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¹ Department of Medicine, ² Department of Microbiology, and ³ Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294
⁴ Emory Vaccine Center at Yerkes National Primate Research Center, Atlanta, GA 30322
⁵ Department of Pediatrics, The Peter Medawar Building for Pathogen Research, University of Oxford, Oxford OX1 3SY, England, UK
⁶ Microsoft Research, Redmond, WA 98052
⁷ Department of Computer Science and Engineering, University of Washington, Seattle, WA 98195
⁸ Department of Pathology and Laboratory Medicine and ⁹ Department of Global Health, Emory University, Atlanta, GA 30322
¹⁰ Los Alamos National Laboratory, Los Alamos, NM 87545
¹¹ Zambia-Emory HIV Research Group, Lusaka, Zambia
¹² HIV Pathogenesis Program, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban 4013, South Africa
¹³ Partners AIDS Research Center, Massachusetts General Hospital, Charlestown, MA 02129

CORRESPONDENCE Paul A. Goepfert: paulg{at}uab.edu

In a study of 114 epidemiologically linked Zambian transmission pairs, we evaluated the impact of human leukocyte antigen class I (HLA-I)–associated amino acid polymorphisms, presumed to reflect cytotoxic T lymphocyte (CTL) escape in Gag and Nef of the virus transmitted from the chronically infected donor, on the plasma viral load (VL) in matched recipients 6 mo after infection. CTL escape mutations in Gag and Nef were seen in the donors, which were subsequently transmitted to recipients, largely unchanged soon after infection. We observed a significant correlation between the number of Gag escape mutations targeted by specific HLA-B allele–restricted CTLs and reduced VLs in the recipients. This negative correlation was most evident in newly infected individuals, whose HLA alleles were unable to effectively target Gag and select for CTL escape mutations in this gene. Nef mutations in the donor had no impact on VL in the recipient. Thus, broad Gag-specific CTL responses capable of driving virus escape in the donor may be of clinical benefit to both the donor and recipient. In addition to their direct implications for HIV-1 vaccine design, these data suggest that CTL-induced viral polymorphisms and their associated in vivo viral fitness costs could have a significant impact on HIV-1 pathogenesis.

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