Effector memory differentiation increases detection of replication-competent HIV-l in resting CD4+ T cells from virally suppressed individuals.

Studies have demonstrated that intensive ART alone is not capable of eradicating HIV-1, as the virus rebounds within a few weeks upon treatment interruption. Viral rebound may be induced from several cellular subsets; however, the majority of proviral DNA has been found in antigen experienced resting CD4+ T cells. To achieve a cure for HIV-1, eradication strategies depend upon both understanding mechanisms that drive HIV-1 persistence as well as sensitive assays to measure the frequency of infected cells after therapeutic interventions. Assays such as the quantitative viral outgrowth assay (QVOA) measure HIV-1 persistence during ART by ex vivo activation of resting CD4+ T cells to induce latency reversal; however, recent studies have shown that only a fraction of replication-competent viruses are inducible by primary mitogen stimulation. Previous studies have shown a correlation between the acquisition of effector memory phenotype and HIV-1 latency reversal in quiescent CD4+ T cell subsets that harbor the reservoir. Here, we apply our mechanistic understanding that differentiation into effector memory CD4+ T cells more effectively promotes HIV-1 latency reversal to significantly improve proviral measurements in the QVOA, termed differentiation QVOA (dQVOA), which reveals a significantly higher frequency of the inducible HIV-1 replication-competent reservoir in resting CD4+ T cells. Quantifying the number of cells harboring HIV-1 provirus is critical to evaluating HIV cure interventions, but precise quantification of the latent reservoir has proven to be technically challenging. Our data demonstrates that targeted differentiation of CD4+ T cells to an effector memory phenotype is a successful strategy for promoting latency reversal in vitro, and significantly enhances the performance of existing protocols to quantify the frequency of replication-competent HIV-1 in resting CD4+ T cells from virally-suppressed individuals. Using peripheral blood samples from well-established and characterized cohorts, we show the presence of a significantly higher frequency of replication-competent provirus than has previously been reported, raising the average estimated frequency 18-fold over the established QVOA measures. These results demonstrate that ex vivo effector memory differentiation has moved reservoir measurements closer to what may be the bona fide inducible replication-competent reservoir frequency, thus beginning to bridge the gap between viral outgrowth and molecular-based quantification. Taken together, these data support accumulating evidence that effector memory differentiation is a key pathway to HIV-1 latency reversal that may be exploited for assay development, mechanistic understanding, and therapeutic interventions. [ABSTRACT FROM AUTHOR]