How some cells protect themselves against HIV

A protein that protects some of our immune cells from the most common and virulent form of HIV works by starving the virus of the molecular building blocks that it needs to replicate, according to research published online in Nature Immunology.

The level of HIV-1 in the blood of an HIV-infected partner is the single most important factor influencing risk of sexual transmission to an uninfected partner, according to a multinational study of heterosexual couples in sub-Saharan Africa. The study, published in the Journal of Infectious Diseases, calculated the risk of HIV-1 transmission per act of sexual intercourse and found the average rate of infection to be about 1 per 900 coital acts. The findings also confirmed that condoms are highly protective and reduce HIV infectivity by 78 percent. James P. Hughes, PhD, and colleagues at the University of Washington and the Fred Hutchinson Cancer Research Center, in Seattle; the University of Witwatersrand in South Africa; the University of Nairobi and Kenyatta National Hospital, in Kenya; and the Rwanda-Zambia HIV Research Group conducted a study that included 3,297 HIV-discordant couples (where one person is HIV-infected, and the other is not) in eastern and southern Africa who were enrolled in a randomized trial of acyclovir suppressive therapy. The couples had frequent follow-up to measure plasma HIV-1 RNA in the infected partner and genetic testing to link the transmitted virus to the index HIV-infected partner, to prevent inclusion of infections acquired from other possible partners. HIV acquisition was not affected by the acyclovir therapy. The study confirmed that condoms are highly protective, reducing the risk of HIV transmission by 78 percent when subjects reported using a condom. Most important, the authors noted, was the level of HIV-1 RNA in the blood of the infected partner. The higher the viral load in the index infected partner, the higher the risk of transmission, emphasizing the importance of lowering viral load to help prevent the spread of HIV-1 through sex. Older age was associated with reduced transmission per sex act, and male circumcision reduced female-to-male transmission by approximately 47 percent. Genital herpes infections and the presence of genital ulcers were associated with increased rates of transmission. "Our results underscore the importance of antiretroviral therapy, and, possibly, treatment of co-infections, to reduce plasma HIV-1 viral load in HIV-1 infected partners, and condom promotion, male circumcision, and treatment of symptomatic sexually-transmitted infections for HIV-1 uninfected partners as potential interventions to reduce HIV-1 transmission," the authors wrote. The findings also showed that the risk of an HIV-infected man transmitting an infection to a woman not infected with HIV was about twice the risk of an HIV-infected woman transmitting to an HIV-uninfected man. However, this difference can be attributed to the difference in viral loads between men and women, the authors noted. On average, HIV-infected men have higher HIV-1 loads. Difference in age and having genital herpes in the HIV-uninfected partners also help account for the disparity—the HIV-uninfected female partners were, on average, younger and had higher rates of genital herpes than their male counterparts. Previous studies examining HIV-1 per-act infectivity have been significantly smaller and not as comprehensive in terms of measuring plasma HIV-1 RNA and the use of genetic linkage of transmissions. In an editorial commentary, Ronald H. Gray, MD, and Maria J. Wawer, MD, both of Johns Hopkins University in Baltimore, noted that Dr. Hughes and his colleagues have possibly recorded the most precise estimates of HIV-1 transmission per sexual act during latent HIV disease, providing a valuable addition to knowledge in this area, where much remains to be learned. Additional research using the genetic data collected from this study, in addition to new data from another recently completed clinical trial, is planned to help explain the variation in transmission risk among couples, the authors noted. Fast Facts: 1. In HIV-discordant couples—where one partner is infected with HIV, and the other is not—viral load of the infected partner was a major factor affecting the HIV transmission rate. 2. Condom use among HIV-discordant couples was 78 percent effective in preventing transmission to the uninfected partner. 3. Factors such as age, male circumcision status, and sexually transmitted infections also affected transmission probabilityThe finding comes from an international team of researchers including scientists from the University of Rochester Medical Center, NYU Langone Medical Center, several institutions in France – and a graduate student who is a political refugee from Africa and is now at work in a Rochester laboratory, intent on helping his people who have been devastated by the HIV epidemic.

