Cellular replication of human immunodeficiency virus type 1 occurs in vaginal secretions.

Most human immunodeficiency virus type 1 (HIV-1) transmission worldwide is the result of exposure to infectious virus in genital secretions. However, current vaccine candidates are based on virus isolates from blood. In this study, vaginal secretions from HIV-1-infected women were examined for evidence of cellular viral replication that produced virus with properties different from that in blood. Multiply spliced HIV-1 messenger RNA, which is found only in cells replicating virus, was detected in all vaginal lavage samples tested. There was a strong correlation between the amounts of multiply spliced HIV-1 messenger RNA and of cell-free HIV-1 RNA in the lavage samples. In addition, significant genotypic differences were found in cell-free virus from matched blood plasma and vaginal secretions. Moreover, drug resistance-associated mutations appeared in plasma virus several months before appearing in vaginal virus. These findings indicate that cellular replication of HIV-1 occurs in vaginal secretions and can result in a virus population with important differences from that in blood.

Human immunodeficiency virus 1 expression in the female genital tract in association with cervical inflammation and ulceration.

OBJECTIVES: Determining the source of human immunodeficiency virus 1 in the female genital tract and identifying factors that influence the amount of virus shed are important in the understanding of heterosexual human immunodeficiency virus 1 transmission. STUDY DESIGN: Cervicovaginal human immunodeficiency virus 1 ribonucleic acid shedding was quantified before and after treatment of cervical squamous intraepithelial lesions in 14 women. Genotypic analysis was performed on peptide HIV-1 env gp120 of the major human immunodeficiency virus 1 species in plasma and cervicovaginal lavage of selected samples. RESULTS: At 2 to 4 weeks after treatment, when cervices were inflamed and ulcerated, human immunodeficiency virus 1 ribonucleic acid in lavage samples increased 1.0 to 4.4 log 10. Genotypic analysis showed significant differences between the predominant human immunodeficiency virus 1 species in paired plasma and lavage samples from 2 of 4 women, suggesting that the increase in human immunodeficiency virus 1 was the result of local viral replication. CONCLUSIONS: Cervical inflammation and ulceration are associated with local human immunodeficiency virus 1 expression, which increases as much as 10,000-fold the amount of human immunodeficiency virus 1 shed into genital secretions. This may explain why sexually transmitted diseases are important risk factors for human immunodeficiency virus transmission.

Rapid CD4(+) T-cell loss induced by human immunodeficiency virus type 1(NC) in uninfected and previously infected chimpanzees.

To investigate the pathogenicity of a virus originating in a chimpanzee with AIDS (C499), two chimpanzees were inoculated with a plasma-derived isolate termed human immunodeficiency virus type 1(NC) (HIV-1(NC)). A previously uninfected chimpanzee, C534, experienced rapid peripheral CD4(+) T-cell loss to fewer than 26 cells/microl by 14 weeks after infection. CD4(+) T-cell depletion was associated with high plasma HIV-1 loads but a low virus burden in the peripheral lymph node. The second chimpanzee, C459, infected 13 years previously with HIV-1(LAV), experienced a more protracted course of peripheral CD4(+) T-cell loss after HIV-1(NC) inoculation, resulting in fewer than 200 cells/microl by 96 weeks postinoculation. The quantities of viral RNA in the plasma and peripheral lymph node from C459 were below the lower limits of detection prior to inoculation with HIV-1(NC) but were significantly and persistently increased after superinfection, with HIV-1(NC) representing the predominant viral genotype. These results show that viruses derived from C499 are more pathogenic for chimpanzees than any other HIV-1 isolates described to date.

Progressive infection in a subset of HIV-1-positive chimpanzees.

Chimpanzees are susceptible to infection with human immunodeficiency virus (HIV)-1; however, infected animals usually maintain normal numbers of CD4(+) T lymphocytes and do not develop immunodeficiency. We have examined 10 chronically infected HIV-1-positive chimpanzees for evidence of progressive infection. In addition to 1 animal that developed AIDS, 3 chimpanzees exhibit evidence of progressive HIV infection. All progressors have low CD4(+) T cell counts (<200 cells/microL), severe CD4:CD8 inversion, and marked reduction in interleukin-2 receptor expression by CD4(+) T cells. In comparison with HIV-positive nonprogressor chimpanzees, progressors have higher plasma and lymphoid virus loads, greater CD38 expression in CD8(+)/HLA-DR(+) T cells, and greater serum concentrations of soluble tumor necrosis factor type II receptors and beta2-microglobulin, all markers of HIV progression in humans. These observations show that progressive HIV-1 infection can occur in chimpanzees and suggest that the pathogenesis of progressive infection in this species resembles that in humans.

