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Volumn 3, Issue 6, 2009, Pages 583-594

The K65R mutation in HIV-1 reverse transcriptase: Genetic barriers, resistance profile and clinical implications

Author keywords

HIV 1 drug resistance; K65R; Nucleoside analogs; Subtype C; Tenofovir

Indexed keywords

ABACAVIR; ABACAVIR PLUS DIDANOSINE PLUS TENOFOVIR DISOPROXIL; ABACAVIR PLUS LAMIVUDINE; ABACAVIR PLUS LAMIVUDINE PLUS TENOFOVIR DISOPROXIL; ABACAVIR PLUS LAMIVUDINE PLUS ZIDOVUDINE; ANTIVIRUS AGENT; ARGININE; ARTRIPLA; DIDANOSINE; DIDANOSINE PLUS LAMIVUDINE PLUS TENOFOVIR DISOPROXIL; EFAVIRENZ PLUS EMTRICITABINE PLUS TENOFOVIR DISOPROXIL; EMTRICITABINE; EMTRICITABINE PLUS LAMIVUDINE; EMTRICITABINE PLUS TENOFOVIR DISOPROXIL; LAMIVUDINE; LAMIVUDINE PLUS NEVIRAPINE PLUS STAVUDINE; LAMIVUDINE PLUS NEVIRAPINE PLUS TENOFOVIR DISOPROXIL; LAMIVUDINE PLUS NEVIRAPINE PLUS ZIDOVUDINE; LAMIVUDINE PLUS TENOFOVIR DISOPROXIL PLUS ZIDOVUDINE; LAMIVUDINE PLUS ZIDOVUDINE; LOPINAVIR; LYSINE; NEVIRAPINE; RNA DIRECTED DNA POLYMERASE; RNA DIRECTED DNA POLYMERASE INHIBITOR; STAVUDINE; TENOFOVIR DISOPROXIL; THYMIDINE DERIVATIVE; UNCLASSIFIED DRUG; ZIDOVUDINE; NUCLEOSIDE ANALOG; VIRUS RNA;

EID: 70849120990     PISSN: 17584310     EISSN: None     Source Type: Journal    
DOI: 10.2217/hiv.09.40     Document Type: Review
Times cited : (59)

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    • Deforche K, Camacho RJ, Grossman Z et al.: Bayesian network analysis of resistance analysis of resistance pathways against efavirenz and nevirapine. AIDS 22, 2107-2115 (2008). □ The non-B HIV Working Group is involved in ascertaining the role of subtype diversity in HIV resistance. There is an association between non-B subtype and K65R resistance. Pooled analysis of all non-B subtypes and restrictions to amino acid, rather than nucleotide diversity may, however, fail to adequately define the role of subtype diversity in the selection of resistance mutations.
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    • Llibre JM, Bonjoch A, Iribarren J et al.: Targeting only reverse transcriptase with zidovudine/lamivudine/abacavir plus tenofovir in HIV-1-infected patients with multidrug-resistant virus: a multicentre pilot study. HIV Med. 9, 508-513 (2008). □ A promising salvage strategy to bridge K65R and TAM resistance in patients harboring multidrug resistance.
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    • Ferrer E, Gatell J, Sanchez P et al.: Zidovudine/lamivudine/abacavir plus tenofovir in HIV-infected naive patients: a 96 week prospective one-arm pilot study. AIDS Res. Hum. Retroviruses 24(7), 931-934 (2008). □ An intriguing future strategy for NRTI/non- NRTI/protease inhibitor-sparing regimens for long-term HIV-1 management, based on the bidirectional antagonism between K65R and TAM pathways.
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    • Brenner BG, Oliveira M, Doualla-Bell F et al.: HIV-1 subtype C viruses rapidly develop K65R resistance to tenofovir in cell culture. AIDS 20(9), F9-F13 (2006). □□ Landmark study using a cell-culture selection approach to demonstrate the accelerated development of K65R in subtype C. Follow-up studies have combined site-directed mutagenesis and enzymatic studies to mechanistically define the molecular basis for facilitated development of K65R in subtype C [72-74]. This has important clinical implications in K65R development using 'less forgiving' suboptimal d4T and ddI regimens in third-world settings.
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    • Miller MD, Margot N, McColl D, Cheng AK: K65R development among subtype C HIV-1 patients in tenofovir DF clinical trials. AIDS 21, 265-266 (2007). □ While these authors argued against the findings of a previous reference [65], clinical studies clearly demonstrate the facilitated development of K65R in resource-poor settings with d4T-NVP and d4T-ddI. However, the potency of TDF/emtricitabine regimens may offset the development of K65R in subtype C.
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    • The public health approach to identify antiretroviral therapy failure: High level nucleoside reverse transcriptase inhibitor resistance among Malawians failing first-line antiretroviral therapy
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    • Hosseinipour M, van Oosterhout JJ, Weigel R et al.: The public health approach to identify antiretroviral therapy failure: high level nucleoside reverse transcriptase inhibitor resistance among Malawians failing first-line antiretroviral therapy. AIDS 23, 1127-1134 (2009). □□ Important study demonstrating clinical correlates for the disparate high rates of K65R in subtype C viruses failing d4T/3TC/NVP regimens in Malawi.
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    • Invernizzi CF, Coutsinos D, Moisi D et al.: Introduction of the 64/65 nucleotide polymorphisms of subtype C into subtype B HIV-1 selects for the K65R mutational pathway in cell culture. Presented at: 15th Conference on Retroviruses and Opportunistic Infections. Boston, MA, USA, 3-6 February 2008 (Poster 849). □□ An important paper using site-directed mutagenesis of two nucleotides in codons 64 and 65 of subtype B to demonstrate the template-based mechanism for the facilitated selection of K65R in subtype C infections.
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