While researchers hope the work will one day lead to a way to make anti-HIV drugs more effective by increasing their potency against the virus, they’re also excited about its implications for our knowledge of other pathogens, such as herpes viruses, which use the same machinery within our cells that HIV does to replicate.

“The findings may explain why certain anti-HIV drugs used today are more effective under some circumstances and not others,” said Baek Kim, Ph.D., professor of Microbiology and Immunology at the University of Rochester Medical Center and one of three corresponding authors of the paper. “It also provides new insights on how many other viruses that afflict people operate in the body.”

The work centers on a protein known as SAMHD1, which is found in white blood cells known as macrophages and related cells known as dendritic cells. Last year scientists discovered that the molecule makes it difficult for HIV-1 to infect macrophages – cells that specialize in gobbling up and destroying invaders like viruses.

Now researchers have discovered that the molecule cuts off the supply line of the raw material that HIV needs to create DNA and replicate. That raw material, dNTP, comprises the building blocks of DNA, and without it, HIV can’t recreate its DNA in our cells.

The team found that SAMHD1 destroys most of these building blocks, making it nearly impossible for HIV-1 to replicate itself where SAMHD1 resides – the macrophages. Instead, HIV-1 uses the macrophage as a safe haven, surviving in patients for years as it dodges the immune system as well as the drugs designed to kill it. It’s thanks largely to its ability to hide out in the body that HIV is able to survive for decades and ultimately win out against the body’s relentless immune assault.

The team also discovered how a protein in the other common type of HIV – HIV-2, which is found mainly in Africa – knocks out SAMHD1. They found that the protein Vpx destroys SAMHD1, clearing the way for HIV-2 to infect macrophages. While scientists have known that HIV-2 needs Vpx to infect macrophages, they hadn’t known precisely why.

Interestingly, while one might think that a virus that is able to replicate itself in crucial cells like macrophages might be more dangerous than one that cannot, that’s not the case with HIV. HIV-2 is actually less virulent than HIV-1.

“We don’t know precisely how SAMHD1 and Vpx affect the virulence of HIV-1 and HIV-2, but it’s something we’re actively exploring,” said Kim. “In this case, the ability of HIV-2 to replicate more quickly in macrophages does not help it become more virulent.”

One possibility is that, like a starving man who becomes more and more desperate for food, the virus – when faced with a shortage of raw materials – puts its mutation gear into overdrive, creating more mutations in an effort to circumvent the pathway blocked by SAMHD1. Such constant mutations are one feature of HIV that makes it so challenging to treat patients.

“It makes sense that a mechanism like this is active in macrophages,” said Kim. “Macrophages literally eat up dangerous organisms, and you don’t want those organisms to have available the cellular machinery needed to replicate. And macrophages themselves don’t need it, because they don’t replicate. So macrophages have SAMHD1 to get rid of the raw material those organisms need to copy themselves. It’s a great host defense.

“The work suggests new ways to target virus replication in macrophages, a critically important cell population that serves as a key reservoir of virus infection and a contributor to HIV-induced disease,” added Kim.

At Rochester, Kim was joined in the research by graduate student Waaqo Daddacha, one of two first authors of the paper. A native of the Oromia region of Ethiopia, Daddacha came as a political refugee to the United States. He started out as a computer programmer, then decided to pursue HIV research as a way to help his homeland, where the rate of HIV is one of the highest in the world. As an undergraduate in Minnesota, he visited several laboratories around the nation that focus on HIV, eventually settling on the Kim lab, which he joined four years ago.

“Back home, many people are infected with HIV, and many people are dying because of it. I wanted to contribute to help solve the problem, and that’s why I decided to pursue HIV research,” said Daddacha, who still has family in Oromia. In Kim’s lab he is focusing on understanding drug resistance among HIV patients and on finding ways to limit resistance to make the drugs more effective in patients.


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