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Journal of Virology, November 2002, p. 11104-11112, Vol. 76, No. 21
0022-538X/02/$04.00+0     DOI: 10.1128/JVI.76.21.11104-11112.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

Evolution of Phenotypic Drug Susceptibility and Viral Replication Capacity during Long-Term Virologic Failure of Protease Inhibitor Therapy in Human Immunodeficiency Virus-Infected Adults

Jason D. Barbour,1,2 Terri Wrin,3 Robert M. Grant,1,4 Jeffrey N. Martin,4 Mark R. Segal,2,5 Christos J. Petropoulos,3 and Steven G. Deeks4*

Gladstone Institute of Virology and Immunology,1 Department of Medicine, University of California, San Francisco, and San Francisco General Hospital,4 Division of Biostatistics,5 Program in Biological and Medical Informatics, Department of Biopharmaceutical Sciences, School of Pharmacy, University of California, San Francisco, San Francisco, California,2 ViroLogic, Inc., South San Francisco, California3

Received 18 April 2002/ Accepted 26 July 2002

Continued use of antiretroviral therapy despite the emergence of drug-resistant human immunodeficiency virus (HIV) has been associated with the durable maintenance of plasma HIV RNA levels below pretherapy levels. The factors that may account for this partial control of viral replication were assessed in a longitudinal observational study of 20 HIV-infected adults who remained on a stable protease inhibitor-based regimen despite ongoing viral replication (plasma HIV RNA levels consistently >500 copies/ml). Longitudinal plasma samples (n = 248) were assayed for drug susceptibility and viral replication capacity (measured by using a single-cycle recombinant-virus assay). The initial treatment-mediated decrease in plasma viremia was directly proportional to the reduction in replicative capacity (P = 0.01). Early virologic rebound was associated the emergence of a virus population exhibiting increased protease inhibitor phenotypic resistance, while replicative capacity remained low. During long-term virologic failure, plasma HIV RNA levels often remained stable or increased slowly, while phenotypic resistance continued to increase and replicative capacity decreased slowly. The emergence of primary genotypic mutations within protease (particularly V82A, I84V, and L90M) was temporally associated with increasing phenotypic resistance and decreasing replicative capacity, while the emergence of secondary mutations within protease was associated with more-gradual changes in both phenotypic resistance and replicative capacity. We conclude that HIV may be constrained in its ability to become both highly resistant and highly fit and that this may contribute to the continued partial suppression of plasma HIV RNA levels that is observed in some patients with drug-resistant viremia.

* Corresponding author. Mailing address: Ward 84, Building 80, 995 Potrero Ave., San Francisco, CA 94110. Phone: (415) 476-4082, ext. 404. Fax: (415) 476-6953. E-mail: sdeeks{at}php.ucsf.edu.

Journal of Virology, November 2002, p. 11104-11112, Vol. 76, No. 21
0022-538X/02/$04.00+0     DOI: 10.1128/JVI.76.21.11104-11112.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.



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