Biological Signature Characteristics of Primary Isolates from Human Immunodeficiency Virus Type 1 Group O in Ex Vivo Human Tonsil Histocultures

Human immunodeficiency virus type 1 (HIV-1) group M viruses have achieved a global distribution, while HIV-1 group O viruses are endemic only in particular regions of Africa. Here, we evaluated biological characteristics of group O and group M viruses in ex vivo models of HIV-1 infection. The replicative capacity and ability to induce CD4 T-cell depletion of eight group O and seven group M primary isolates were monitored in cultures of human peripheral blood mononuclear cells and tonsil explants. Comparative and longitudinal infection studies revealed HIV-1 group-specific activity patterns: CCR5-using (R5) viruses from group M varied considerably in their replicative capacity but showed similar levels of cytopathicity. In contrast, R5 isolates from group O were relatively uniform in their replicative fitness but displayed a high and unprecedented variability in their potential to deplete CD4 T cells. Two R5 group O isolates were identified that cause massive depletion of CD4 T cells, to an extent comparable to CXCR4-using viruses and not documented for any R5 isolate from group M. Intergroup comparisons found a five- to eightfold lower replicative fitness of isolates from group O than for isolates from group M yet a similar overall intrinsic pathogenicity in tonsil cultures. This study establishes biological ex vivo characteristics of HIV-1 group O primary isolates. The current findings challenge the belief that a grossly reduced replicative fitness or inherently impaired cytopathicity of viruses from this group underlies their low global prevalence.Independent cross-species transmission events from simian immunodeficiency virus-infected apes have led to four distinct phylogenetic lineages of human immunodeficiency virus (HIV) in humans (45). The main (M) group of HIV type 1 (HIV-1) is responsible for the HIV pandemic, while HIV-1 group O (outlier) and HIV-2 are endemic only in west and central Africa, and HIV-1 group N (non-M/non-O) infection has been documented only in a small number of Cameroonians (56). These cross-species transmissions are believed to have occurred in western Africa around the same time, but only HIV-1 group M founded the pandemic (33, 37).The global distribution of HIV-1 group O is remarkably restricted. The relative seroprevalence of group O is reported to be highest in the Republic of Cameroon, Equatorial Guinea, and Gabon (7, 42, 57), implicating this area as the possible starting point of this HIV-1 lineage''s epidemic. Rare group O infections have been documented in industrialized countries, the majority comprising patients of Cameroonian descent (8, 25, 30, 40, 46). Notably, the prevalence of group O among HIV-1-positive blood samples in Cameroon showed a marked decline from the period 1986 to 1988 (20.6% of all HIV-1 infections) to the period 1997 to 1998 (1.4%) (7) with evidence of a low, but stabilized, prevalence in the subsequent period up to 2004 (10, 55). Primary isolates from group O and group M display pronounced genetic differences (24, 54), yet the reasons for the decreasing prevalence of HIV-1 group O relative to group M in west Africa and the almost exclusive contribution of group M to the AIDS pandemic are unclear. Many factors could, in principle, have contributed to this variable spread through the human population, including host genetic effects, transmission bottlenecks, behavioral and environmental restrictions, founder effects, and other factors (33, 53).Clinical observations do not suggest major differences in disease progression in patients infected with HIV-1 groups O and M (23, 24, 35, 39). This notion is based on limited data on the immune status and virological parameters for group O-infected individuals. Few experimental in vitro studies have compared the replicative fitness of HIV types or groups (1, 2, 50, 52, 54). In head-to-head replication competition experiments of pairs of primary isolates from group M and group O in peripheral blood mononuclear cell (PBMC) cultures, Arien et al. reported a greater than 100-fold reduced replicative fitness of group O viruses (2). They suggested that grossly reduced “ex vivo pathogenic fitness” and impaired transmission from dendritic cells to cocultured T cells (“ex vivo transmission fitness”) are intrinsic properties of group O viruses that may contribute to their low prevalence and limited geographical spread (2, 3).Here, we evaluated characteristics of a panel of primary isolates from HIV-1 group O compared to a panel from group M in three primary cell models of HIV infection. In addition to replication studies in single-donor PBMCs used in a previous fitness study (2), we employed multidonor pools of PBMCs and an ex vivo human tonsil lymphoid aggregate culture (HLAC) model. HIV readily replicates to high titers in tonsil cultures that maintain the cell composition and cytokine milieu of a lymphoid target organ in vivo (17). Previously, studies in this model have shed light on key pathogenic properties of HIV, including cell tropism and cytopathic effects in relation to coreceptor usage, productive infection of resting CD4 T cells, early host responses to infection, and viral coinfections (5, 6, 14, 18-20, 27, 38, 43, 48-50). A unique characteristic of this ex vivo model is that it allows parallel assessment of an isolate''s replicative fitness and cytopathicity, the latter determined by its ability to deplete CD4 T cells. The current investigation may enhance our understanding of parameters critical for HIV-1 spread in the human population and could thus potentially also provide clues to prevention and therapy.