The basis for the switch from CCR5 to CXCR4 coreceptor usage seen in ϳ50% of human immunodeficiency virus type 1 (HIV-1) subtype B-infected individuals as disease advances is not well understood. Among the reasons proposed are target cell limitation and better immune recognition of the CXCR4 (X4)-tropic compared to the CCR5 (R5)-tropic virus. We document here X4 virus emergence in a rhesus macaque (RM) infected with R5-tropic simian/human immunodeficiency virus, demonstrating that coreceptor switch can happen in a nonhuman primate model of HIV/AIDS. The switch to CXCR4 usage in RM requires envelope sequence changes in the V3 loop that are similar to those found in humans, suggesting that the R5-to-X4 evolution pathways in the two hosts overlap. Interestingly, compared to the inoculating R5 virus, the emerging CXCR4-using virus is highly neutralization sensitive. This finding, coupled with the observation of X4 evolution and appearance in an animal with undetectable circulating virus-specific antibody and low cellular immune responses, lends further support to an inhibitory role of antiviral immunity in HIV-1 coreceptor switch.The human immunodeficiency virus (HIV) enters target cells via interaction of the viral glycoprotein with the cellular receptor CD4 and two principal coreceptors, CCR5 (R5 viruses) and CXCR4 (X4 viruses) (2). Most HIV type 1 (HIV-1) transmission results in a predominantly R5 virus infection. With time, X4 variants arise and coexist with R5 virus variants in ϳ50% of subtype B-infected individuals, and this event is associated with rapid CD4 ϩ T-cell loss and disease progression (22, 37). The determinant(s) of phenotypic change from R5 to X4 maps largely to the V3 loop of the envelope gp120 (6, 18, 39) and can be inferred by analysis of the amino acid sequence of this region (11). Although the underlying basis for virus coreceptor switch late in infection remains ill defined, several hypotheses that include changes in target cell populations during the course of infection and/or differential immune recognition of X4 and R5 viruses have been proposed (31,34). Furthermore, it is unclear whether X4 viruses evolve during the course of infection or are transmitted but selected against early in infection.We have used infection of rhesus macaques (RM) with simian/human immunodeficiency viruses (SHIV) expressing the envelopes of X4 and R5 HIV-1 isolates to study the impact of coreceptor usage in virus transmission and pathogenesis. We previously reported that both X4 and R5 SHIVs can be transmitted intravenously or intravaginally but showed that the basis for the immunodeficiencies caused by these viruses is different. Whereas primary infection with X4 SHIV caused severe and sustained peripheral blood and secondary lymphoid tissue
CD4ϩ T-cell loss, infection with R5 SHIV resulted in transient loss of CD4 ϩ T cells at these sites (15, 17). Thus, infection with SHIVs of different coreceptor usage recapitulates the different stages of HIV infection in humans: R5 SHIV provides a model of early infection ...