Correlation between human immunodeficiency virus type 1 RNA levels in the female genital tract and immune activation associated with ulceration of the cervix.

To address the hypothesis that local immune activation resulting from genital ulceration enhances human immunodeficiency virus type 1 (HIV-1) replication and shedding into the genital tract, paired plasma and cervicovaginal lavage (CVL) samples were obtained from 12 HIV-infected women before and after treatment of cervical intraepithelial lesions. Two weeks after treatment, inflammation and ulceration of the cervix were accompanied by major increases in mean concentrations of HIV-1 RNA (200-fold), tumor necrosis factor-alpha, interleukin 6, and soluble markers shed by activated lymphocytes and macrophages (sCD25 and sCD14, respectively) in CVL samples (P<.01 for each), but not plasma. Strong temporal and quantitative correlations were observed between concentrations of immunological markers and HIV-1 load in this compartment during a 10-week follow-up. Furthermore, in the presence of genital ulceration, HIV-1 in CVL samples was more readily captured by antibodies directed against virion-associated HLA-DR, a marker of host-cell activation, compared with virus in plasma. We suggest that local immune activation increases HIV-1 load in genital secretions, potentially increasing the risk of HIV-1 transmission.

Correlation of human immunodeficiency virus type 1 RNA levels in blood and the female genital tract.

In this study, the correlations of human immunodeficiency virus type 1 (HIV-1) RNA levels in blood plasma, vaginal secretions, and cervical mucus of 52 HIV-1-infected women were determined. The amount of cell-free HIV-1 RNA in blood plasma was correlated with that in vaginal secretions (Spearman's rank correlation coefficient (r) = 0.64, P<.001). In both blood plasma and vaginal secretions, the amounts of cell-free and cell-associated HIV-1 RNA were highly correlated (r=0.76, P<.01 and r=0.85, P<.01, respectively). Cell-free HIV-1 RNA levels in blood plasma and vaginal secretions were negatively correlated with CD4+ T lymphocyte count (r=-0.44, P<.01 and r=-0.40, P<.01, respectively). Similar to the effect observed in blood plasma, initiation of antiretroviral therapy significantly reduced the amount of HIV-1 RNA in vaginal secretions. These findings suggest that factors that lower blood plasma virus load may also reduce the risk of perinatal and female-to-male heterosexual transmission by lowering vaginal virus load.

Comparison of filtration properties of hepatitis B virus, hepatitis C virus and simian virus 40 using a polyvinylidene fluoride membrane filter.

BACKGROUND AND OBJECTIVES: We examined the ability of a modified polyvinylidene fluoride membrane filter to remove blood-borne and surrogate viruses. MATERIALS AND METHODS: Phages PR772 and PP7, hepatitis B virus (HBV), hepatitis C virus and simian virus 40 (SV40) were spiked in minimum essential media with 10% fetal calf serum and the concentration of these viruses compared before and after filtration by either plaque assay or polymerase chain reaction. RESULTS: Viruses >50 nm were removed to below detection limits (>10(6) logs) for all filters tested. A 5-log reduction of HBV (42 nm) and 2- to 3-log reduction of HCV (30-65 nm) was observed. CONCLUSION: A predictable size-based removal of viral agents was observed. The results also suggest the possible utility of SV40 as a surrogate to HBV for membrane filter challenge studies.

The use of a microporous polyvinylidene fluoride (PVDF) membrane filter to separate contaminating viral particles from biologically important proteins.

