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Journal of Virology, January 2001, p. 595-602, Vol. 75, No. 2
0022-538X/01/$04.00+0   DOI: 10.1128/JVI.75.2.595-602.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Establishment of New Transmissible and Drug-Sensitive Human Immunodeficiency Virus Type 1 Wild Types due to Transmission of Nucleoside Analogue-Resistant Virus

Anthony de Ronde,^1,* Maaike van Dooren,^1, Lia van der Hoek,¹ Denise Bouwhuis,¹ Esther de Rooij,¹ Bob van Gemen,² Rob de Boer,³ and Jaap Goudsmit¹

Department of Human Retrovirology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam,¹ Primagen, 1105 BA Amsterdam,² and Theoretical Biology, Utrecht University, 3584 CH Utrecht,³ The Netherlands

Received 30 May 2000/Accepted 14 October 2000

Sequence analysis of human immunodeficiency virus type 1 (HIV-1) from 74 persons with acute infections identified eight strains with mutations in the reverse transcriptase (RT) gene at positions 41, 67, 68, 70, 215, and 219 associated with resistance to the nucleoside analogue zidovudine (AZT). Follow-up of the fate of these resistant HIV-1 strains in four newly infected individuals revealed that they were readily replaced by sensitive strains. The RT of the resistant viruses changed at amino acid 215 from tyrosine (Y) to aspartic acid (D) or serine (S), with asparagine (N) as a transient intermediate, indicating the establishment of new wild types. When we introduced these mutations and the original threonine (T)-containing wild type into infectious molecular clones and assessed their competitive advantage in vitro, the order of fitness was in accord with the in vivo observations: 215Y < 215D = 215S = 215T. As detected by real-time nucleic acid sequence-based amplification with two molecular beacons, the addition of AZT or stavudine (d4T) to the viral cultures favored the 215Y mutant in a dose-dependent manner. Our results illustrate that infection with nucleoside analogue-resistant HIV leads in newly infected individuals to mutants that are sensitive to nucleoside analogues, but only a single mutation removed from drug-resistant HIV. Such mutants were shown to be transmissible, stable, and prone to rapid selection for resistance to AZT or d4T as soon as antiretroviral therapy was administered. Monitoring of patients for the presence of new HIV-1 wild types with D, S, or N residues at position 215 may be warranted in order to estimate the threat to long-term efficacy of regimens including nucleoside analogues.

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^* Corresponding author. Mailing address: Department of Human Retrovirology, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands. Phone: 31.20.566.8571. Fax: 31.20.566.9080. E-mail: ronde{at}amc.uva.nl.

Present address: Primagen, 1105 BA Amsterdam, The Netherlands.

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Journal of Virology, January 2001, p. 595-602, Vol. 75, No. 2
0022-538X/01/$04.00+0   DOI: 10.1128/JVI.75.2.595-602.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

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