“…It is thought that the emergence of V32I and I84V took place relatively quickly because of the use of HIV 11MIX as a starting virus population, which led to homologous recombination occurring from one isolate to another in the presence of escalating doses of DRV, expediting the emergence of highly DRV-resistant Interestingly, in both HIV 11MIX 037-1-WK40 , and HIV 11MIX 044-1-WK40 , the unique substitution, A28S, known to lead to a significant reduction in protease activity (24) and poor viral fitness (25), had been acquired by passage 40 (highlighted in red in Figure 5), while both resultant variants had not apparently acquired high levels of resistance to GRL-037 or GRL-044 and did not replicate well in the presence of either of the two compounds (Figure 3). Since the A28S substitution has been seen with a few PIs, such as TMC-126 (26), GRL-98065 (27), brecanavir (25), and GRL-1398 (12) and not with any of the currently available FDA-approved PIs except only in a few cases (28,29), we repeated the selection assay with APV, DRV, and GRL-044 ( Figure 3 , Experiment 2). When we determined the amino acid sequence of the protease of HIV 11MIX with direct nucleic acid sequencing after HIV 11MIX was selected in the presence of GRL-044 in the second selection assay, the same A28S substitution was identified by week 27 as highlighted in red at the bottom of Figure 5.…”