Resistance profiles of (+)2'-deoxy-3'-oxa-4'-thiocytidine and (-)2'-deoxy-3'-oxa-4'-thio-5-fluorocytidine.

Resistant variants were selected in vitro against two novel nucleoside analogues, (+) dOTC and (-) dOTFC using the HIV-1 molecular clone HXB2D. The variants obtained displayed 6.5-fold and 10-fold resistance to these compounds, respectively. Cloning and sequencing of the RT genes of the selected viruses identified two mutations, M184I for (+) dOTC and M184V for (-) dOTFC. Results with mutated recombinant clones of HXB2D confirmed the importance of these mutations in MT-4 cells. The resistance profiles of clinical samples with wild-type or 3TC-resistant phenotypes were also studied; low to moderate levels of cross-resistance were observed against the novel compounds.     

河南省部分地区人类免疫缺陷病毒1型耐药性发生和演变的队列研究

目的 了解河南省某地人类免疫缺陷病毒(HIV)耐药性毒株的进化演变规律.方法 将河南省南部某地74例接受齐多夫定(AZT)+去羟肌苷(ddI)+奈韦拉平(NVP)联合抗病毒治疗的艾滋病患者纳入研究队列,分别在抗病毒治疗后3、6、12、18个月进行随访调查,通过逐一访谈了解一般情况、服药方案、服药依从性及保障措施、抗病毒治疗前后的临床表现等,同时采集14 ml EDTA抗凝静脉血,检测CD4/CD8细胞数、病毒载量及基因型耐药性.结果 核苷类反转录酶抑制剂中,发生频率最高的耐药突变位点是:67、118、151和215.治疗3、6、12、18个月时AZT耐药发生率分别为6.76%、13.51%、14.86%和9.46%,ddI的耐药发生率分别为2.70%、6.76%、8.11%和5.45%,AZT的耐药发生率高于ddI,核苷类反转录酶抑制剂的耐药性呈现出先上升后下降的趋势.非核苷类反转录酶抑制剂的耐药发生率高于核苷类反转录酶抑制剂,发生频率最高的耐药突变位点是:103和181.治疗3、6、12、18个月时,NVP耐药发生率分别为9.46%、18.92%、22.97%和32.43%.非核苷类反转录酶抑制剂呈现出持续上升的耐药发生趋势.耐药和不耐药患者的病毒载量和CD4+T淋巴细胞计数无显著性差异.服药依从性差可能是耐药发生的主要影响因素.结论 本组患者中已出现对非核苷类反转录酶抑制剂的高度耐药,服药依从性是耐药发生的主要影响因素.应加强服药的监督管理,改善患者的服药依从性.     

人免疫缺陷病毒I型抗AZT抗药株的体外研究

人免疫缺陷病毒Ⅰ型（ＨＩＶ－１）抗３＇─叠氮─３＇─脱氧胸腺嘧啶（ＡＺＴ）抗药株经体外感染Ｃ８１６６淋巴细胞在高浓度ＡＺＴ条件下筛选获得,并暂命名为ＨＩＶ─１─Ｒ株。该抗药株与ＨＴＬＶ─ⅢＢ株相比,在同一感染复数（Ｍ０１）病毒量感染Ｃ８１６６细胞,经不同浓度的ＡＺＴ处理后,其复制的病毒量和对ＡＺＴ的敏感性有显著的差异,抗药株感染Ｃ８１６６细胞,加ＡＺＴ处理后,分离细胞ＤＮＡ作ＰＣＲ扩增后分析,特异性病毒的ＤＮＡ量比敏感株高１００倍以上,显示其抗药性作用点在病毒逆转录ＤＮＡ前。     

Emergence of minor drug-resistant HIV-1 variants after triple antiretroviral prophylaxis for prevention of vertical HIV-1 transmission

Background

WHO-guidelines for prevention of mother-to-child transmission of HIV-1 in resource-limited settings recommend complex maternal antiretroviral prophylaxis comprising antenatal zidovudine (AZT), nevirapine single-dose (NVP-SD) at labor onset and AZT/lamivudine (3TC) during labor and one week postpartum. Data on resistance development selected by this regimen is not available. We therefore analyzed the emergence of minor drug-resistant HIV-1 variants in Tanzanian women following complex prophylaxis.

