Genetically-characterising full-length HIV-1 RNA is critical for identifying genetically-intact genomes, and comparing these RNA genomes to proviral DNA. We have developed a method for sequencing plasma-derived RNA using long-range sequencing (PRLS assay; ∼8.3 kb from
gag
to the 3’, or ∼5 kb from
integrase
to the 3’ end). We employed the
gag
-3’ PRLS assay to sequence HIV-1 RNA genomes from ART-naïve participants during acute/early infection (n=6) or chronic infection (n=2). On average only 65% of plasma-derived genomes were genetically-intact. Defects were found in all genomic regions, but were concentrated in
env
and
pol
. We compared these genomes to near-full-length proviral sequences from paired PBMC samples for the acute/early group, and found that near-identical (>99.98% identical) sequences were identified only during acute infection. For three participants who initiated therapy during acute infection, we used the
int
-3’ PRLS assay to sequence plasma-derived genomes from an analytical treatment interruption, and identified 100% identical genomes between pre-therapy and rebound timepoints. The PRLS assay provides a new level of sensitivity for understanding the genetic composition of plasma-derived HIV-1 RNA from viremic individuals either pre-therapy or after treatment interruption, which will be invaluable in assessing possible HIV-1 curative strategies.
Importance:
We developed novel plasma-derived RNA using long-range sequencing assays (PRLS assay;
gag
-3’ 8.3 kb and
int
-3’ 5.0 kb). Employing the
gag
-3’ PRLS assay, we found that 26-51% of plasma-derived genomes are genetically-defective, largely as a result of frameshift mutations and deletions. These genetic defects were concentrated in the
env
region compared to
gag
and
pol
, likely a reflection of viral immune escape in
env
during untreated HIV-1 infection. Employing the
int
-3’ PRLS assay, we found that analytical treatment interruption (ATI) plasma-derived sequences were identical and genetically-intact. Several sequences from the ATI plasma samples were identical to viral sequences from pre-therapy plasma and PBMC samples, indicating that HIV-1 reservoirs established prior to therapy contribute to viral rebound during an ATI. Therefore, near-full-length sequencing of HIV-1 particles is required to gain an accurate picture of the genetic landscape of plasma HIV-1 virions in studies of HIV-1 replication and persistence.