1846 • JID 2010:202 (15 December) • Ling et al
M A J O R A R T I C L E
The Large Intestine as a Major Reservoir
for Simian Immunodeficiency Virus in Macaques
with Long-Term, Nonprogressing Infection
Binhua Ling, Mahesh Mohan, Andrew A. Lackner, Linda C. Green, Preston A. Marx, Lara A. Doyle,
and Ronald S. Veazey
Tulane National Primate Research Center, Tulane University Health Sciences Center, Covington, Louisiana
Although patients with human immunodeficiency virustype 1 infectionwhoarereceivingantiretroviraltherapy
and those with long-term, nonprogressive infection (LTNPs) usually have undetectable viremia, virus persists
in tissue reservoirs throughout infection. However, the distribution and magnitude of viral persistence and
replication in tissues has not been adequately examined. Here, we used the simian immunodeficiency virus
(SIV) macaque model to quantify and compare viral RNA and DNA in the small (jejunum) and large (colon)
intestine of LTNPs. In LTNPs with chronic infection, the colon had consistently higher viral levels than did
the jejunum. The colon also had higher percentages of viral target cells (memory CD4+CCR5+T cells) and
proliferating memory CD4+T cells than did the jejunum, whereas markers of cell activation were comparable
in both compartments. These data indicate that the large intestine is a major viral reservoir in LTNPs, which
may be the result of persistent, latently infected cells and higher turnover of naive and central memory CD4+
T cells in this major immunologic compartment.
type 1 (HIV-1) infection include individuals who sup-
press plasma viremia while receiving antiretroviralther-
apy (ART) and those with long-term, nonprogressive
infection (LTNPs) who naturally suppress HIV-1 for
10–15 years without antiretroviral drug intervention[1,
2]. However, HIV infection is never eradicated in pa-
tients receiving ART [3–7] or LTNPs (or even “elite
controllers”) . The persistence of HIV in tissue res-
ervoirs remains a major obstacle to eradicating HIV in
infected patients. To date, the underlying mechanisms
Received 7 March 2010; accepted 19 July 2010; electronically published 4
Potential conflicts of interest: none reported.
Financial support: The American Foundation for AIDS Research (to B.L.) and
National Institutes of Health (RR00164).
Presented in part: Conference of Retroviruses and Opportunistic Infections2008,
Boston, Massachusetts, 3-6 February 2008; the XIV International Congress of
Virology, Istanbul, Turkey, 10-15 August 2008.
Reprints or correspondence: Dr Binhua Ling, Tulane National Primate Research
Center, 18703 Three Rivers Rd, Covington, LA 70433 (firstname.lastname@example.org).
The Journal of Infectious Diseases
? 2010 by the Infectious Diseases Society of America. All rights reserved.
of persistence of virus in tissue reservoirs are unknown
. However, evidence suggests that latently infected
CD4+T cells, which may have been infected as memory
persist in tissues and serve as a source for continual
viral replication. Although multiple potential tissueres-
ervoirs for virus have been proposed, including the
brain, intestine, bonemarrow,lymphnodes,andgenital
tract [10, 11], the gut-associated lymphoid tissue
(GALT) has unique anatomical and functional features
that may make it a major reservoir for HIV sequestra-
tion, persistence, and ongoing replication.
The GALT consists of both organized lymphoid nod-
ules and Peyer’s patches, which are immune-inductive
sites that consist of resting, naive, and transitional cells,
as well as diffuse yet dense populations of lymphocytes
and antigen-presenting cells distributed throughout the
mucosa that constitute the immune-effector sites. The
immune-effector sites consist of abundant CD4+T cells
having a memory CCR5+phenotype that we and others
have shown to be important in the early infection and
viral ramp-up phase of simian immunodeficiency virus
(SIV) and HIV infection [12–15]. Most of the im-
SIV Reservoir in the Gut in Rhesus Macaques • JID 2010:202 (15 December) • 1847
mune-inductive sites are in the terminal centimeters of the
small intestine and abundantly throughout the large intestine.
