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Journal of Virology, April 2009, p. 3374-3378, Vol. 83, No. 7
0022-538X/09/$08.00+0 doi:10.1128/JVI.02161-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.
Differentially Stimulated CD4+ T Cells Display Altered Human Immunodeficiency Virus Infection Kinetics: Implications for the Efficacy of Antiviral Agents
Dimitrios N. Vatakis,1,3
Christopher C. Nixon,2
Gregory Bristol,1,3 and
Jerome A. Zack1,2,3*
David Geffen School of Medicine at UCLA, Department of Medicine, Division of Hematology/Oncology,1
Department of Microbiology Immunology and Molecular Genetics,2
UCLA AIDS Institute, Los Angeles, California 900953
Received 13 October 2008/
Accepted 2 January 2009

ABSTRACT
The activation state of CD4
+ T cells plays a crucial role in
the establishment of a productive human immunodeficiency virus
infection. Here, we show that T cells stimulated for 1 day demonstrated
delayed kinetics of viral reverse transcription and integration
compared to cells stimulated for 2 days prior to infection.
As a result, the efficiency of reverse transcription and integration
inhibitors differs in these differentially stimulated cells.
These studies increase our understanding of how T cells support
viral replication and provide insight regarding the efficiency
of antiretroviral therapy in lymphoid compartments.

