Genetic variation of the HIV-1 subtype C transmitted/founder viruses long terminal repeat elements and the impact on transcription activation potential and clinical disease outcomes
Authors: Madlala Paradise , Mkhize Zakithi , Naicker Shamara , Khathi Samukelisiwe P. , Maikoo Shreyal , Gopee Kasmira , Dong Krista L , Ndung’u Thumbi 
Published: February 2023

AbstractA genetic bottleneck is a hallmark of HIV-1 transmission such that only very few viral strains, termed transmitted/founder (T/F) variants establish infection in a newly infected host. Phenotypic characteristics of these variants may determine the subsequent course of disease. The HIV-1 5’ long terminal repeat (LTR) promoter drives viral gene transcription and is genetically identical to the 3’ LTR. We hypothesized that HIV-1 subtype C (HIV-1C) T/F virus LTR genetic variation is a determinant of transcriptional activation potential and clinical disease outcome. The 3’LTR was amplified from plasma samples of 41 study participants acutely infected with HIV-1C (Fiebig stages I and V/VI). Paired longitudinal samples were also available at one year post-infection for 31 of the 41 participants. 3’ LTR amplicons were cloned into a pGL3-basic luciferase expression vector, and transfected alone or together with Transactivator of transcription (tat) into Jurkat cells in the absence or presence of cell activators (TNF-α, PMA, Prostratin and SAHA). Inter-patient T/F LTR sequence diversity was 5.7% with subsequent intrahost viral evolution observed in 48.4% of the participants analyzed at 12 months post-infection. T/F LTR variants exhibited differential basal transcriptional activity, with significantly higher Tat-mediated transcriptional activity compared to basal (p<0.001). Basal and Tat-mediated T/F LTR transcriptional activity showed significant positive correlation with contemporaneous viral loads and negative correlation with CD4 T cell counts (p<0.05) during acute infection respectively. Furthermore, Tat-mediated T/F LTR transcriptional activity significanly correlated positively with viral load set point and viral load; and negatively with CD4 T cell counts at one year post infection (all p<0.05). Lastly, PMA, Prostratin, TNF-αand SAHA cell stimulation resulted in enhanced yet heterologous transcriptional activation of different T/F LTR variants. Our data suggest that T/F LTR variants may influence viral transcriptional activity, disease outcomes and sensitivity to cell activation, with potentional implications for therapeutic interventions.Author summaryThere is heterogeneity in the rates of clinical disease progression in antiretroval therapy-naïve people living with HIV (PLWH). In heterosexual HIV-1 transmission, only a single or very few viral strains, called transmitted/founder (T/F) viruses establish infection in a newly infected host. The long terminal repeat (LTR) is the viral promoter that drives viral gene transcription and is important for the HIV-1 life cycle. In this study we investigated the impact of HIV-1 subtype C T/F virus LTR genetic variation on transcriptional activity, clinical disease outcomes and response to cell activation. Our data show inter-patient T/F LTR genetic variation and limited intrahost evolution by 12 months post infection. T/F LTR variants exhibit differential basal LTR transcriptional activity, which is significanly increased in the presence of the Transactivator of transcription (Tat) protein. Furthermore, we show that T/F LTR transcription activity significanly correlates positively with viral load and viral load set point but negatively with CD4 T cell count. Lastly, we show that T/F LTR variants exhibit differential responses to cell activators PMA, TNF-α, Prostratin and SAHA. Taken together our data suggest that T/F viruses LTR genetic variation and functional heterogeneity are important determinants of clinical outcomes and virus reactivation potential.