-to-cell spread and
increased CD4+ T cell activation are important for HIV-1 progression. Notably,
the model predicts that cell-to-cell spread becomes increasingly effective as
infection progresses and thus may present a considerable treatment barrier.
Deriving predictions of various treatments' influence on HIV-1 progression
highlights the importance of earlier intervention and suggests that treatments
effectively targeting cell-to-cell HIV-1 spread can delay progression to AIDS.
This study suggests that hybrid spreading is a fundamental feature of HIV
infection, and provides the mathematical framework incorporating this feature
with which to evaluate future therapeutic strategies
