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Dual Selection Pressure by Drugs and HLA Class I-Restricted Immune Responses on Human Immunodeficiency Virus Type 1 Protease ^,

Department of Medicine III, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany,¹ Institute of Clinical and Molecular Virology, University of Erlangen-Nuremberg, Erlangen, Germany,² Institute of Biochemistry, Emil-Fischer-Center, University of Erlangen-Nuremberg, Erlangen, Germany,³ German Competence Network on HIV/AIDS⁴

Received 19 July 2006/ Accepted 21 December 2006

To determine the influence of human immunodeficiency virus type 1 (HIV-1)-specific CD8⁺ T cells on the development of drug resistance mutations in the HIV-1 protease, we analyzed protease sequences from viruses from a human leukocyte antigen class I (HLA class I)-typed cohort of 94 HIV-1-positive individuals. In univariate statistical analyses (Fisher's exact test), minor and major drug resistance mutations as well as drug-associated polymorphisms showed associations with HLA class I alleles. All correlations with P values of 0.05 or less were considered to be relevant without corrections for multiple tests. A subset of these observed correlations was experimentally validated by enzyme-linked immunospot assays, allowing the definition of 10 new epitopes recognized by CD8⁺ T cells from patients with the appropriate HLA class I type. Several drug resistance-associated mutations in the protease acted as escape mutations; however, cells from many patients were still able to generate CD8⁺ T cells targeting the escape mutants. This result presumably indicates the usage of different T-cell receptors by CD8⁺ T cells targeting these epitopes in these patients. Our results support a fundamental role for HLA class I-restricted immune responses in shaping the sequence of the HIV-1 protease in vivo. This role may have important clinical implications both for the understanding of drug resistance pathways and for the design of therapeutic vaccines targeting drug-resistant HIV-1.

Published ahead of print on 3 January 2007.

Supplemental material for this article may be found at http://jvi.asm.org/.

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