Although lamivudine and emtricitabine, two L-deoxycytidine analogs, have been widely used as antiviral drugs for years, a structural basis for D-stereoselectivity against L-dNTPs, enantiomers of natural nucleotides (D-dNTPs), by any DNA polymerase or reverse transcriptase has not been established due to lack of a ternary structure of a polymerase, DNA, and an incoming L-dNTP. Here, we report 2.10-2.25 Å ternary crystal structures of human DNA polymerase λ, DNA, and L-deoxycytidine 5′-triphosphate (L-dCTP), or the triphosphates of lamivudine ((−)3TC-TP) and emtricitabine ((−)FTC-TP) with four ternary complexes per asymmetric unit. The structures of these 12 ternary complexes reveal that relative to D-deoxycytidine 5′-triphosphate (D-dCTP) in the canonical ternary structure of Polλ-DNA-D-dCTP, L-dCTP, (−)3TC-TP, and (−)FTC-TP all have their ribose rotated by 180°. Among the four ternary complexes with a specific L-nucleotide, two are similar and show that the L-nucleotide forms three Watson-Crick hydrogen bonds with the templating nucleotide dG and adopts a chair-like triphosphate conformation. In the remaining two similar ternary complexes, the L-nucleotide surprisingly interacts with the side chain of a conserved active site residue R517 through one or two hydrogen bonds, whereas the templating dG is anchored by a hydrogen bond with the side chain of a semiconserved residue Y505. Furthermore, the triphosphate of the L-nucleotide adopts an unprecedented N-shaped conformation. Our mutagenic and kinetic studies further demonstrate that the side chain of R517 is critical for the formation of the abovementioned four complexes along proposed catalytic pathways for L-nucleotide incorporation and provide the structural basis for the D-stereoselectivity of a DNA polymerase. (Fig. 1), possess L-stereochemistry. Both lamivudine and emtricitabine have been shown to be more effective in inhibiting HIV-1 RT and less toxic than their enantiomeric D-isomers (1-4). In addition, both lamivudine, a potent inhibitor of hepatitis B virus (HBV) (5), and telbivudine, the L-analog of thymidine, are approved drugs for the treatment of HBV infection, whereas emtricitabine is currently in clinical trials for this purpose (6). These L-nucleoside analogs demonstrate less clinical toxicity than their corresponding D-isomers, likely because human DNA polymerases possess strong D-stereoselectivity by preferentially binding and incorporating D-dNTPs over unnatural nucleotides with L-stereochemistry (L-dNTPs) during DNA synthesis. Surprisingly, a structural basis for the discrimination against L-dNTPs by any DNA polymerase or RT has not been established, although D-stereoselectivity has been successfully explored in antiviral drug development.Despite high clinical efficacy, NRTIs are often associated with various drug toxicities resulting from the inhibition of host DNA polymerases that share a catalytic mechanism akin to HIV-1 RT (7). There are 16 identified human DNA polymerases that belong to A-, B-, X-, and Y-families. NRTI-associated mitoc...