Menu Fermer

Nucleoside and nucleotide reverse transcriptase inhibitors

 Mutations associated with resistanceMutations associated with « possible resistance »
ZDV
  T215A/C/D/E/G/H/I/L/N/S/V/Y/F [1, 2, 3, 4]
At least 3 mutations among: M41L, D67N, K70R, L210W, K219Q/E [1, 2, 3, 4]
 Q151M
 Insertion at codon 69
 
3TC/FTC
 K65R [8, 9, 11]
 M184V/I
 Insertion at codon 69
 Q151M
ABC
  At least 3 mutations among: M41L, D67N, M184V/I, L210W, T215A/C/D/E/G/H/I/L/N/S/V/Y/F [5, 20]
 K65R [6, 8, 9, 24]
 L74V/I [16, 17, 18, 19, 20, 24]
 Y115F [24]
 Q151M
 Insertion at codon 69
  2 mutations among: M41L, D67N, L210W, T215A/C/D/E/G/H/I/L/N/S/V/Y/F [5, 20]
 M184V/I [24]
TDF/TAF
  At least 4 mutations among: M41L, E44D, D67N, T69D/N/S, L74V/I, L210W, T215A/C/D/E/G/H/I/L/N/S/V/Y/F [10, 12, 21, 25, 26]
 K65R/E/N [6, 7, 8, 9, 22, 23, 25, 26]
 Insertion at codon 69
 K70E [13, 14, 15]
  3 mutations among: M41L, E44D, D67N, T69D/N/S, L74V/I, L210W, T215A/C/D/E/G/H/I/L/N/S/V/Y/F [10, 12, 21, 25, 26]
ISL
 M184V/I [27,28,29]  A114S [29]

ZDV: zidovudine, 3TC: lamivudine, FTC: emtricitabine, ddI: didanosine, d4T: stavudine, ABC: abacavir, TDF: tenofovir, TAF : tenofovir alafenamide, ISL: islatravir.

For didanosine and stavudine refer to previous rules (See Archives, September 2017, version 27)

For DNA provirus, impact of stop codons and G->A mutations on ARV resistance is unknown.

1/ Riva C et al. Transmitted virus with substitutions at position 215 and risk of virological failure in antiretroviral naive patients starting highly active antiretroviral therapy. XI International HIV drug resistance workshop : basic principles and clinical implications , 2-5 July 2002, Seville, Spain, abstract 124.

2/ Lanier ER et al. Effect of baseline 215D/C/S « revertant » mutations on virological response to lamivudine /zidovudine- containing regimens and emergence of 215Y upon virological failure. XI International HIV drug resistance workshop : basic principles and clinical implications, 2-5 July 2002, Seville, Spain abstract 146.

3/ Garcia-Lerma et al. Increased ability for selection of zidovudine resistance in a distinct class of wild-type HIV-1 from drug-naive persons. PNAS 2001 ; 98 : 13907-13912.

4/ Chappey C et al. Evolution of amino acid 215 in HIV-1 reverse transcriptase in response to intermittent drug selection. XII International HIV drug resistance workshop : basic principles and clinical implications, 10-14 June 2003, Los Cabos, Mexico, abstract 32.

5/ Brun-Vézinet F et al. Clinically relevant interpretation of genotype for resistance to abacavir : a study from the Narval trial (ANRS 088). AIDS 2003; 17(12):1795-802.

6/ Stone C, Ait-Khaled M, Craig C, Griffin P, Tisdale M. Human immunodeficiency virus type 1 reverse transcriptase mutation selection during in vitro exposure to tenofovir alone or combined with abacavir or lamivudine. Antimicrob Agents Chemother. 2004 Apr;48(4):1413-5.

7/ Miller MD et al. Multivariate analyses of antiviral response to tenofovir DF therapy in antiretroviral–experienced patients. XI International HIV drug resistance workshop : basic principles and clinical implications, 2-5 July 2002, Seville, Spain abstract 14.

8/ Margot NA, Lu B, Cheng A, Miller MD; Study 903 Team. Resistance development over 144 weeks in treatment-naive patients receiving tenofovir disoproxil fumarate or stavudine with lamivudine and efavirenz in Study 903. HIV Med. 2006 Oct;7(7):442-50.

9/ Parikh et al. K65R : a multi-nucleoside resistance mutation of a low but increasing frequency. XII International HIV drug resistance workshop : basic principles and clinical implications, 10-14 June 2003, Los Cabos, Mexico, abstract 136.

10/ Masquelier B et al. Genotypic and pharmacological determinants of the virological response to tenofovir in nucleoside reverse transcriptase inhibitor-experienced patients. Antivir Ther. 2004 ; 9(3):315-23.

11/ Mulamba GB et al. Pre-steady state kinetic analysis of the incorporation of FTC 5’-monophosphate and 3TC 5’-monophosphate by mutants HIV-1 RTs K65R, K65R/Q151M and Q151M. 16th International Conference on Antiviral Research, 27 April-1 May 2003, Savannah, USA. Abstract 39.