Method

1395 pregnant women were tested for HIV-1 at Kyela District Hospital, Tanzania. 87/202 HIV-positive women started complex prophylaxis. Blood samples were collected before start of prophylaxis, at birth and 1–2, 4–6 and 12–16 weeks postpartum. Allele-specific real-time PCR assays specific for HIV-1 subtypes A, C and D were developed and applied on samples of mothers and their vertically infected infants to quantify key resistance mutations of AZT (K70R/T215Y/T215F), NVP (K103N/Y181C) and 3TC (M184V) at detection limits of <1%.

Results

50/87 HIV-infected women having started complex prophylaxis were eligible for the study. All women took AZT with a median duration of 53 days (IQR 39–64); all women ingested NVP-SD, 86% took 3TC. HIV-1 resistance mutations were detected in 20/50 (40%) women, of which 70% displayed minority species. Variants with AZT-resistance mutations were found in 11/50 (22%), NVP-resistant variants in 9/50 (18%) and 3TC-resistant variants in 4/50 women (8%). Three women harbored resistant HIV-1 against more than one drug. 49/50 infants, including the seven vertically HIV-infected were breastfed, 3/7 infants exhibited drug-resistant virus.

Conclusion

Complex prophylaxis resulted in lower levels of NVP-selected resistance as compared to NVP-SD, but AZT-resistant HIV-1 emerged in a substantial proportion of women. Starting AZT in pregnancy week 14 instead of 28 as recommended by the current WHO-guidelines may further increase the frequency of AZT-resistance mutations. Given its impact on HIV-transmission rate and drug-resistance development, HAART for all HIV-positive pregnant women should be considered.     

Antiviral action of membranotropic compounds modified by adamantane and norbornene pharmacophores exerted on different HIV-1 strains

The anti-HIV activity of new membranotropic compounds, i.e. of the polycarboxylate matrix and of its derivatives modified by adamantane and norbonene, was studied in respect of HIV-1 strains, whose tropicity to coreceptors CCR5 and CXCR4 was different, as well as in respect of HIV-1 variants resistant to azidothymidine (AZT) in a continuous culture of human lymphoid cells (MT-4) and in mononuclear cells of peripheral blood from healthy donors. Testing of complex compounds in a culture of infected MT-4 human lymphoid cells showed an effective inhibition of viral reproduction of LAV.04 (CXCR4-tropic variant) and of HIV11(EVK) as well as AZT-resistant variants. The studied pharmacophores-modified compounds displayed, in infection of the primary culture of human mononuclear cells of the HIV-1 R5 and X4 strains, a notable antiviral activity with their HIV efficiency significantly exceeding the one of the original matrix.     

In vitro selection and characterization of human immunodeficiency virus type 1 resistant to Zidovudine and tenofovir

In this study, we undertook to generate HIV-1 resistance to PMPA by in vitro passage and to characterize the cross-resistance patterns and RT mutations in the generated resistant virus. The HIV-1 A102-resistant to AZT was serially passaged for 4 months in the presence of increasing concentrations of PMPA up to maximum of 40 microM on the fresh MT-2 cells. After 25 passages, HIV-1 developed decreased sensitivity to PMPA after long-term in vitro exposure. Selected HIV-1 mutants were characterized by decreased susceptibility to PMPA (4-fold). This decrease could be related to PMPA resistant caused by an amino acid change associated with a V148M substitution. From these results, additional studies will be needed to determine whether a similar mutation in HIV RT develops in patients receiving PMPA or its orally bioavailable prodrug, tenofovir dipivoxil fumarate.     

Dynamic changes in HIV-1 quasispecies from azidothymidine (AZT)-treated patients.

The emergence of azidothymidine (AZT)-resistant human immunodeficiency virus (HIV) variants in clinical samples was studied by a direct genomic sequencing method. Sequential lymphocyte samples from four patients, who had been treated with AZT for up to 27 months, were shown to gradually accumulate multiple nucleotide changes, some of which are known to be associated with AZT resistance. Several samples were shown to contain mixtures of wild-type and mutated genomes, indicating gradual rather than sudden changes in the HIV-1 quasispecies. These results demonstrate for the first time that automated solid-phase DNA sequencing is a rapid and useful tool for investigation of antiviral drug resistance and suggest that DNA sequencing may be important in routine clinical diagnostics in the future.