Viral agents (influenza A virus, 80-120 nm; phage T1, 50 nm head, 150 nm head, 150 nm tail; phage PR772, 53 nm; poliovirus, 28-30 nm; and phage PP7, 25 nm) were used to determine the ability of a newly developed, modified polyvinylidene fluoride (PVDF) membrane filter to remove viruses from several fluids. These included ultrapure water, Dulbecco's modified Eagle minimum essential medium (DMEM) and DMEM with 10% fetal bovine serum (DMEM-10). Small volume (10 ml) filtration experiments were done with 47-mm disks while larger volumes (1 litre) were done with virus suspended in DMEM-10, using cartridge filters with a surface area of 1.63 m2. With 47-mm disks, influenza A virus and phage T1 were removed to below detectable limits in all fluids tested (titre reduction [Tr] > 2.0 x 10(6) and > 5.8 x 10(8), respectively). The retention of phage PP7 and poliovirus was consistent but fluid dependent. The greatest concentration of phage PP7 and poliovirus was removed from ultrapure water (phage PP7, Tr = 2.1 x 10(7); poliovirus, TR > 3.2 x 10(4), while the removal efficiency from DMEM-10 was substantially lower (phage PP7, Tr = 2.3; poliovirus, Tr = 2.1 x 10(2)). Results of cartridge challenges in DMEM-10 were comparable to the corresponding small disk challenges. These results demonstrate that this PVDF membrane filter was very effective (Tr > 10(6)) in removing viral particles (> 50 nm); smaller viruses (< 50 nm) were also consistently removed, but the level of removal depended on the virus and type of fluid tested. In separate experiments, the recovery of purified albumin (69,000 Da) and IgG (150,000 Da) in the filtrate was also determined at approx. 0.015 mg/ml and approx. 10 mg/ml. Recovery of albumin and IgG was > 90%. Efficient virus retention coupled with high recovery of protein < 150,000 Da suggest potential applications of this membrane filter, when protection against adventitious viral contaminants is desired.

Endotoxin removal using 6,000 molecular weight cut-off polyacrylonitrile (PAN) and polysulfone (PS) hollow fiber ultrafilters.

The removal of pyrogenic and microbial contaminants from high purity water and parental solutions during production is a concern to pharmaceutical manufacturers. In a previous study, 6000 molecular weight cut-off (MWCO) polyacrylonitrile (PAN) and polysulfone (PS) ultrafilters were shown to remove poliovirus (Titer reduction [Tr], > 6 logs) and phages T1 and PP7 (Tr, 7 logs) from ultrapure water, 0.85% saline with 1% trypicase soy broth, and Dulbecco's Eagle minimal essential medium with 10% fetal bovine serum (15). In this study, we evaluated the ability of the 6,000 MWCO PAN and PS ultrafilters to remove purified endotoxin (Escherichia coli lipopolysaccharide) which was added to commercial Water for Irrigation. An endotoxin concentration reduction of > 6 logs was achieved with both PAN and PS ultrafilters (detection sensitivity, 0.0031 EU/ml) when a minimum of 3.92 x 10(3) EU/ml of endotoxin was added to Water for Irrigation. These results indicate that the 6,000 MWCO PAN and PS ultrafilters are very effective in removing endotoxin from fluids such as Water for Irrigation.

The removal of phages T1 and PP7, and poliovirus from fluids with hollow-fiber ultrafilters with molecular weight cut-offs of 50,000, 13,000, and 6000.

We tested the ability of hollow-fiber ultrafilters with molecular weight cut-offs (MWCOs) of 50,000, 13,000, and 6000 to remove and detect viral agents (phage T1, 50-150 nm; phage PP7, poliovirus, 28-30 nm) from ultrapure water, 0.85% saline with 1% trypticase soy broth, and Dulbecco's modified Eagle minimum essential medium with 10% fetal bovine serum (DMEM-10). Virus diluted in saline and DMEM-10 were tested to evaluate filter performance under conditions that minimize the adsorption of viral particles to the filter matrix. During filtration, the retentate was returned to the input reservoir, and the permeate was removed to a separate vessel. Thus, the virus concentration in the feed increased over the course of filtration. Filter performance was evaluated by comparing the concentration of infectious virus in the initial virus suspension with the virus concentration in the permeate and retentate. Very efficient removal of phages T1 and PP7 was observed with the filters with MWCOs of 13,000 and 6000 (titer reduction > 7 logs) for all three fluids tested. No poliovirus was detected in the permeate of the ultrafilters with MWCOs of 13,000 or 6000 (titer reduction > 6 logs). These results indicate that the ultrafilters with MWCOs of 13,000 and 6000 were very effective in removing small viral particles (25-30 nm) by size exclusion. The recovery efficiency of the virus in the retentate varied by fluid type. However, filtration with virus diluted in DMEM-10 resulted in consistent recovery of the viruses tested. The results suggest that these ultrafilters may have the dual potential of removing viral contaminants from fluids and concentrating virus in the retentate.