؉ patients who spontaneously controlled viral replication, but not viruses from viremic patients expressing these alleles, was significantly greater than that of viruses from patients not expressing these protective HLA-B alleles. Overall, a significant negative correlation between hTRIM5␣ sensitivity and viral load was observed. In HLA-B*57 ؉ patients, the T242N mutation in the HLA-B*57-restricted TW10 CD8 ؉ T lymphocyte (CTL) epitope was strongly associated with hTRIM5␣ sensitivity. In HLA-B*27 ؉ controllers, hTRIM5␣ sensitivity was associated with a significant reduction in emergence of key CTL mutations. In several patients, viral evolution to avoid hTRIM5␣ sensitivity was observed but could be associated with reduced viral replicative capacity. Thus, in individuals expressing protective HLA-B alleles, the combined pressures exerted by CTL, hTRIM5␣, and capsid structural constraints can prevent viral escape both by impeding the selection of necessary resistance/compensatory mutations and forcing the selection of escape mutations that increase hTRIM5␣ sensitivity or impair viral replicative capacity.