Meta-Analysis To Test the Association of HIV-1 nef Amino Acid Differences and Deletions with Disease Progression

Previous relatively small studies have associated particular amino acid replacements and deletions in the HIV-1 nef gene with differences in the rate of HIV disease progression. We tested more rigorously whether particular nef amino acid differences and deletions are associated with HIV disease progression. Amino acid replacements and deletions in patients'' consensus sequences were investigated for 153 progressor (P), 615 long-term nonprogressor (LTNP), and 2,311 unknown progressor sequences from 582 subtype B HIV-infected patients. LTNPs had more defective nefs (interrupted by frameshifts or stop codons), but on a per-patient basis there was no excess of LTNP patients with one or more defective nef sequences compared to the Ps (P = 0.47). The high frequency of amino acid replacement at residues S⁸, V¹⁰, I¹¹, A¹⁵, V⁸⁵, V¹³³, N¹⁵⁷, S¹⁶³, V¹⁶⁸, D¹⁷⁴, R¹⁷⁸, E¹⁸², and R¹⁸⁸ in LTNPs was also seen in permuted datasets, implying that these are simply rapidly evolving residues. Permutation testing revealed that residues showing the greatest excess over expectation (A¹⁵, V⁸⁵, N¹⁵⁷, S¹⁶³, V¹⁶⁸, D¹⁷⁴, R¹⁷⁸, and R¹⁸⁸) were not significant (P = 0.77). Exploratory analysis suggested a hypothetical excess of frameshifting in the regions ⁹SVIG and ¹¹⁸QGYF among LTNPs. The regions V¹⁰ and ¹⁵²KVEEA of nef were commonly deleted in LTNPs. However, permutation testing indicated that none of the regions displayed significantly excessive deletion in LTNPs. In conclusion, meta-analysis of HIV-1 nef sequences provides no clear evidence of whether defective nef sequences or particular regions of the protein play a significant role in disease progression.HIV-infected people can be categorized according to the number of years in which they progress to AIDS. Long-term nonprogressors (LTNPs) do not progress to AIDS even after more than 10 years of infection, and they maintain stable CD4 lymphocyte counts (5, 8). Nonprogression status may reflect differences in either in the host, in viral genetics, or in environmental factors. Within the virus, R⁷⁷Q, a mutation in the HIV-1 vpr gene, was associated with both LTNP infection and impaired induction of apoptosis (38). However, this mutation was not statistically significant, and no other clearly attenuating mutations or deletions were detected (20). Most attention, however, has focused on role of the viral nef protein.In rhesus monkeys infected with simian immunodeficiency virus (SIV), a model for studying AIDS pathogenesis (37), animals infected with nef-deficient SIV showed an attenuated course of infection (17, 30, 31, 51). nef was also a major determinant of pathogenicity in transgenic mice with AIDS-like symptoms induced by HIV-1 (27). Some patients with LTNP strains of HIV were found to have gross deletions in the nef gene (16, 33, 49), suggesting the importance of nef for HIV-1 progression in humans.Previous studies related to phylogenetic analysis have reported that nef sequences from patients with different rates of progression do not form distinct clusters (28, 29, 40, 43). Each patient had sequences that clustered together and could be differentiated from those of the other patients, supporting the monophyletic origin of the infections. The absence of intragroup clustering suggested that no correlation existed between the phylogenetic relationship of the nef sequences and the progression rate in the patients (10). The differences in genetic distance between LTNP and progressors (Ps) were not statistically significant, suggesting that the degree of sequence variation in nef is unlikely to reflect the stage of HIV-1 disease (4).Amino acids 25 to 36 in HIV-1 nef are important both for several well-defined in vitro functions of nef and for the pathogenicity of HIV-1 in humans, and nef''s ability to enhance virion infectivity was fully restored when the deletion was repaired by the insertion of that region (8). Nef proteins derived from LTNPs and slow progressors (SPs) were found to be defective or far less capable of enhancing viral replication and/or viral infectivity in herpesvirus saimiri-transformed human T cells and peripheral blood mononuclear cells (PBMC) (24). The sizes of the deletions in the nef/LTR (long terminal repeat) region increased progressively from 84 to 1,400 bp during the 5-year follow-up period in one case of a SP (35). Gross defects were also present in the RNA-derived sequences of an LTNP individual because of a frameshift and the premature termination of the protein (4). HIV-1 sequences from the isolates or patient PBMC had similar deletions in the nef gene and in the region of overlap of nef and the U3 region of the LTR (16). There was a 36-bp deletion close to the 5′ end of nef that impaired nef function in an LTNP (8).Many studies not only have described nef as carrying large deletions in LTNPs (16, 33) but also found a higher proportion of disrupted nef gene sequences in LTNPs. A study of six HIV patients who reached at least 11 years of age without or with mild symptoms revealed that LTNPs had higher proportions of disrupted nef sequences (10). Seven LTNPs, all belonging to the same cohort of infected hemophiliacs, had more defective nef sequences than in progressors; the number of disrupted nef sequences within each individual was significantly higher in LTNPs than in progressors (4).The nef amino acid sequence has been reported to be highly polymorphic even within a particular subtype (4, 22, 28, 29, 40, 42, 53). Single amino acid deletions have been found predominantly at three locations that are structurally less defined loop regions: positions 8 to 11, 49 to 51, and 155 to 162 (25). Five variants (T¹⁵, N⁵¹, H¹⁰², L¹⁷⁰, and E¹⁸²) have been noted among LTNPs, whereas nine variants (N-terminal PxxP motif; A¹⁵, R³⁹, T⁵¹, T¹⁵⁷, C¹⁶³, N¹⁶⁹, Q¹⁷⁰, and M¹⁸²) have been noted among progressors (32). nef has been often changed at residues localized in the folded core domain at cytotoxic-T-lymphocyte epitopes (E¹⁰⁵, K¹⁰⁶, E¹¹⁰, Y¹³², K¹⁶⁴, and R²⁰⁰); moreover, LTNP-associated variations occur in the core domain of nef. Recently, nef sequence variations have been found in the WL motif of the CD4 binding site, as well as a premature stop codon in infected LTNPs that could potentially contribute to the attenuation of the virus; however, these deletions were found to be insignificant (13).There has been a broad agreement that grossly defective nefs are associated with an attenuated course of infection (17, 30, 31, 51) but rare in HIV-1 infection (32). Grossly defective nef genes or significant changes from relevant clade reference sequences were not identified in a study of 32 LTNP children (13). One study noted that the proportion of disrupted nef sequences within each patient was significantly higher in LTNPs compared to Ps; however, the proportions of individuals with nef defects (in LTNPs, 5 of 7, and in Ps, 6 of 8) were similar (4). No major defects have been reported in a few other studies (28, 39, 40). Another study of a small number of patients does not indicate that gross deletions play any major role in delaying or halting disease progression in infected drug abusers in Italy (11), and premature stop codons were observed at equivalent, yet low, frequencies among the different clinical groups (41). In addition, disease progression has been reported in a HIV patient with a virus grossly deleted of nef (26).Thus, overall, most of these studies were based on observation or case study rather than systematic scientific evaluation (11). The objective of the present study was to determine in a substantially larger sample than investigated to date whether there is any association between disease progression and particular nef amino acid differences or deletions.