Although these immune-inductive sites primarily are com-
prised of resting T and B cells, these sites are dynamic, in that
they are continually responding to luminal (foreign) antigens,
resulting in frequent CD4+T cell activation,proliferation,hom-
ing, and turnover, which conceivably serves as a mechanism
for viral persistence and re-seeding of distant tissue sites inHIV
In contrast, the proximal small intestine (jejunum) is prac-
tically devoid of organized lymphoid tissue and primarily har-
bors immunologically “activated” memory cells, which express
high levels of CCR5. These intestinal memory CD4+CCR5+T
cells are the major early target for HIV and SIV replication and
amplification, regardless of the route of infection [12, 14–20].
Once depleted, memory CD4+CCR5+T cells do not repopulate
the lamina propria in significant numbers in untreated ma-
caques that have progressive disease. Thus, we hypothesized
that the large intestine, with its abundant organized lymphoid
tissue, which has all of the cells necessary for establishment of
a chronic reservoir, may be a preferred site for viral persistence
and replication in patients “controlling” infection.
To examine the ability of the intestinal compartments to
serve as a reservoir in LTNPs, we examined Chinese rhesus
macaques (Chinese RM) infected with SIV (SIVmac). Although
most Chinese RM infected with SIVmac develop AIDS,wehave
shown that ∼30% control infection and become LTNPs, even
though virus can consistently be isolated from tissues .
Tissue viral DNA and RNA loads and cell phenotypes were
compared among lymphocytes in the large (colon) and small
(jejunum) intestine, lymph nodes draining the jejunum (LNjej)
and colon (LNcol), and peripheral blood mononuclear cells
(PBMCs). Our results indicate that, although the entire gastro-
intestinal tract is a reservoir for SIV persistence in disease pro-
gression, the colon is a greater reservoir for viral persistence in
LTNPs than are the jejunum, draining lymph nodes, or blood.
Furthermore, maintenance and proliferation of CD4+CCR5+T
cells seemingly contribute to this viral persistence.
Animals and virus inoculation.
mulatta) were used. Animals were housed at the Tulane Na-
tional Primate Research Center and maintained in accordance
with the standards of the American Association for Accredi-
tation of Laboratory Animal Care and the “Guide for the Care
and Use of Laboratory Animals” prepared by the National Re-
search Council. All studies were approved by the Tulane In-
stitutional Animal Care and Use Committee. Five animals were
intravenously infected with 100 median tissue culture infective
dose (TCID50) SIVmac239, 3 were given 1 mL of plasma con-
taining SIVmac239 passaged in Chinese RM, and 4 were in-
Twelve Chinese RM (Macaca
travenously inoculated with 500 TCID50 SIVmac251. In ad-
dition, tissues from 4 naive Chinese RM were used as controls.
Lymphocyte isolation from blood and intestinal tissues.
PBMCs were separated from ethylenediaminetetraacetic acid
(EDTA)–blood by Ficoll density gradient centrifugation.Toob-
tain sufficient numbers of intestinal cells, a 2-cm wedge-shaped
surgical resection of jejunum and descending colon was ob-
tained from each animal a single time. The time point of post–
SIV infection for surgery was different for each SIV-infected
animal because of the different time of SIV inoculation. How-
ever, all surgeries in LTNPs and progressors were performed
during the chronic phase of SIV infection. Biopsy specimens
from the jejunal and colonic lymph nodes were collected si-
multaneously. Cells were isolated fromlymphnodesbymincing
tissues with scalpel blades and gently pressing through nylon
mesh screens with a syringe plunger. Lamina propria lympho-
cytes from jejunum (LPLjej) and colon (LPLcol) tissues were
isolated as described elsewhere [18, 22, 23]. In brief, intestinal
lymphocytes were isolated using EDTA/collagenase digestion
and percoll density gradient centrifugation, LPL purity was
180% as tested by flow cytometry analysis, and intestinal cell
viability was always 190% .
Antibodies, immunofluorescent staining, and flowcytometry.
