Wide variation in susceptibility of transmitted/founder HIV-1 subtype C Isolates to protease inhibitors and association with in vitro replication efficiency

Sci Rep. 2016 Nov 30:6:38153. doi: 10.1038/srep38153.

Abstract

The gag gene is highly polymorphic across HIV-1 subtypes and contributes to susceptibility to protease inhibitors (PI), a critical class of antiretrovirals that will be used in up to 2 million individuals as second-line therapy in sub Saharan Africa by 2020. Given subtype C represents around half of all HIV-1 infections globally, we examined PI susceptibility in subtype C viruses from treatment-naïve individuals. PI susceptibility was measured in a single round infection assay of full-length, replication competent MJ4/gag chimeric viruses, encoding the gag gene and 142 nucleotides of pro derived from viruses in 20 patients in the Zambia-Emory HIV Research Project acute infection cohort. Ten-fold variation in susceptibility to PIs atazanavir and lopinavir was observed across 20 viruses, with EC50s ranging 0.71-6.95 nM for atazanvir and 0.64-8.54 nM for lopinavir. Ten amino acid residues in Gag correlated with lopinavir EC50 (p < 0.01), of which 380 K and 389I showed modest impacts on in vitro drug susceptibility. Finally a significant relationship between drug susceptibility and replication capacity was observed for atazanavir and lopinavir but not darunavir. Our findings demonstrate large variation in susceptibility of PI-naïve subtype C viruses that appears to correlate with replication efficiency and could impact clinical outcomes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Atazanavir Sulfate / therapeutic use
  • DNA Replication / drug effects*
  • DNA Replication / genetics
  • Darunavir / therapeutic use
  • Drug Resistance, Viral / drug effects*
  • Drug Resistance, Viral / genetics
  • Genotype
  • HIV Infections / drug therapy*
  • HIV Infections / virology
  • HIV Protease Inhibitors / therapeutic use*
  • HIV-1 / drug effects*
  • HIV-1 / genetics
  • HIV-1 / physiology
  • Humans
  • Lopinavir / therapeutic use
  • Microbial Sensitivity Tests
  • Virus Replication / drug effects
  • Virus Replication / genetics
  • Zambia
  • gag Gene Products, Human Immunodeficiency Virus / genetics

Substances

  • HIV Protease Inhibitors
  • gag Gene Products, Human Immunodeficiency Virus
  • Lopinavir
  • Atazanavir Sulfate
  • Darunavir