Evolution of the HIV-1 integration site landscape and inducible reservoir in early-treated people

Persistence of the HIV-1 reservoir is the major barrier to a cure. Little is known about the dynamics of the proviral integration site landscape and inducibility of the viral reservoir in early-treated individuals. Here, we perform a longitudinal analysis of the viral reservoir in individuals who started treatment during acute infection and compare these findings to chronically-treated individuals. Even in early-treated individuals, clonal expansion contributes to reservoir persistence. Integration site analysis reveals similar distributions after one year of antiretroviral therapy (ART), irrespective of treatment initiation timing. Notably, proviruses integrated in heterochromatin regions are already detected in early-treated individuals after one year on ART and are progressively enriched after five years on ART, suggesting post-integration selection mechanisms. Using a lipid nanoparticle containing Tat mRNA (Tat-LNP) in combination with phorbol myristate acetate (PMA), we detect for the first time the inducible reservoir in individuals treated during acute infection with small reservoir sizes. Furthermore, we show that, in both the acute and chronic cohorts, the inducible reservoir shifts towards a more differentiated T cell compartment over time. Collectively, these findings indicate that clonal expansion and integration site selection contribute to reservoir persistence early after ART initiation in individuals treated shortly after seroconversion.