Treatment with integrase inhibitor suggests a new interpretation of HIV RNA decay curves that reveals a subset of cells with slow integration.

TitleTreatment with integrase inhibitor suggests a new interpretation of HIV RNA decay curves that reveals a subset of cells with slow integration.
Publication TypeJournal Article
Year of Publication2017
AuthorsE Cardozo F, Andrade A, Mellors JW, Kuritzkes DR, Perelson AS, Ribeiro RM
JournalPLoS Pathog
Volume13
Issue7
Paginatione1006478
Date Published2017 Jul
ISSN1553-7374
KeywordsCD4-Positive T-Lymphocytes, Half-Life, HIV Infections, HIV-1, Humans, Integrase Inhibitors, Raltegravir Potassium, RNA Stability, RNA, Viral, Viral Load, Virus Integration, Virus Replication
Abstract

The kinetics of HIV-1 decay under treatment depends on the class of antiretrovirals used. Mathematical models are useful to interpret the different profiles, providing quantitative information about the kinetics of virus replication and the cell populations contributing to viral decay. We modeled proviral integration in short- and long-lived infected cells to compare viral kinetics under treatment with and without the integrase inhibitor raltegravir (RAL). We fitted the model to data obtained from participants treated with RAL-containing regimes or with a four-drug regimen of protease and reverse transcriptase inhibitors. Our model explains the existence and quantifies the three phases of HIV-1 RNA decay in RAL-based regimens vs. the two phases observed in therapies without RAL. Our findings indicate that HIV-1 infection is mostly sustained by short-lived infected cells with fast integration and a short viral production period, and by long-lived infected cells with slow integration but an equally short viral production period. We propose that these cells represent activated and resting infected CD4+ T-cells, respectively, and estimate that infection of resting cells represent ~4% of productive reverse transcription events in chronic infection. RAL reveals the kinetics of proviral integration, showing that in short-lived cells the pre-integration population has a half-life of ~7 hours, whereas in long-lived cells this half-life is ~6 weeks. We also show that the efficacy of RAL can be estimated by the difference in viral load at the start of the second phase in protocols with and without RAL. Overall, we provide a mechanistic model of viral infection that parsimoniously explains the kinetics of viral load decline under multiple classes of antiretrovirals.

DOI10.1371/journal.ppat.1006478
Alternate JournalPLoS Pathog.
PubMed ID28678879
PubMed Central IDPMC5513547
Grant ListR01 AI104373 / AI / NIAID NIH HHS / United States
UM1 AI106701 / AI / NIAID NIH HHS / United States