12/ Waters J et al. K65R, L74V and TAMs in HIV-1 RT associated with reduced response to tenofovir DF in antiretroviral-experienced patients. 13th Conference on Retroviruses and opportunistic Infections. 5-8 february 2006, Denver, Colorado, poster 633.

13/ Kagan RM, Lee TS, Ross L, Lloyd RM Jr, Lewinski MA, Potts SJ. Molecular basis of antagonism between K70E and K65R tenofovir-associated mutations in HIV-1 reverse transcriptase. Antiviral Res. 2007 Sep;75(3):210-8.

14/ Kagan R et al. Adefovir HIV-1 RT mutation K70E in the age of tenofovir. XIV International HIV Drug Resistance Workshop: basic principles and clinical implications, 7-11 June 2005, Québec City, Québec, Canada, abstract 93.

15/ Sluis-Cremer N, Sheen CW, Zelina S, Torres PS, Parikh UM, Mellors JW. Molecular mechanism by which the K70E mutation in human immunodeficiency virus type 1 reverse transcriptase confers resistance to nucleoside reverse transcriptase inhibitors. Antimicrob Agents Chemother. 2007 Jan;51(1):48-53.

16/ Miller V et al. HIV-1 reverse transcriptase (RT) genotype and susceptibility to RT inhibitors during abacavir monotherapy and combination therapy. AIDS 2000; 14:163–171.

17/ Moyle GJ, et al. Ziagen Once-Daily in Antiretroviral Combination Therapy (CNA30021) Study Team. Abacavir once or twice daily combined with once-daily lamivudine and efavirenz for the treatment of antiretroviral-naive HIV-infected adults: results of the Ziagen Once Daily in Antiretroviral Combination Study. J Acquir Immune Defic Syndr. 2005 Apr 1;38(4):417-25.

18/ Irlbeck D et al. Treatment-emergent mutations for previously naïve HIV-infected adults failing ZDV+3TC+EFV and ABC+3TC+EFV (CNA30024). 11th Conference on Retroviruses and Opportunistic Infections. San Francisco, CA, USA. February 8–11, 2004. Abtract 661.

19/ Gathe JC Jr et al. SOLO: 48-week efficacy and safety comparison of once-daily fosamprenavir /ritonavir versus twice-daily nelfinavir in naive HIV-1-infected patients. AIDS. 2004 Jul 23;18(11):1529-37

20/ Wirden et al. Risk factors for selection of the L74I reverse transcriptase mutation in human immunodeficiency virus type 1-infected patients. Antimicrob Agents Chemother. 2006 Jul;50(7):2553-6.

21/ Wirden M, et al. Antiretroviral combinations implicated in emergence of the L74I and L74V resistance mutations in HIV-1-infected patients. AIDS. 2009 Jan 2;23(1):95-9.

22/ Fourati S et al. Identification of a rare mutation at reverse transcriptase Lys65 (K65E) in HIV-1-infected patients failing on nucleos(t)ide reverse transcriptase inhibitors. J Antimicrob Chemother. 2013 Jun 19.

23/ Ross LL et al. A rare HIV reverse transcriptase mutation, K65N, confers reduced susceptibility to tenofovir, lamivudine and didanosine. AIDS 2006 Mar 21;20(5):787-9.

24/ Tisdale M et al. Combination of mutations in human immunodeficiency virus type 1 reverse transcriptase required for resistance to the carbocyclic nucleoside 1592U89. Antimicrob Agents Chemother. 1997 May;41(5):1094-8.

25/ Callebaut C et al. In Vitro Virology Profile of Tenofovir Alafenamide, a Novel Oral Prodrug of Tenofovir with Improved Antiviral Activity Compared to That of Tenofovir Disoproxil Fumarate. Antimicrob Agents Chemother. 2015 Oct;59(10):5909-16.

26/ Margot NA et al. Rare emergence of drug resistance in HIV-1 treatment-naïve patients after 48 weeks of treatment with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide. HIV Clin Trials. 2016 Mar;17(2):78-87.

27/ Kawamoto et al. 2008. 2′-Deoxy-4′-C-ethynyl-2-halo-adenosines active against drug-resistant human immunodeficiency virus type 1 variants. Int J Biochem Cell Biol. 40, 2410–2420.

28/ Takamatsu et al. 2018 The high genetic barrier of EFdA/MK-8591 stems from strong interactions with the active site of drug-resistant HIV-1 reverse transcriptase. Cell Chem Biol. 2018; 25(10): 1268–1278.e3. doi:10.1016/j.chembiol.2018.07.01.

29/ Diamond T et al. Islatravir selects for HIV 1 variants in MT4 GFP cells that profoundly reduce replicative capacity in peripheral blood mononuclear cells. HIV Glasgow 2020. P120.