ObjectiveIn heavily pretreated patients, resistance mutations arise in both protease (PR) and reverse transcriptase (RT) sequences; however, the relative impact of PR and RT mutations on viral fitness cannot be evaluated with the majority of systems. To address this issue we have developed a model based on recombinant viruses (RVs) that allows the analysis of the replication capacity (RC) of viral populations in which PR and RT are cloned either in combination or separately.
MethodsRVs were generated for full-length polymerase (pol) gene, PR or RT sequences from nine naïve and 14 heavily pretreated HIV-infected patients in therapeutic failure. The relative RC was assessed by comparing luciferase activity between mutant RV and wild-type (wt) isolates.
ResultsA strong decrease (460%) in the RC of the pol RV population was observed in the 14 heavily pretreated patients as compared with the wt RVs. The analysis of PR and RT RVs from these patients showed that the decrease in RC was mainly attributable to PR sequences in three of these 14 patients and to RT sequences in seven of these patients. In the four remaining patients, PR and RT sequences independently reduced the RC of the RVs to similar extents.
ConclusionsDifferent patterns of mutations in either PR or RT have a strong impact on RC in highly experienced HIV-infected patients.Keywords: drug resistance, protease, Renilla luciferase, replicative fitness, reverse transcriptase
IntroductionTreatment of HIV-1-infected patients with highly active antiretroviral therapy (HAART) has significantly reduced the rate of morbidity and mortality associated with HIV-1 infections [1]. Although the main goal of HAART in the management of HIV disease is the suppression of viral replication, defined as the achievement and maintenance of undetectable viraemia in plasma [2,3], failure to achieve complete viral suppression is common [4]. However, despite virological failure, a number of patients have exhibited 'discordant CD4 cell/viral load' responses, defined as stable or increasing CD4 cell counts while viraemia persists [5][6][7][8][9]. Different immune-based mechanisms have been proposed to explain this paradoxical phenomenon: impaired viral replication in thymic tissue [10], decreased cell death by activation-induced apoptosis [11], or regeneration of HIV-specific immune responses [12,13]. However, several studies have suggested a direct decrease in replication capacity (RC) as a result of resistance mutations and a consequent reduction in cytopathic effect as the cause of the sustained immunological benefit observed in the presence of a high viral load.Viral fitness can be defined as the ability of a virus to replicate in a given environment in comparison with a reference strain. This is a complex parameter that depends on multiple viral and host factors. Alterations in any of the viral genes involved in cell entry, reverse transcription, integration, gene expression, assembly, egress or *Present address: Department of Infectious Diseases, Hospital Clinic IDIBAPS, Barcelo...