Antiretroviral therapy that targets HIV type-1 (HIV-1) reverse transcriptase (RT) can be linked to mutations in the thumb–connection (amino acids [AA] 241–426) and RNase H (AA 427–560) domains, which could affect drug resistance.
Methods
Genotypical and statistical analyses were performed on HIV-1 RT from 100 antiretroviral treatment-naive and 248 antiretroviral treatment-experienced patients, the majority of whom were infected with HIV-1 subtype B. The RT region was analysed in three parts: the polymerase (AA 1–240), thumb–connection (AA 241–426) and RNase H (AA 427–560) domains.
Results
The polymerase domain had statistically significant changes between the two groups at 24 AA positions that are known resistance sites. Within the thumb–connection domain, R284 and N348 had statistically significant changes between the groups (P=0.007 and P≤0.001, respectively). In treatment-experienced patients, 17.3% had R284K, whereas 24.5% had N348I substitutions. Both R284 and N348 were 100% conserved in treatment-naive patients. Within the RNase H domain, only K451 showed a statistically significant change (P≤0.001), with K451R present in 11% of treatment-experienced patients but remaining 100% conserved among treatment-naive patients.
Conclusions
RT mutations at three positions outside of the polymerase region were associated with antiretroviral therapy: R284K, N348I and K451R. Both R284K and K451R interact with the phosphate backbone of the template or primer in HIV-1 RT crystal structures and could potentially influence the positioning of the primer strand, thus affecting polymerization, the efficiency of nucleoside reverse transcriptase inhibitor excision and/or RNase H activity.
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