PBMCs, LPLjej, LPLcol, LNjej, and LNcol were stained for T
cell immunophenotyping, proliferation, and activation with
the following fluorescently conjugated monoclonal antibodies:
CD3, Pacific Blue (SP34); CD8, PE-Texas Red (MHCD0817);
CD4, FITC (L200); CD95, PE-Cy5 (DX2); CD28, APC (28.2);
CCR5, PE (3A9); Ki-67, PE (B56); HLA-DR, PE-Cy7 (L243);
and CD69, APC-Cy7 (FN50). Cells were stained with surface
markers, washed, fixed, and permeabilized with fixation/per-
meabilization solution prior to intracellular Ki-67 staining.
Samples were analyzed using a FACSAria flow cytometer. Cells
were gated through CD3+T lymphocytes, and ?20,000 events
were collected per sample.
Quantification of plasma viral RNA, cellular SIV RNA,
and viral DNA.
SIV plasma viral loads (pVL) were analyzed
by bDNA assay (Siemens Medical Solutions). The limit of
detection was 125 copies/mL. For cell-associated RNA quan-
tification, total RNA from
LNjej, and LNcol were extracted using the RNeasy mini kit.
Genomic DNA was extracted using the DNeasy Blood &
Tissue Kit (Qiagen). RNA and DNA were measured by
NanoDrop Spectrophotometer. Real-time TaqMan PCR as-
say was used as described elsewhere . Primers 5’-GCTA-
GTGTGTGTTCCCATCTCTCCTA-3’ (forward primer) and
5’-GCTTCGGTTTCCCAAAGCAGAAAG-3’ (reverse primer)
were used along with probe 5’-6FAM-TCGCCGCCTGGTCA-
ACTCGGTACTCGGTAA-TAMRA-3’. Briefly, ∼50 ng of total
RNA was reverse transcribed using the TaqMan Reverse Tran-
scription Reagents kit (PE Applied Biosystems) in 10-mL re-
PBMCs, LPLjej, LPLcol,
1848 • JID 2010:202 (15 December) • Ling et al
with long-tern nonprogressive infection are shown in bold and underlined. Animal L01 had a transient peak of viremia ∼60 months after infection as
a result of experimental CD8+T cell depletion (*), but viremia was undetectable thereafter. The limit of detection was 125 copies/mL by bDNA assay
(Siemens Medical Solutions). Intestinal biopsy specimens were taken after viral set point at the chronic phase of SIV infection ranging from 10 months
(P02) to 6 years (L01).
Plasma viral loads in simian immunodeficiency virus (SIVmac)–infected rhesus macaques of Chinese origin. Animal numbers of animals
action, then 15 mL of the PCR master mix was added to obtain
25 mL and subjected to 40 cycles of quantitative real-time
PCR analyses. Fluorescence signal was detected with an ABI
Prism 7900 Sequence Detector. Data were captured and an-
alyzed with Sequence Detector Software(AppliedBiosystems).
Viral copy number per
and calculated by plotting CT values obtained from samples
against a standard curve generated with in vitro transcribed
RNA representing known viral copy numbers and based on
cells used for RNA and DNA extraction and PCR experiments.
The limit of detection was 10 copies per 106cells.
Nonparametric statistical analyses
(Mann-Whitney U test or Wilcoxon sign-rank test) were used
to compare cell-associated SIV DNA, cell-associated SIV RNA,
and frequency of infection in different compartments between
groups of LTNPs and progressors. Paired t test was used to
compare levels of memory CD4+CCR5+T cells between jeju-
num and colon. The Spearman correlation was used to assess
the relationship of levels of memory CD4+CCR5+T cells be-
tween jejunum and colon. GraphPad Prism statistical software,
version 4.0, was used to analyze data, and statistical significance
was set at a 2-sided P value of !.05.
lymphocytes was determined
pVL in Chinese RMs after infection withSIVmac.
infected LTNPs  and 5 progressors were compared. All
animals were inoculated with either SIVmac251 or SIVmac239,
and pVLs are shown for individual animals in Figure 1. Ma-
caque L01 had been depleted of CD8+cells in an earlier ex-
periment ∼60 months after SIV infection , and although
this animal displayed transient viremia during the depletion,
viremia was undetectable thereafter. Although some LTNPs had
pVL “blips,” all maintained the criteria for macaque LTNPs,
defined here as persistently low (?103copies/mL) to unde-
tectable plasma viremia for months and survival for 136
months after infection. The 5 progressors had pVLs that con-
sistently ranged from 104–107copies/mL throughout chronic
infection. Animal P03 had a transient period of viral control
in the first 5 months of infection, but pVL increased thereafter,
and thus was included as a progressor.
