title: Genetic correlates of in vivo viral resistance to indinavir, a human immunodeficiency virus type 1 protease inhibitor.
abstract: Indinavir (IDV) (also called CRIXIVAN, MK-639, or L-735,524) is a potent and selective inhibitor of the human immunodeficiency virus type 1 (HIV-1) protease. During early clinical trials, in which patients initiated therapy with suboptimal dosages of IDV, we monitored the emergence of viral resistance to the inhibitor by genotypic and phenotypic characterization of primary HIV-1 isolates. Development of resistance coincided with variable patterns of multiple substitutions among at least 11 protease amino acid residues. No single substitution was present in all resistant isolates, indicating that resistance evolves through multiple genetic pathways. Despite this complexity, all of 29 resistant isolates tested exhibited alteration of residues M-46 (to I or L) and/or V-82 (to A, F, or T), suggesting that screening of these residues may be useful in predicting the emergence of resistance. We also extended our previous finding that IDV-resistant viral variants exhibit various patterns of cross-resistance to a diverse panel of HIV-1 protease inhibitors. Finally, we noted an association between the number of protease amino acid substitutions and the observed level of IDV resistance. No single substitution or pair of substitutions tested gave rise to measurable viral resistance to IDV. The evolution of this resistance was found to be cumulative, indicating the need for ongoing viral replication in this process. These observations strongly suggest that therapy should be initiated with the most efficacious regimen available, both to suppress viral spread and to inhibit the replication that is required for the evolution of resistance.
authors.affiliation: Department of Antiviral Research, Merck Research Laboratories, West Point, Pennsylvania 19486, USA. jon_condra@merck.com.
authors.forename: J H
authors.initials: JH
authors.lastname: Condra
authors.forename: D J
authors.initials: DJ
authors.lastname: Holder
authors.forename: W A
authors.initials: WA
authors.lastname: Schleif
authors.forename: O M
authors.initials: OM
authors.lastname: Blahy
authors.forename: R M
authors.initials: RM
authors.lastname: Danovich
authors.forename: L J
authors.initials: LJ
authors.lastname: Gabryelski
authors.forename: D J
authors.initials: DJ
authors.lastname: Graham
authors.forename: D
authors.initials: D
authors.lastname: Laird
authors.forename: J C
authors.initials: JC
authors.lastname: Quintero
authors.forename: A
authors.initials: A
authors.lastname: Rhodes
authors.forename: H L
authors.initials: HL
authors.lastname: Robbins
authors.forename: E
authors.initials: E
authors.lastname: Roth
authors.forename: M
authors.initials: M
authors.lastname: Shivaprakash
authors.forename: T
authors.initials: T
authors.lastname: Yang
authors.forename: J A
authors.initials: JA
authors.lastname: Chodakewitz
authors.forename: P J
authors.initials: PJ
authors.lastname: Deutsch
authors.forename: R Y
authors.initials: RY
authors.lastname: Leavitt
authors.forename: F E
authors.initials: FE
authors.lastname: Massari
authors.forename: J W
authors.initials: JW
authors.lastname: Mellors
authors.forename: K E
authors.initials: KE
authors.lastname: Squires
authors.forename: R T
authors.initials: RT
authors.lastname: Steigbigel
authors.forename: H
authors.initials: H
authors.lastname: Teppler
authors.forename: E A
authors.initials: EA
authors.lastname: Emini
mesh_terms: D001483:Base Sequence; D004279:DNA, Viral; D004352:Drug Resistance, Microbial; D014644:Genetic Variation; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology*; D016333:HIV Protease / Q000737:chemistry / Q000378:metabolism*; D017320:HIV Protease Inhibitors / Q000494:pharmacology*; D015497:HIV-1 / Q000145:classification / Q000187:drug effects* / Q000201:enzymology / Q000302:isolation & purification; D006367:HeLa Cells; D006801:Humans; D019469:Indinavir / Q000494:pharmacology*; D008969:Molecular Sequence Data; D010641:Phenotype
chemical_list: D004279:DNA, Viral; D017320:HIV Protease Inhibitors; D019469:Indinavir; D016333:HIV Protease