Fitness disadvantage of the transitional intermediates compared to the initial R5 viruses has been suggested to constitute one of the blockades to coreceptor switching, explaining the late appearance of X4 viruses. Using a simian model for human immunodeficiency virus type 1 (HIV-1) coreceptor switching, we demonstrate in this study that similar molecular evolutionary pathways to coreceptor switch occur in more than one R5 simian/ human immunodeficiency virus (SHIV) SF162P3N -infected macaque. In infected animals where multiple pathways for expansion or switch to CXCR4 coexist, fitness of the transitional intermediates in coreceptor usage efficiency influences their outgrowth and representation in the infecting virus population. Dualtropic and X4 viruses appear at different disease stages, but they have lower entry efficiency than the coexisting R5 strains, which may explain why they do not outcompete the R5 viruses. Similar observations were made in two infected macaques with coreceptor switch, providing in vivo evidence that fitness disadvantage is an obstacle to X4 emergence and expansion.Entry of the human immunodeficiency virus type 1 (HIV-1) requires interactions between the viral envelope glycoprotein and cell surface CD4 and a chemokine receptor, either CCR5 or CXCR4 (4). Most HIV transmissions are initiated with CCR5-using (R5) viruses. However, in nearly half of treatment-naïve HIV-1 subtype B-infected individuals, variants that use CXCR4 (X4) arise late in infection, and their emergence is associated with accelerated CD4 ϩ T cell loss and rapid disease progression (3,9,13,33,46,47,55,56). The R5-to-X4 evolutionary process in vivo and in vitro transitions through intermediates that are able to use both coreceptors (13,46,51) and requires amino acid changes in the V3 loop of envelope glycoprotein gp120 (26). However, while the genotypic and phenotypic determinants for expansion or switch to CXCR4 use are well characterized, the mechanistic basis and obstacles for change in coreceptor preference in vivo are yet to be fully elucidated. Among several factors that have been proposed as playing important roles, fitness disadvantage of the transitional intermediates compared with the initial R5 viruses has been suggested to constitute one of the blockades to coreceptor switching (34, 42), explaining the late appearance of X4 viruses.We recently developed an R5 simian/human immunodeficiency virus (SHIV) SF162P3N infection of a rhesus macaque model to study coreceptor switch in vivo (27,28,43). The macaques infected intravenously (i.v.) or intrarectally (i.r.) with R5 SHIV SF162P3N in which X4 virus evolved and emerged are rapid progressors (RPs), with a clinical course that is characterized by extremely high levels of virus replication and weak or undetectable antiviral antibody and cellular immune responses. We demonstrated that, similar to findings in humans (11,15,20,31,49,52), sequence changes in the V3 loop of envelope gp120 determine the phenotypic change from R5 to X4 in macaques. Furthermore, consisten...