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Impact of HIV-1 pol diversity on drug resistance and its clinical implications

Kantor, Rami

Current Opinion in Infectious Diseases: December 2006 - Volume 19 - Issue 6 - p 594–606
doi: 10.1097/QCO.0b013e3280109122
Antimicrobial agents: viral/parasitic

Purpose of review: HIV knowledge is based on subtype B, common in resource-rich settings, whereas globally non-B subtypes predominate. Inter-subtype pol diversity encompasses multiple genotypic differences among HIV variants, the consequence of which is unknown. This review summarizes publications from the past year relevant to the impact of HIV diversity on drug resistance evolution and its potential clinical implications.

Recent findings: The benefit of antiretroviral therapy in non-B infected patients is ongoing, though subtype heterogeneity in rates of disease progression is observed. Pol inter-subtype diversity is high, and known subtype B drug resistance mutations occur in non-B subtypes. New mutations and subtype-specific mutation rates are identified, however, unexplained drug susceptibilities are seen, and additional insight is offered on structural pathogenic mechanisms of resistance in non-B subtypes. These differences may affect genotypic interpretation and our ability to apply drug resistance to patient care.

Summary: Current evidence suggests good treatment response and comparable drug resistance evolution in HIV-1 B and non-B infected patients, with increasingly emerging differences. Impact of inter-subtype diversity on drug susceptibility and on evolution of drug resistance should continue to be a major research focus to increase our understanding and ability to improve global patient care.

Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA

Correspondence to Rami Kantor, MD, Assistant Professor of Medicine (Research), Brown University Medical School, Division of Infectious Diseases, The Miriam Hospital, 164 Summit Avenue, RISE 157, Providence, RI 02906, USA Tel: +1 401 7934997; fax: +1 401 7934709; e-mail: rkantor@brown.edu

© 2006 Lippincott Williams & Wilkins, Inc.