To compare levels of cellular SIV viral DNA between different
tissue compartments, viral DNA was quantified by real-time
PCR (Figure 2A and 2B). In the LTNP group, 3 macaques had
SIV Reservoir in the Gut in Rhesus Macaques • JID 2010:202 (15 December) • 1849
blood, lamina propria lymphocytes from jejunum, colon, jenunal mesenteric lymph node (LNjej), and colonic mesenteric lymph node (LNcol) in animals
with long-term nonprogressive infection (LTNPs) and progressors. A, Cell-associated SIV DNA in blood and tissues of LTNPs. B, Cell-associated SIV
DNA in blood and tissues of progressors. *and ** , when compared with the matched sample in LTNPs. C, Cell-associated RNA loadsP ! .05P ! .01
in blood and tissues of LTNPs. *and ** , when compared with peripheral blood specimens within the same group. D, Cell-associatedP ! .05P ! .01
RNA loads in blood and tissues of progressors. * when compared with peripheral blood within the same group.P ! .05
the matched sample in LTNPs. Each symbol represents a different animal. Horizontal lines indicate mean values.
Levels of cell-associated simian immunodeficiency virus (SIV) DNA and RNA in periphereal blood mononuclear cells(PBMCs)fromperipheral
when compared with
P ! .05
undetectable viral DNA in ?1 compartment (L04, L06, and
L07). Data were not available for LNjej for L02, L03, L05, and
L07, and data were not available for LNcol for L02 and L07.
As a group, mean levels of SIV viral DNA were 103copies per
106cells or lower in all compartments, yet with a trend (not
statistically significant) for consistently higher levels in jejunum
and colon, compared with PBMCs, LNjej, and LNcol (Figure
2A). In the progressor group, all tissues had mean viral DNA
1103copies per 106cells, with no statistically significant differ-
ences detected between compartments among progressors.
Interestingly, there were no significant differences between
the viral DNA levels in the colon and jejunum of progressors
and levels in the same compartments in LTNPs. However, pro-
gressors had significantly higher viral DNA levels in blood,
comparedwith LTNPs(P p .006
( ) (Figure 2B).P p .016
),LNjej(),andLNcolP p .029
Comparison of viral RNA in different tissues of LTNPs.
Cellular viral RNA levels were also comparedinthesametissues
of progressors and LTNPs (Figure 2C and 2D). In the LTNP
group, 5 of 7 animals had undetectable cell-associated viral
RNA (!10 copies per 106cells) in PBMCs. However, viral RNA
was consistently detected in colon specimens and was found
in 5 of 7 jejunum specimens from LTNPs (Figure 2C). Three
LTNPs had undetectable viral RNA in LNjej (L04), jejunum
(L06), or both jejunum and LNjej (L03) specimens. Data were
not available for LNjej for L02, L05, and L07 and were not
available for LNcol for L02 and L07. Quantitatively, mean viral
RNA levels were also significantly higher in colon specimens
(767 copies per 106cells) and LNcol (486 copies per 106cells)
than PBMCs (38 copies per 106cells) (Figure 2C).
