Abstract

Suppression of HIV replication by antiretroviral therapy (ART) or host immunity can prevent AIDS but not other HIV-associated conditions including neurocognitive impairment (HIV-NCI). Pathogenesis in HIV-suppressed individuals has been attributed to reservoirs of latent-inducible virus in resting CD4+ T cells. Macrophages are persistently infected with HIV but their role as HIV reservoirs in vivo has not been fully explored. Here we show that infection of conventional mice with chimeric HIV, EcoHIV, reproduces physiological conditions for development of disease in people on ART including immunocompetence, stable suppression of HIV replication, persistence of integrated, replication-competent HIV in T cells and macrophages, and manifestation of learning and memory deficits in behavioral tests, termed here murine HIV-NCI. EcoHIV established latent reservoirs in CD4+ T lymphocytes in chronically-infected mice but could be induced by epigenetic modulators ex vivo and in mice. In contrast, macrophages expressed EcoHIV constitutively in mice for up to 16 months; murine leukemia virus (MLV), the donor of gp80 envelope in EcoHIV, did not infect macrophages. Both EcoHIV and MLV were found in brain tissue of infected mice but only EcoHIV induced NCI. Murine HIV-NCI was prevented by antiretroviral prophylaxis but once established neither persistent EcoHIV infection in mice nor NCI could be reversed by long-acting antiretroviral therapy. EcoHIV-infected, athymic mice were more permissive to virus replication in macrophages than were wild-type mice, suffered cognitive dysfunction, as well as increased numbers of monocytes and macrophages infiltrating the brain. Our results suggest an important role of HIV expressing macrophages in HIV neuropathogenesis in hosts with suppressed HIV replication.

Highlights

  • Combination antiretroviral therapy (ART) has changed the course of HIV pathogenesis

  • Unlike infected people we find that infected mice maintain good immune responses to HIV that appear to act like ART to keep virus levels low and allow mice to resist other complications

  • HIV-infected mice are subject to learning and memory problems; they carry silenced HIV long-term in T lymphocytes but we found that macrophages, infected in both humans and mice, continue to produce HIV in mice indicating that additional means may be needed to control HIV-infected macrophages

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Summary

Introduction

By stable suppression of virus replication, immune competence is maintained, serious AIDSrelated conditions are largely prevented, and infected individuals live longer [1,2,3]. Despite these treatment benefits, HIV-suppressed patients remain at high risk of chronic diseases affecting gut, heart, and other tissues [4, 5]. Chronic HIV morbidities are attributed to two factors, the persistence of replication competent HIV at low burdens within stable reservoirs of resting T lymphocytes [11, 12] and secondarily, metabolic effects of some prolonged antiretroviral treatment [13, 14]. How HIV contributes to individual chronic diseases in patients on ART is poorly understood

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