title: Molecular evidence for drug-induced compartmentalization of HIV-1 quasispecies in a patient with periodic changes to HAART.
abstract: OBJECTIVE
  To perform molecular analysis of the predominant viral populations and drug-resistance mutations from plasma and peripheral blood mononuclear cell (PBMC) compartments over time from an HIV infected patient, who experienced virological failure while on different HAART regimens.
  
  
  METHODS
  In a longitudinal study proviral and plasma HIV-1 sequences were amplified in the pol, protease and env genes and were sequenced directly and analysed phylogenetically. Virus was recovered from time points corresponding to viral load peaks using co-culturing techniques. The periodic failure of different highly active antiretroviral therapy (HAART) regimens was analysed sequencing.
  
  
  RESULTS
  Longitudinal follow-up studies revealed four inflection peaks of plasma viraemia associated with the recovery of culturable virus in vitro, which indicated failure of the concurrent HAART regimen. Molecular analysis of viral strains revealed evidence of continual evolution and compartmentalization of drug-resistance mutants/quasispecies between plasma and PBMC, with the widest spectrum of mutations isolated from plasma. Importantly, these data show the periodic appearance and clearance of drug-resistance mutants concomitant with the introduction and withdrawal of zidovudine over time.
  
  
  CONCLUSIONS
  This report is unique in showing drug-induced compartmentalization of viral quasispecies under the control of different HAART regimens in both plasma and PBMC. Introduction and withdrawal of zidovudine from the HAART regimen had direct bearing on the appearance and disappearance of specific zidovudine drug-resistance mutations in plasma-derived virus. This data has important implications for the management of HIV-infected patients with poor compliance with certain HAART regimens, and also in predicting the late emergence of drug-resistance mutations via the latent integrated provirus.
authors.affiliation: Retroviral Genetics Laboratory, Centre for Virus Research, Westmead Millennium Institutes, Westmead Hospital, NSW, Sydney, Australia.
authors.forename: Y M
authors.initials: YM
authors.lastname: Wang
authors.forename: W B
authors.initials: WB
authors.lastname: Dyer
authors.forename: C
authors.initials: C
authors.lastname: Workman
authors.forename: B
authors.initials: B
authors.lastname: Wang
authors.forename: J S
authors.initials: JS
authors.lastname: Sullivan
authors.forename: N K
authors.initials: NK
authors.lastname: Saksena
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D018920:Coculture Techniques; D004352:Drug Resistance, Microbial / Q000235:genetics; D019143:Evolution, Molecular; D005500:Follow-Up Studies; D015752:Genes, env; D015751:Genes, pol; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000821:virology*; D016333:HIV Protease / Q000235:genetics; D015497:HIV-1 / Q000235:genetics*; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000821:virology; D008137:Longitudinal Studies; D008297:Male; D009154:Mutation; D015215:Zidovudine / Q000494:pharmacology* / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D015215:Zidovudine; D016333:HIV Protease