In contrast, all progressors had detectable viral RNA in all
compartments (Figure 2D) with levels that were consistently
1850 • JID 2010:202 (15 December) • Ling et al
blood, jejunum, and colon in a representative normal Chinese rhesus macaque (RM). Cells were first gated on lymphocytes, CD3+T cells and then
CD4+T cells, and they were then analyzed for CD95+and CCR5+. B, Comparison of mucosal memory CD4+CCR5+T cells (Index) between jejunum and
colon within the same group. * . (Data were not available for 1 progressor).P ! .05
and long-term nonprogression (LTNP) groups. when compared to the matched samples in the LTNP group. The index was previously describedP ! .01
elsewhere but reflects the proportion of total CD4+T cells of the T cell pool (CD3+) that are memory (CD95+) and CCR5+. C, Correlation of memory
CD4+CCR5+T cells between jejunum and colon in all animals, including groups of control animals, LTNPs, and progressors. D, Proliferation of memory
CD4+T cells in different tissue compartments. *compared with peripheral blood specimens within the same group. n.s., no significance.P ! .05
Comparison of mucosal memory CD4+CCR5+T cells and proliferation in jejunum and colon. A, memory CD4+CCR5+T cell expression in
when compared with the matched sample in the control
P ! .05
and significantly higher in intestinal tissues than in PBMCs
(Figure 2D). As expected, viral RNA in LTNPs was significantly
lower in all tissue compartments when compared with corre-
sponding tissues of progressors but was always detected in the
colon, regardless of viremia. Combined, these results confirm
that the intestine, and particularly the large intestine, is a major
reservoir for viral persistence in LTNPs even when viral RNA
or DNA is undetectable in peripheral blood (Figure 2C).
Comparison of intestinal SIV-target cells in chronic SIV
Intestinal memory CD4+CCR5+T cells are the ma-
jor early targets for SIV infection. Because the colon and je-
junum have different ratios of immune-inductive to immune-
effector sites reflected in different ratios of CD4+T cell subsets,
we hypothesized that there would be differences in levels of
viral target cells in the jejunum and colon and that this could
be associated with viral persistence. Thus, we compared ex-
pression of memory CD4+CCR5+T cells in these compartments
using slight modifications of a previously described index that
accounts for both the total proportion of CD4+T cells obtained
in a sample and the percentage of those that are memory
CD4+CCR5+T cells . Basically, this “target cell index” is
the percentage of total CD4+T cells in the sample (gated
through CD3) multiplied by the percentage of CD4+T cells
co-expressing CD95 and CCR5 (target cells) ?100. Figure 3A
demonstrates the gating strategy used to define memory CD4+
T cells in blood and tissues. Because there were no significant
differences in CCR5 expression on blood and LN CD4+T cells
(data not shown), comparisons shown focus on the jejunum
SIV Reservoir in the Gut in Rhesus Macaques • JID 2010:202 (15 December) • 1851
Chinese rhesus macaques (RMs) (A), animals with long-term nonprogression of disease (LTNPs) (B) and progressors (C). Proliferation of CD4+subsets
including naive, TCM, and TEMin compartments in normal Chinese RM (D), LTNPs (E) (*
and progressors (F) (* , when compared with TEMin blood specimens obtained from progressors.P ! .05
Frequency of naive (CD95-negative), central memory (TCM), and effector memory CD4+T cells (TEM) in tissue compartments of normal
when compared with TEMin blood and jejunum in LTNPs),P ! .05
and colon. Figure 3B shows the levels of SIV target cells in the
jejunum and colon in each group of animals. In the control
and LTNP groups, colon specimens had significantly higher
levels of target cells than did jejunum specimens (
contrast, in progressors, few target cells remained in jejunum
and colon specimens and these levels were significantly lower
than levels in matched samples from controls (
jejunum and colon specimens) and LTNPs (
specimens and in colon specimens). Moreover, whenP ! .01
all samples were analyzed together, there was a strong positive
correlation between levels of target cells in the 2 compartments
(; ) (Figure 3C). However, when analyzedR p 0.8286 P ! .001
separately by group, the correlation was not significant in the
controls and in progressors, possibly because of the small sam-
ple size in the control group and because of severe depletion
in both compartments in progressors (data not shown).
Proliferation of memory CD4+T cells was also examined by
Ki-67 expression on cells in various compartments (Figure3D).
