title: Nonpolymorphic human immunodeficiency virus type 1 protease and reverse transcriptase treatment-selected mutations.
abstract: The spectrum of human immunodeficiency virus type 1 (HIV-1) protease and reverse transcriptase (RT) mutations selected by antiretroviral (ARV) drugs requires ongoing reassessment as ARV treatment patterns evolve and increasing numbers of protease and RT sequences of different viral subtypes are published. Accordingly, we compared the prevalences of protease and RT mutations in HIV-1 group M sequences from individuals with and without a history of previous treatment with protease inhibitors (PIs) or RT inhibitors (RTIs). Mutations in protease sequences from 26,888 individuals and in RT sequences from 25,695 individuals were classified according to whether they were nonpolymorphic in untreated individuals and whether their prevalence increased fivefold with ARV therapy. This analysis showed that 88 PI-selected and 122 RTI-selected nonpolymorphic mutations had a prevalence that was fivefold higher in individuals receiving ARVs than in ARV-naïve individuals. This was an increase of 47% and 77%, respectively, compared with the 60 PI- and 69 RTI-selected mutations identified in a similar analysis that we published in 2005 using subtype B sequences obtained from one-fourth as many individuals. In conclusion, many nonpolymorphic mutations in protease and RT are under ARV selection pressure. The spectrum of treatment-selected mutations is changing as data for more individuals are collected, treatment exposures change, and the number of available sequences from non-subtype B viruses increases.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, CA 94305, USA.
authors.forename: Rajin
authors.initials: R
authors.lastname: Shahriar
authors.forename: Soo-Yon
authors.initials: SY
authors.lastname: Rhee
authors.forename: Tommy F
authors.initials: TF
authors.lastname: Liu
authors.forename: W Jeffrey
authors.initials: WJ
authors.lastname: Fessel
authors.forename: Anthony
authors.initials: A
authors.lastname: Scarsella
authors.forename: William
authors.initials: W
authors.lastname: Towner
authors.forename: Susan P
authors.initials: SP
authors.lastname: Holmes
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Zolopa
authors.forename: Robert W
authors.initials: RW
authors.lastname: Shafer
mesh_terms: D019380:Anti-HIV Agents / Q000494:pharmacology*; D024882:Drug Resistance, Viral; D016333:HIV Protease / Q000737:chemistry / Q000235:genetics*; D017320:HIV Protease Inhibitors / Q000494:pharmacology*; D054303:HIV Reverse Transcriptase / Q000737:chemistry / Q000235:genetics*; D006801:Humans; D009154:Mutation; D018894:Reverse Transcriptase Inhibitors / Q000494:pharmacology*
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors; C514824:reverse transcriptase, Human immunodeficiency virus 1; D054303:HIV Reverse Transcriptase; D016333:HIV Protease; C514803:p16 protease, Human immunodeficiency virus 1