Antiretroviral treatment failure is associated with the emergence of resistant human immunodeficiency virus type 1 (HIV-1) populations which often express altered replicative capacity (RC). The resistance and RC of clinical HIV-1 strains, however, are generally assayed using activated peripheral blood mononuclear cells (PBMC) or tumor cell lines. Because of their high proliferation rate and concurrent high deoxynucleoside triphosphate (dNTP) content, both resistance and RC alterations might be misestimated in these cell systems. We have evaluated the resistance of HIV-1 clones expressing a variety of RT resistance mutations in primary human macrophages using a single cycle system. Our experiments indicate that d4T, ddI, and 3TC are more potent in macrophages than in HeLa-derived P4 tumor cells. Mutant viruses bearing thymidine analogue mutations (TAMs) or the K65R mutation had similar resistance levels in the two cell types. Strikingly, however, the M184V mutant, although fully resistant to 3TC in P4 cells, maintained some susceptibility to 3TC in macrophages from 8 of 11 donors. Using the same system, we found that the impact of resistance mutations on HIV RC was minimal in activated PBMC and in P4 cells. In contrast, mutant viruses exhibited strongly impaired RC relative to the wild type (WT) in macrophages, with the following RC order: WT > two TAMs > four TAMs ؍ M184V > K65R. In undifferentiated monocytes, WT virus replication could be detected in three of six donors, but replication of all mutant viruses remained undetectable. Altogether, our results confirm that nucleoside reverse transcriptase inhibitors (NRTIs) are powerful antiviral agents in differentiated macrophages, reveal that HIV resistance to some NRTIs may be less efficient in these cells, and indicate that resistance-associated loss of RC is more pronounced in macrophages than in high-dNTP content cell systems.Nucleoside analogues, also referred to as nucleoside reverse transcriptase inhibitors (NRTIs) are one of the main drug classes used in the treatment of human immunodeficiency virus type 1 (HIV-1) infection. After phosphorylation into their active triphosphate form by cellular kinases, these compounds, which lack a 3Ј-hydroxyl group, inhibit reverse transcription through termination of viral DNA synthesis. HIV-1 resistance to NRTIs is achieved via two distinct and generally exclusive mechanisms: (i) decreased incorporation of the triphosphorylated NRTI or (ii) excision of the triphosphorylated NRTI and primer unblocking. Decreased NRTI incorporation is mediated by mutations such as the M184V substitution, which induces high-level resistance to -L-2Ј,3Ј-dideoxy-3Ј-thiacytidine (3TC or lamivudine) (24,35,61,64), as well as other mutations such as K74V, K65R, or the Q151M complex. These mutations promote resistance through impairment of the correct positioning of triphosphate NRTIs within the RT active site (19,67). In contrast, thymidine analogue mutations (TAMs), such as the M41L, the D67N, the K70R, the L210W, the T215F/Y, and the K219Q...