In both groups, the colon had significantly higher levels of Ki-
67+T cells than did peripheral blood (
junum in those with progressive disease also had significantly
higher rates of proliferation than did peripheral blood (P p
) (Figure 3D). In LTNPs, the colon had the highest rate of .020
CD4+T cell proliferation of all tissues examined (Figures 3D
Percentages of CD4+T cell subsets were also compared be-
tween the 5 compartments in normal Chinese RM, LTNPs, and
progressors. The distribution of naive (CD28+CD95?), central
). InP ! .05
P ! .05
P ! .05
), and the je-P p .03
memory (CD28+CD95+) and effector memory (CD28?CD95+)
CD4+T cells in the blood, jejunum, and colon were similar
between LTNPs and progressors (Figure 4B and 4C). However,
LTNPs had higher percentages of naive CD4+T cells and fewer
TCMcells in LNjej and LNcol than did progressors (Figures 4B
and 4C). In general, naive CD4+T cells were predominant in
lymph nodes and blood, whereas most CD4+T cells in gut had
a central memory (TCM) phenotype (Figure 4A). In the gut,
TCMwere predominant in both jejunum and colon but were
not significantly different between the 2 groups (Figure 4B and
4C). However, percentages of proliferating (Ki-67+) TEMwere
significantly higher in the colon than in anyothercompartment
in LTNPs (Figure 4E). In addition, percentages of Ki-67+ TEM
were higher in all gut and LN compartments than in peripheral
blood specimens in progressors (Figure 4F). In summary, colon
samples from LTNPs had significantly higher rates of CD4+T
cell proliferation and higher percentages of naive CD4+T cells
than did samples from other compartments, both of which
cells may contribute to viral persistence and ongoing viral rep-
lication in the colon of LTNPs.
It is generally accepted that viral replication is associated with
immune activation , which correlates with disease pro-
gression in HIV and SIV infection [25, 26]. To examinewhether
there was any difference in immune activation among different
compartments, we examined CD69 (anearlyactivationmarker)
and HLA-DR (late activation) to compare the frequency of
1852 • JID 2010:202 (15 December) • Ling et al
ments in normal Chinese rhesus macaques, animals with long-term non-
progression of disease (LTNPs), and progressors, as determined by early
activation marker CD69+on CD4+T cells (A) and HLA-DR expression on
CD4+T cells (B). *, compared with peripheral blood specimensP ! .05
from within the same group.
Comparison of T cell activation in different tissue compart-
activated CD4+T cells between jejunum and colon. Most CD4+
T cells in the colon and jejunum of both progressorsandLTNPs
co-expressed CD69 with no significant differences, but both
were significantly higher than in uninfected Chinese RM (Fig-
ure 5A). However, percentages of CD4+HLA-DR+T cells were
low in all compartments of LTNPs and comparable to the con-
trol group, whereas progressors had significantly higher levels
of HLA-DR+CD4+T cells in both jejunum and colon, partic-
ularly in the latter, where 120% of CD4+cells had an activated
(HLA-DR+) phenotype (Figure 5B). Thus, high levels of CD4+
T cell activation and cellular proliferation, specifically in GALT,
may be associated with maintenance of the CD4+T cells sup-
portive of continual infection and dissemination.
The current studies used a unique LTNP Chinese RM model
to study intestinal mucosalreservoirsinHIV-1–infectedLTNPs.
To our knowledge, this is the first study to directly compare
viral levels between the smallandlargeintestineinSIVinfection
with LTNP phenotype. We found that the colon consistently
had detectable levels of cellular viral RNA thatwereconsistently
higher than in jejunum or peripheral blood. Furthermore, the
colon had significantly higher proportions of SIV-target cells
as well as increased percentages of naive and proliferating CD4+
T cells, compared with the jejunum in LTNPs. Our results
obtained from SIV-infected LTNPs, together with studies of
ART [4–7], indicate that GALT is a major site for viral persis-
tence in long-term survivors, whether this is because of ART
or because they are “natural” LTNPs. Furthermore, these data
suggest that the large intestine is consistently the major site of
viral persistence in LTNPs with undetectable viremia, which
likely result from higher rates of CD4+T cell target cells and
turnover in this compartment.