TEXT
Unlike activated T cells, quiescent CD4
+ T cells are resistant
to human immunodeficiency virus (HIV) infection. Early studies
showed that this block was characterized by the premature termination
of reverse transcription (RT) (
11,
12,
22,
25,
34,
35). Subsequent
studies, using more-sensitive techniques, established that RT
in quiescent cells was far slower and less stable than in activated
cells (
17,
36). In addition, we and others demonstrated that
while cells activated for 48 h can be efficiently infected,
infection prior to T-cell activation is very inefficient, characterized
by a large delay in the kinetics of RT and integration, even
if the cell is stimulated immediately following infection (
11,
18,
27,
30). Therefore, the activation state of T cells markedly
affects the progression of the early stages of HIV infection
(
29).
Nondividing cell types such as macrophages have been shown to be permissive to HIV infection (6, 14, 21, 24). Subsequent work showed that entry into the G1b phase of the cell cycle was sufficient to support the infection of T cells (11). Furthermore, it was demonstrated that various cytokine signals allowed infection in resting T cells (29). In vivo, T-cell activation generally occurs in lymphoid tissues, following the sequestration and presentation of foreign epitopes by antigen-presenting cells. HIV infection spreads via T-cell activation in these localized regions (1, 5). Within these regions, however, the relative state of T-cell activation is variable (5). Cells likely receive activation signals at different times relative to their exposure to virus.
To examine this issue, we stimulated quiescent CD4+ T cells for 24 or 48 h to generate target cells with different levels of activation. We then infected these cells with HIV and examined multiple stages of viral replication (RT, integration, viral gene transcription, and viral protein synthesis). Based on the kinetics of infection, we treated these differentially stimulated cells with RT and integration inhibitors to determine viral susceptibility.
Phenotype of quiescent CD4+ T cells stimulated for 24 or 48 h.
Quiescent CD4+ T cells were isolated from total peripheral blood mononuclear cells by negative selection as previously described (30). This enabled us to stimulate a highly purified homogeneous population of truly quiescent CD4+ T cells. We then stimulated these cells for 24 or 48 h with plate-bound anti-CD3 (1 µg/ml) and soluble anti-CD28 (50 ng/ml). Cell cycle and activation states were assessed by flow cytometric assays (30) to examine cellular DNA and RNA synthesis, as well as the expression of T-cell activation markers (CD25, CD69, and HLA-DR). The cells stimulated for 24 h did not yet progress past the G1b phase of the cell cycle and expressed high levels of CD69 (Fig. 1). However, the 48-h-stimulated cells were distributed in all phases of the cell cycle and expressed high levels of all three activation markers, especially CD25 and HLA-DR (Fig. 1). Although 24-h stimulation was too early to produce robust cycling, these cells entered the G1b phase of the cell cycle, which we previously determined was sufficient for HIV infection (11).
Kinetics of HIV infection in 24- and 48-h-stimulated CD4+ T cells.
Since a significant amount of 24-h-stimulated T cells were in
a permissive state, it was of interest to examine the detailed
kinetics of HIV infection compared to that of the 48-h-stimulated
cells. Following stimulation, the cells were infected with HIV
NL4-3 for 2 h (multiplicity of infection [MOI], 0.5) and cultured
in the presence of the protease inhibitor indinavir (100 nM)
to ensure a single-round infection. We first assessed the kinetics
of RT by a quantitative real-time PCR as previously described
(
30). In the cells stimulated for 48 h prior to infection, full-length
viral DNA began to appear 4 h postinfection and peaked at 12
h, while in the cells stimulated for 24 h, the completion of
RT was delayed and became apparent 6 h postinfection, peaking
at the 24-h time point (Fig.
2A and D). A similar delay in kinetics
was observed when analyzing samples for the presence of integrated
proviral DNA, as assessed by an Alu-based PCR integration assay
(Fig.
2B and D) (
15,
30). In the 48-h-stimulated group, integration
peaked at 12 h postinfection, while in cells stimulated for
24 h, integration was seen at the 24-h time point. The differences
in RT and integration are temporal rather than quantitative
(difference of less than fivefold), as the absolute levels converged
at later time points. Interestingly, both groups exhibited the
accumulation of intracellular p24 Gag (assessed by intracellular
staining (
15,
30) 24 h postinfection, albeit at different amounts
(Fig.
2C and D). Thus, 24-h stimulation rendered cells permissive
to HIV infection.
Effect of the CD4+ T-cell activation state on the efficacy of antiretroviral drugs.
The differences observed in HIV kinetics led us to examine the
sensitivity of the above cell populations to antiretroviral
drugs targeting the early stages in the viral life cycle. To
address this, cells were treated with zidovudine (AZT) (10 µM),
efavirenz (EFV) (0.1 µM) (
4,
23,
33), or the integrase
inhibitors 118-D-24 (80 µM) (
26) and raltegravir (50 nM),
which was recently approved for clinical use (
8-
10), at various
time points postinfection. The inhibition of viral replication
was assessed by quantifying intracellular p24 Gag levels 48
h postinfection. The response to AZT treatment correlated well
with RT kinetics. AZT was effective at blocking infection in
the 48-h-stimulated cells when added up to 6 h after infection
(Fig.
3A). In contrast, in 24-h-stimulated cells, the drug was
effective if added up to 12 h postinfection. In a separate set
of experiments (Fig.
3B), we examined the effect of EFV compared
to that of AZT. Although AZT and EFV inhibit RT, they function
through different mechanisms, possibly leading to altered inhibition
kinetics (
4,
23,
33). However, there was no observed difference
between the two RT inhibitors.
The effectiveness of the integrase inhibitors 118-D-24 and raltegravir
(Fig.
4) reflected the kinetics of integration between the two
cell populations. The drug effectiveness of 118-D-24 did not
exceed 70% inhibition (as opposed to RT inhibitors, for which
inhibition exceeded 90%). 118-D-24 added to cells stimulated
for 24 h showed a significantly greater ability to inhibit integration
when added 12 h postinfection than in cells stimulated for 48
h. However, in both cell types, the effect of the inhibitor
was lost if added 14 h postinfection. On the other hand, the
efficacy of raltegravir was far superior. Inhibition was more
than 90% under both conditions. When added to cells stimulated
for 24 h, the drug inhibited when added up to 12 h postinfection,
while in 48-h-stimulated cells, some virus could escape inhibition
at 8 h postinfection. Therefore, due to the delayed progression
of viral replication, the 24-h-stimulated cells were susceptible
to antiretroviral drugs over a longer period of time.
In vivo CD4
+ T cells are found in diverse anatomic locations
such that the encounter with antigen or stimulating cytokines
is not a homogeneous event. This results in different T-cell
activation states in a single location (
5,
16,
29). As a productive
HIV infection is dependent on the target cell's activation state
(
11,
19,
25,
28,
30,
34), this has major implications for viral
pathogenesis and therapy.
In this study, we determined the kinetics of HIV infection in differentially activated T cells. Cells stimulated for 24 h displayed a 12-h delay in RT and integration compared to the 48-h-stimulated cells. Interestingly, viral protein expression kinetics were similar in both cell populations. Therefore, the kinetics of the early stages of the viral life cycle may be modulated by host mechanisms, such as signal transduction pathways (3, 7, 19, 25, 32) or host cytoskeletal organization activated during T-cell activation (2, 13). T-cell activation may also change the patterns of HIV integration due to distinct cellular gene expression patterns (20, 31).
Based on the results above, we reasoned that antiretroviral drugs targeting viral RT and integration would have differential effects on the virus depending on the activation state of the host cell. Our data showed that the effective window for RT and integration inhibitors was increased for partially activated cells (the 24-h-stimulated group) compared with that for fully activated T cells (the 48-h-stimulated group). A similar trend was seen when we treated the two cell groups with integrase inhibitors.
These data clearly demonstrate that antiviral drug effectiveness is tightly linked to the rate of viral life cycle progression, which in turn is dependent on the cell activation state. Our data suggest that integration inhibitors, due to their prolonged period of efficacy, might be useful as postexposure prophylactic agents in circumstances such as known needlestick injuries. While these results do not reflect true in vivo drug efficacy, as dosing, availability, and metabolism may affect drug concentrations, a deeper understanding of the cellular mechanisms required for a productive infection can lead to the development of more potent therapies against HIV.

ACKNOWLEDGMENTS
We thank Helen J. Brown for critically reading the manuscript.
The following reagents were obtained through the AIDS Research
and Reference Reagent Program, Division of AIDS, NIAID, NIH:
AZT, EFV, integrase inhibitor 118-D-24, and indinavir sulfate.
Raltegravir was provided by Merck (Whitehouse Station, NJ).
This work was supported by NIH grants AI36059, AI03059, and AI070010 and the UCLA CFAR (AI28697).

FOOTNOTES
* Corresponding author. Mailing address: 615 Charles E. Young Drive South, BSRB 173 Mailcode: 736322, Los Angeles, CA 90095. Phone: (310) 825-0876. Fax: (310) 983-1067. E-mail:
jzack{at}ucla.edu 
Published ahead of print on 7 January 2009. 

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Journal of Virology, April 2009, p. 3374-3378, Vol. 83, No. 7
0022-538X/09/$08.00+0 doi:10.1128/JVI.02161-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.
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