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JAC Advance Access published online on June 10, 2005
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dki194
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Leading article

Diversity of thymidine analogue resistance genotypes among newly diagnosed HIV-1-infected persons

J. Gerardo García-Lerma 1*

1 Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS G-19, Atlanta, GA 30333, USA

* To whom correspondence should be addressed.
J. Gerardo García-Lerma, E-mail: GGarcia-lerma{at}cdc.gov


  Abstract

The introduction of highly active antiretroviral therapy (HAART) has resulted in a significant decrease in HIV and AIDS-related mortality and morbidity. However, these treatments can select for drug-resistant viruses which are associated with poor virological responses to the antiretroviral therapy and possible loss of clinical benefit. Drug-resistant viruses can also be transmitted between individuals. In the absence of drug pressure, transmitted drug-resistant viruses gradually lose resistance mutations that confer a selective disadvantage as they evolve to more fit viruses. As a result, unusual resistance-related genotypes not commonly seen in treated patients may arise in the population. Viruses with unique patterns of thymidine analogue-associated mutations (TAMs) have now been identified in a substantial proportion of treatment-naive recently diagnosed persons. In this leading article, I discuss these findings and the potential impact of these unique reverse transcriptase (RT) genotypes on evolution of resistance and treatment responses.

Keywords: revertant viruses; fitness; virus evolution.
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