Rapid progression to disease is observed in patients infected with human immunodeficiency virus (HIV) (9, 13, 30, 38, 40, 60) and macaques experimentally infected with simian immunodeficiency virus (SIV) (15, 18, 21, 22, 24, 31, 44, 47, 52, 64). In both cases, the level of plasma viremia is significantly higher than in conventional progressors, and the cellular and humoral immune responses are very weak and only transiently observed. In this study, as well as prior studies, we defined rapid progressors (RPs) as SIV-inoculated macaques with persistent antigenemia that failed to develop or maintain antibody responses and showed clinical deterioration that necessitated euthanasia before 6 months of inoculation. Recent studies have shown that SIV-infected RP macaques suffer an early massive loss of memory CD4+ T cells, presumably due to virus-induced destruction (24, 31, 34, 37, 44, 45, 52, 61). The loss of memory CD4+ T cells is profound and irreversible in RP macaques, suggesting a strong correlation between the maintenance of CD4+ memory T cells and rapid progression to disease (31, 44, 45, 52). Although these studies of RPs using the SIV model are useful for understanding the mechanism of rapid progression in HIV infection, it is not clear why the depletion of memory CD4+ T cells is so profound in RP macaques and how they develop disease rapidly after the depletion. Recent studies have shown that RP macaques can be distinguished from conventional progressors in terms of pathological manifestations (2, 18, 21, 31). RP macaques uniformly exhibit SIV encephalitis and pneumonia, the presence of multinucleated giant cells, and a predominance of SIV-expressing macrophages in nonlymphoid tissues, such as lung and brain. In contrast, conventional progressor macaques show the pathological features more analogous to AIDS in humans, i.e., the predominance of opportunistic infections. However, the definitive hallmark of rapid progression is the failure to maintain SIV-specific immune responses (18, 21, 64). RP macaques mount an initial humoral and cellular immune response at the appropriate time following infection, but these responses wane rapidly within the first 3 to 4 weeks of infection (21). This immune defect is observed not only in immunity to SIV, but also in immune responses against unrelated antigens, including recall antigens (tetanus toxoid) or new antigen (hepatitis A virus). This profound and global immune failure is consistent with the early loss in T-helper function caused by a massive loss of memory CD4+ T cells (24, 31, 34, 37, 44, 45, 52, 61) and may be critical for the subsequent rapid progression of disease. Despite the lack of immune pressure, the envelope of SIV undergoes unique molecular evolution in RP macaques (8, 31). Sequence analysis of viruses in three SIVsmE543-3-infected RP macaques (8) revealed a unique convergent pattern of substitutions in env, including the loss of a highly conserved potential N-linked glycosylation (PNG) site in the V1-V2 region (N158D/S or S160N/G), substitutions in the V3 analog (P337T/S/H/L and R348W), and substitutions in the highly conserved GDPE motif (G386R and D388N/V). These RP-specific mutations are associated with the acquisition of CD4-independent usage of CCR5 in cell fusion assays (8, 11, 57). In addition, mutational analyses have shown that, like in HIV type 1 (HIV-1) (33, 46), the GDPE motif and/or V3 loop analog of SIV are important for cell tropism and interactions with CD4 and coreceptors (11, 20, 49, 57). These data suggested that RP-specific mutations were selected in RP macaques to adapt to a specific microenvironment in RP macaques through altered cell tropism and receptor usage. In order to study the role of these variants with RP-specific mutations in rapid progression, seven infectious molecular clones were generated from the terminal-phase plasma of an RP macaque (31). We initially predicted that these clones would show an advantage over parental SIV in terms of replication efficacy or cell tropism that would explain the high viral loads in the plasma and tissues of RP macaques. However, clones with RP-specific mutations replicated less efficiently than their parent, SIVsmE543-3, in primary rhesus peripheral blood mononuclear cells and macrophages (31). From these in vitro analyses, it was not clear why RP variants predominated in RP macaques or whether RP variants contributed to the development of rapid disease progression. The goal of the present study was to analyze the biological properties of RP variants in vivo using infectious molecular clones. For this purpose, we chose SIVsmH635FC, since it was closest in terms of sequence to the consensus sequence of plasma virus in the donor animal. Macaques were inoculated with SIVsmH635FC alone or in combination with parental SIVsmE543-3, and virus replication, changes in CD4+ T-cell subsets in blood and mucosal sites, antibody responses, and the stability of RP-specific mutations were evaluated. The coinfected animals allowed us to evaluate the in vivo fitness of SIVsmH635FC relative to that of SIVsmE543-3.