Longitudinal clonal dynamics of HIV-1 latent reservoirs measured by combination quadruplex polymerase chain reaction and sequencing
HIV-1 infection produces a long-lived reservoir of latently infected CD4+ T cells that represents the major barrier to HIV-1 cure. The reservoir contains both intact and defective proviruses, but only the proviruses that are intact can re-initiate infection upon cessation of antiretroviral therapy (ART). Here we combine 4 color quantitative polymerase chain reaction and next-generation sequencing (Q4PCR) to distinguish intact and defective proviruses and measure reservoir content longitudinally in 12 infected individuals. Q4PCR differs from other PCR based methods in that the amplified proviruses are sequence verified as intact or defective. Samples were collected systematically over the course of up to 10 years beginning shortly after the initiation of ART. The size of the defective reservoir was relatively stable with minimal decay during the 10-year observation period. In contrast, the intact proviral reservoir decayed with estimated half-life of 4.9 years. Nevertheless, both intact and defective proviral reservoirs are dynamic. As a result, the fraction of intact proviruses found in expanded clones of CD4+ T cells increases overtime with a concomitant decrease in overall reservoir complexity. Thus, reservoir decay measurements by Q4PCR are quantitatively similar to viral outgrowth (VOA) and intact proviral DNA PCR (IPDA) with the addition of sequence information that distinguishes intact and defective proviruses and informs reservoir dynamics. The data is consistent with the notion that intact and defective proviruses are under distinct selective pressure, and that the intact proviral reservoir is progressively enriched in expanded clones of CD4+ T cells resulting in diminishing complexity over time. SignificanceHIV-1 infection requires lifelong treatment with antiretroviral therapy (ART) due to viral rebound of a latent reservoir of intact, transcriptionally silent provirus found to persist in the genome of CD4+ T cells. One of the major challenges to understanding the nature of the latent reservoir is accurately characterizing the measuring the size of the reservoir. Herein, we use quadruplex polymerase chain reaction (Q4PCR) to assess the dynamics of the latent reservoir in HIV+ individuals who have been on long-term ART for up to 10 years. Our results show that Q4PCR can be used to accurately measure the latent reservoir, while providing the added benefit of assessing the genetic diversity of the reservoir to better understand changes to clonal dynamics overtime.