HIV-1 promotes cell-to-cell interactions enabling spread from CD4+ T cells to microglia

HIV-1 infection of the brain occurs early in acute infection and results in neuroinflammation and – when untreated – in cognitive impairment, yet the mechanisms by which microglia become infected remain poorly defined. Evidence from simian immunodeficiency virus (SIV) studies supports a model in which infected CD4+ T cells disseminate HIV-1 to tissue macrophages, but this has not yet been confirmed for human microglia. Here, we used human monocyte-derived microglia (MDMi) and autologous HIV-1-infected primary CD4+ T cells to investigate viral transmission and immune cell interactions. Transcriptional profiling of MDMi confirmed microglia signature genes such as CX3CR1, P2RY12 and C1QB , and surface staining showed expression of CD4 and the HIV-1 coreceptor CCR5. Compared to cell-free infection, direct cell-to-cell contact between MDMi and HIV-1-infected CD4+ T cells markedly enhanced productive infection of MDMi. HIV-1 infection downmodulated the “don’t-eat-me” signal CD47 and increased phosphatidylserine on the surface of primary CD4+ T cells. Consequently, HIV-1 infection of primary CD4+ T cells increased microglia–CD4+ T cell interactions and resulted in enhanced phagocytosis by MDMi. Together, this supports a mechanism where HIV-1 facilitates cell-to-cell spread from primary CD4+ T cells to microglia, which has important implications for therapeutic targeting of HIV-1 brain reservoir seeding.