Science, Vol.269, No.5224, 696-699, 1995
Potential Mechanism for Sustained Antiretroviral Efficacy of AZT-3Tc Combination Therapy
Combinations of antiretroviral drugs that prevent or delay the appearance of drug-resistant human immunodeficiency virus-type 1 (HIV-1) mutants are urgently required. Mutants resistant to 3’-azidothymidine (ATT, zidovudine) became phenotypically sensitive in vitro by mutation of residue 184 of viral reverse transcriptase to valine, which also induced resistance to (-)2’-deoxy-3’-thiacytidine (3TC). Furthermore, AZT-3TC coresistance was not observed during extensive in vitro selection with both drugs. In vivo AZT-3TC combination therapy resulted in a markedly greater decrease in serum HIV-1 RNA concentrations than treatment with AZT alone, even though valine-184 mutants rapidly emerged. Most samples assessed from the combination group remained ATT sensitive at 24 weeks of therapy, consistent with in vitro mutation studies.
Keywords:HUMAN-IMMUNODEFICIENCY-VIRUS;HIGH-LEVEL RESISTANCE;TYPE-1 REVERSE-TRANSCRIPTASE;ZIDOVUDINE AZT;MUTATION;SENSITIVITY;SUSCEPTIBILITIES;INHIBITORS;AGENTS