HIV cell-to-cell spread slows evolution of drug resistance

Many enveloped viruses such as HIV have evolved to transmit by two infection modes: cell-free infection and cell-to-cell spread. Cell-to-cell spread is highly efficient as it involves directed viral transmission from the infected to the uninfected cell. In contrast, cell-free infection relies on chance encounters between the virion and cell. Despite the higher efficiency of cell-to-cell spread, there is substantial transmission by cell-free infection in conjunction with cell-to-cell spread. A possible reason is that cell-free infection offers a selective advantage by increasing sensitivity to factors interfering with infection, hence accelerating evolution of resistance relative to cell-to-cell spread alone. Here we investigated whether a combination of cell-free infection and cell-to-cell spread confers a selective advantage in experimental evolution to an antiretroviral drug. We maintained HIV infection using coculture of infected with uninfected cells in the face of moderate inhibition by the reverse transcriptase inhibitor efavirenz. We tested the effect on the rate of drug resistance evolution of replacing one coculture infection cycle with an infection cycle involving cell-free infection only, and observed earlier evolution of drug resistance mutations to efavirenz. When we increased selective pressure by adding a second reverse transcriptase inhibitor, emtricitabine, infection with the cell-free step consistently evolved multidrug resistance to both drugs and was able to replicate. In contrast, infection without a cell-free step mostly failed to evolve multidrug resistance. Therefore, HIV cell-to-cell spread decreases the ability of HIV to rapidly evolve resistance to inhibitors, which is conferred by cell-free infection. Author summaryCell-to-cell spread of HIV differs from cell-free, diffusion-based HIV infection in that viral transmission is directed from the infected to the uninfected cell through cellular interactions. Cell-to-cell spread has been recognized as a highly efficient infection mode that is able to surmount inhibition by antibodies and antiretroviral drugs. However, the effect of HIV cell-to-cell spread on the rate of evolution of viral resistance to infection inhibitors has not been studied. Here we used experimental evolution to investigate the effect of cell-to-cell spread versus cell-free infection on the emergence of drug resistance mutations to one or a combination of antiretroviral drugs. We found that replacing one infection cycle in experimental evolution with cell-free infection, where the filtered supernatant from infected cells, but not the cellular fraction, is used as the viral source, results in more rapid evolution of resistance. The consequences are that multidrug resistance consistently evolves with a cell-free viral cycle, but not when infection is solely by coculture of infected and uninfected cells. A possible consequence is that in environments where HIV cell-to-cell spread may predominate and some residual viral replication occurs in the face of ART, the emergence of drug resistance mutations would be delayed.