The presence of large concentrations of inductive lymphoid
tissue in the colon (and rectum) likely provides a better milieu
for viral persistence than does the jejunum or other lymphoid
tissues. For example, essentially all CD4+T cells in the jejunum
have an activated memory phenotype, and almost all of these
cells are eliminated in early SIV infection. However, the or-
ganized lymphoid tissue of the colon, although in close prox-
imity to the lamina propria, has a large proportion of naive
CD4+T cells that can be summoned by activation to increase
CCR5 expression and the cellular machinery necessary for in-
fection and replication. Furthermore, these inductive sites are
continuously exposed to environmental antigens, which results
in greater rates of CD4+T cell activation and turnover in these
sites, compared with systemic lymphoid tissues, all of which
may contribute to viral persistence and ongoing replication in
this site. Moreover, CD4+T cells activated in these colonic
inductive sites migrate to the draining lymph nodes and blood,
and they eventually recirculate and return home to the diffuse
lamina propria throughout the length of the intestinal tract
. The mucosal homing marker a4b7 has recently been
implicated by several labs to be a major factor in SIV or HIV
infection [28–31]. Here, we suggest that the GALT may serve
as a sequestered site for continual viral persistence, which
evades an otherwise effective immune response.
A study by Marle et al  has shown that colorectal tissue
had significantly higher levels of HIV gene expression than did
other gastrointestinal compartments, such as the duodenum.
Moreover, Chomont et al  has demonstrated that both TCM
and transitional memory (TTM) CD4+T cells are 2 major HIV
cellular reservoirs in ART-treated individuals . Our results of
high percentages of TCMand TEMin the colon and the larger
levels of virus in this anatomic site are consistent with their
findings. Persistence and turnover of these target cells in the
colon of LTNP may explain why viral tissue reservoirs persist
and are difficult to eradicate.
Demonstrating that the colon is a greater reservoir than je-
junum in chronic infection has significant clinical implications.
Although we did not examine viral RNA and DNA levels in
SIV Reservoir in the Gut in Rhesus Macaques • JID 2010:202 (15 December) • 1853
other parts of the large intestine, such as the rectum, it is likely
that LTNPs would also have higher viral levels in the rectum
than in the small intestine, because its histological organization
is similar to that of the colon. Therefore, vaccine or antiviral
therapy studies can be evaluated by rectal or colon biopsies,
without the need to examine biopsies from the small intestine.
It is generally accepted that immune activation and inflam-
mation is associated with viral replication during HIV-1 infec-
tion . Immune activation can stimulate additional CD4+T
cells to convertto activatedmemoryCCR5+Tcells,whichresult
in additional targets for viral replication . Patients who
have lower levels of immune activation can control infection
with low viral loads [26, 35]. Although in agreement that im-
mune activation may distinguish LTNPs from progressors, our
results indicate that immune activation is not a major con-
tributor in distinguishing reservoirs of the jejunum and colon
in LTNPs, because immune activation is comparable in the 2
In summary, our results suggest that the large intestine is
the major reservoir in SIV-infected LTNPs. Furthermore, the
data suggest that persistence of infection may be associatedwith
the unique mechanisms of cellular activation and homing of
GALT cells to other tissue sites, which serve as a source of naive
resting cells (that harbor latent virus), which eventuallybecome
activated, resulting in viral transcription, replication, and seed-
ing of infected CD4+T cells to other tissue sites. Eliminating
this reservoir may be difficult, but efforts to reduce oreliminate
virus from these tissue sites by selective targeting of drugs or
vaccines to intestinal tissues may be a useful strategy for re-
ducing viral replication in HIV-1–infected patients.
We thank Mike Hart and Linda Rogers, for technical assistance; C. Lan-
clos, J. Bruhn, and D. Waguespack, for flow cytometry assistance; Dr. T.
Ooms, for veterinary support; and the animal care staff at the Tulane
National Primate Research Center (Covington, LA)
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