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Journal of Virology, June 2001, p. 4999-5008, Vol. 75, No. 11
0022-538X/01/$04.00+0   DOI: 10.1128/JVI.75.11.4999-5008.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Genotypic Correlates of Phenotypic Resistance to Efavirenz in Virus Isolates from Patients Failing Nonnucleoside Reverse Transcriptase Inhibitor Therapy

Lee Bacheler,1,* Susan Jeffrey,1 George Hanna,2 Richard D'Aquila,2 Lany Wallace,1 Kelly Logue,1 Beverly Cordova,1 Kurt Hertogs,3 Brendan Larder,4 Renay Buckery,1 David Baker, Karen Gallagher,1 Helen Scarnati,1 Radonna Tritch,1 and Chris Rizzo1

DuPont Pharmaceuticals Company, Wilmington, Delaware1; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts2; Virco NV, Mechelen, Belgium3; and Virco UK, Cambridge, United Kingdom4

Received 27 November 2000/Accepted 23 February 2001

Efavirenz (also known as DMP 266 or SUSTIVA) is a potent nonnucleoside inhibitor of human immunodeficiency virus type 1 (HIV-1) reverse transcriptase (RT) activity and of HIV-1 replication in vitro and in vivo. Most patients on efavirenz-containing regimens have sustained antiviral responses; however, rebounds in plasma viral load have been observed in some patients in association with the emergence of mutant strains of HIV-1. Virus isolates from the peripheral blood mononuclear cells (PBMCs) of patients with such treatment failures, as well as recombinant viruses incorporating viral sequences derived from patient plasma, show reduced in vitro susceptibility to efavirenz in association with mutations in the RT gene encoding K103N, Y188L, or G190S/E substitutions. Patterns of RT gene mutations and in vitro susceptibility were similar in plasma virus and in viruses isolated from PBMCs. Variant strains of HIV-1 constructed by site-directed mutagenesis confirmed the role of K103N, G190S, and Y188L substitutions in reduced susceptibility to efavirenz. Further, certain secondary mutations (V106I, V108I, Y181C, Y188H, P225H, and F227L) conferred little resistance to efavirenz as single mutations but enhanced the level of resistance of viruses carrying these mutations in combination with K103N or Y188L. Viruses with K103N or Y188L mutations, regardless of the initial selecting nonnucleoside RT inhibitor (NNRTI), exhibited cross-resistance to all of the presently available NNRTIs (efavirenz, nevirapine, and delavirdine). Some virus isolates from nevirapine or delavirdine treatment failures that lacked K103N or Y188L mutations remained susceptible to efavirenz in vitro, although the clinical significance of this finding is presently unclear.

* Corresponding author. Mailing address: DuPont Pharmaceuticals Co., E336/36B Experimental Station, Wilmington, DE 19880-0336. Phone: (302) 695-4278. Fax: (302) 695-9466. E-mail: lee.bacheler{at}dupontpharma.com.

Journal of Virology, June 2001, p. 4999-5008, Vol. 75, No. 11
0022-538X/01/$04.00+0   DOI: 10.1128/JVI.75.11.4999-5008.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


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