HIV-1 group P infection: towards a dead-end infection?

HIV/1 group P (HIV-1/P) is the last HIV/1 group discovered and to date, comprises only two strains. To obtain new insights into this divergent group, we screened for new infections by developing specific tools, and analysed phenotypic and genotypic properties of the prototypic strain RBF168. In addition, the follow-up of the unique patient monitored so far, has raised the knowledge of the natural history of this infection and its therapeutic management. We developed an HIV-1/P specific sero-molecular strategy and screened over 29,498 specimen samples. Infectivity and evolution of the gag-30 position, considered as marker of adaptation to human, were explored by successive passages of RBF168 strain onto human PBMCs. Natural history and immuno-virological responses to combined antiretroviral therapy (cART) were analysed based on CD4 counts and plasmatic viral load evolution. No new infection was detected. Infectivity of RBF168 was found lower, relative to other main HIV groups and the conservative methionine found in the gag-30 position revealed a lack of adaptation to human. The follow-up of the patient during the five-year ART-free period, showed a relative stability of CD4 cell count with a mean of 326 mm. Initiation of cART led to rapid RNA undetectability with a significant increase of CD4, reaching 687 mm after 8 years. Our results showed that HIV-1/P strains remain extremely rare and could be less adapted and pathogenic than other HIV strains. These data lead to the hypothesis that HIV-1/P infection could evolve towards, or even already correspond to, a dead-end infection.