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Selection, Transmission, and Reversion of an Antigen-Processing Cytotoxic T-Lymphocyte Escape Mutation in Human Immunodeficiency Virus Type 1 Infection

Todd M. Allen,^1, Marcus Altfeld,^1, Xu G. Yu,¹ Kristin M. O'Sullivan,¹ Mathias Lichterfeld,¹ Sylvie Le Gall,¹ Mina John,² Bianca R. Mothe,³ Paul K. Lee,¹ Elizabeth T. Kalife,¹ Daniel E. Cohen,⁴ Kenneth A. Freedberg,¹ Daryld A. Strick,¹ Mary N. Johnston,¹ Alessandro Sette,⁵ Eric S. Rosenberg,¹ Simon A. Mallal,² Philip J. R. Goulder,^1,6 Christian Brander,¹ and Bruce D. Walker^1*

Howard Hughes Medical Institute, Partners AIDS Research Center, Infectious Disease Division, Massachusetts General Hospital, and Division of AIDS, Harvard Medical School,¹ Fenway Community Health Center, Boston, Massachusetts,⁴ Centre for Clinical Immunology and Biomedical Statistics, Royal Perth Hospital, Perth, Western Australia 6000, Australia ,² Epimmune,³ La Jolla Institute for Allergy and Immunology, San Diego, California 92121 ,⁵ Department of Pediatrics, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom⁶

Received 17 November 2003/ Accepted 2 February 2004

Numerous studies now support that human immunodeficiency virus type 1 (HIV-1) evolution is influenced by immune selection pressure, with population studies showing an association between specific HLA alleles and mutations within defined cytotoxic T-lymphocyte epitopes. Here we combine sequence data and functional studies of CD8 T-cell responses to demonstrate that allele-specific immune pressures also select for mutations flanking CD8 epitopes that impair antigen processing. In persons expressing HLA-A3, we demonstrate consistent selection for a mutation in a C-terminal flanking residue of the normally immunodominant Gag KK9 epitope that prevents its processing and presentation, resulting in a rapid decline in the CD8 T-cell response. This single amino acid substitution also lies within a second HLA-A3-restricted epitope, with the mutation directly impairing recognition by CD8 T cells. Transmission of the mutation to subjects expressing HLA-A3 was shown to prevent the induction of normally immunodominant acute-phase responses to both epitopes. However, subsequent in vivo reversion of the mutation was coincident with delayed induction of new CD8 T-cell responses to both epitopes. These data demonstrate that mutations within the flanking region of an HIV-1 epitope can impair recognition by an established CD8 T-cell response and that transmission of these mutations alters the acute-phase CD8⁺ T-cell response. Moreover, reversion of these mutations in the absence of the original immune pressure reveals the potential plasticity of immunologically selected evolutionary changes.

T.M.A. and M.A. contributed equally to this work.

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