title: Human immunodeficiency virus type 1 resistance or cross-resistance to nonnucleoside reverse transcriptase inhibitors currently under development as microbicides.
abstract: Microbicides based on nonnucleoside reverse transcriptase inhibitors (NNRTIs) are currently being developed to protect women from HIV acquisition through sexual contact. However, the large-scale introduction of these products raises two major concerns. First, when these microbicides are used by undiagnosed HIV-positive women, they could potentially select for viral resistance, which may compromise subsequent therapeutic options. Second, NNRTI-based microbicides that are inactive against NNRTI-resistant strains might promote the selective transmission of these viruses. In order to address these concerns, drug resistance was selected in vitro by the serial passage of three viral isolates from subtypes B and C and CRF02_AG (a circulating recombinant form) in activated peripheral blood mononuclear cells (PBMCs) under conditions of increasing concentrations of three NNRTIs (i.e., TMC120, UC781, and MIV-160) that are currently being developed as candidate microbicides. TMC120 and MIV-160 displayed a high genetic barrier to resistance development, whereas resistance to UC781 emerged rapidly, similarly to efavirenz and nevirapine. Phenotypically, the selected viruses appeared to be highly cross-resistant to current first-line therapeutic NNRTIs (i.e., delavirdine, nevirapine, and efavirenz), although they retained some susceptibility to the more recently developed NNRTIs lersivirine and etravirine. The ability of UC781, TMC120, and MIV-160 to inhibit the in vitro-selected NNRTI-resistant viruses was also limited, although residual activity could be observed for the candidate microbicide NNRTI MIV-170. Interestingly, only four p2/p7/p1/p6/PR/RT/INT recombinant NNRTI-resistant viruses (i.e., TMC120-resistant VI829, EFV-resistant VI829, MIV-160-resistant VI829, and EFV-resistant MP568) showed impairments in replicative fitness. Overall, these in vitro analyses demonstrate that due to potential cross-resistance, the large-scale introduction of single-NNRTI-based microbicides should be considered with caution.
authors.affiliation: Department of Microbiology, Virology Unit, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Belgium. pselhorst@itg.be
authors.forename: Philippe
authors.initials: P
authors.lastname: Selhorst
authors.forename: Ana C
authors.initials: AC
authors.lastname: Vazquez
authors.forename: Katty
authors.initials: K
authors.lastname: Terrazas-Aranda
authors.forename: Johan
authors.initials: J
authors.lastname: Michiels
authors.forename: Katleen
authors.initials: K
authors.lastname: Vereecken
authors.forename: Leo
authors.initials: L
authors.lastname: Heyndrickx
authors.forename: Jan
authors.initials: J
authors.lastname: Weber
authors.forename: Miguel E
authors.initials: ME
authors.lastname: Quiñones-Mateu
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Ariën
authors.forename: Guido
authors.initials: G
authors.lastname: Vanham
mesh_terms: D000480:Alkynes; D000813:Anilides / Q000494:pharmacology; D000890:Anti-Infective Agents / Q000494:pharmacology*; D048588:Benzoxazines / Q000494:pharmacology; D002460:Cell Line; D002478:Cells, Cultured; D003521:Cyclopropanes; D020008:Delavirdine / Q000494:pharmacology; D024882:Drug Resistance, Viral / Q000235:genetics*; D005663:Furans / Q000494:pharmacology; D005838:Genotype; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics*; D006801:Humans; D019829:Nevirapine / Q000494:pharmacology; D018894:Reverse Transcriptase Inhibitors / Q000494:pharmacology*; D013844:Thiazoles / Q000494:pharmacology*; D013854:Thioamides; D013890:Thiourea / Q000031:analogs & derivatives* / Q000494:pharmacology
chemical_list: D000480:Alkynes; D000813:Anilides; D000890:Anti-Infective Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D005663:Furans; C580640:MIV-160; D018894:Reverse Transcriptase Inhibitors; D013844:Thiazoles; D013854:Thioamides; D019829:Nevirapine; D020008:Delavirdine; D013890:Thiourea; C098320:efavirenz; C100668:UC-781