The HIV type 1 coreceptor CCR5 and its role in viral transmission and disease progression.

The purified CD4+ lymphocytes of a group of highly exposed but HIV-1-uninfected individuals were determined to be less susceptible to infection with multiple non-syncytium-inducing (NSI) primary isolates of HIV-1 than were CD4+ lymphocytes from nonexposed control individuals. This relative resistance to HIV-1 infection did not extend to T cell line-adapted or syncytium-inducing (SI) primary viral isolates, was restricted by the envelope glycoprotein, and was associated with an increased production of the C-C chemokines RANTES, MIP-1alpha, and MIP-1beta. The block to replication in CD4+ lymphocytes from two exposed-uninfected subjects was at the point of entry, as was the block imposed by the recombinant C-C chemokines RANTES, MIP-1alpha, and MIP-1beta. Resistance to infection and the high production of beta chemokines were characteristic of every CD4+ lymphocyte clone from the exposed-uninfected subjects. We have now identified the mechanism underlying this in vitro and in vivo resistance to infection: These individuals have inherited a homozygous 32-bp nucleotide deletion (delta32) within the gene encoding the coreceptor for primary NSI isolates of HIV-1 (CCR5). This deletion encodes a severely truncated and unstable protein that is not expressed on the cell surface. This allele is common in the Caucasian population, with a frequency of 0.0808, but is not found in people of African or Asian ancestry. To determine its role in HIV-1 transmission and disease progression, we analyzed the CCR5 genotype of 1252 homosexual men enrolled in the Chicago component of the Multicenter AIDS Cohort Study (MACS). No infected participant was found to be homozygous for the delta32 allele whereas 3.6% of at-risk but uninfected Caucasian participants were homozygous, showing the highly protective role of this genotype against sexual acquisition of HIV-1. No evidence was found to suggest that heterozygotes were protected against HIV-1 infection, but a limited protective role against disease progression was noted. The delta32 allele of CCR5 is therefore an important host factor in HIV-1 transmission and pathogenesis.