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Research Article

Impact of HIV-1 Subtype and Antiretroviral Therapy on Protease and Reverse Transcriptase Genotype: Results of a Global Collaboration

  • Rami Kantor mail,

    *To whom correspondence should be addressed. E-mail: rkantor@ brown.edu

    Affiliation: Division of Infectious Disease and Center for AIDS Research, Stanford University, Stanford, California, United States of America

    ¤Current affiliation: Division of Infectious Diseases, Brown University, Providence, Rhode Island, United States of America

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  • David A Katzenstein,

    Affiliation: Division of Infectious Disease and Center for AIDS Research, Stanford University, Stanford, California, United States of America

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  • Brad Efron,

    Affiliation: Department of Statistics and Division of Biostatistics, Stanford University, Stanford, California, United States of America

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  • Ana Patricia Carvalho,

    Affiliation: Hospital Egas Moniz, Lisbon, Portugal

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  • Brian Wynhoven,

    Affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada

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  • Patricia Cane,

    Affiliation: Health Protection Agency, Porton Down, United Kingdom

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  • John Clarke,

    Affiliation: Wright Fleming Institute, Imperial College, St. Mary's Hospital, London, United Kingdom

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  • Sunee Sirivichayakul,

    Affiliation: Chulalongkorn University, Bangkok, Thailand

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  • Marcelo A Soares,

    Affiliation: Universidade Federal do Rio de Janeiro, Brazil

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  • Joke Snoeck,

    Affiliation: Rega Institute for Medical Research, Leuven, Belgium

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  • Candice Pillay,

    Affiliation: National Institute of Communicable Diseases, Johannesburg, South Africa

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  • Hagit Rudich,

    Affiliation: Central Virology, Public Health Laboratories, Ministry of Health, Tel-Hashomer, Israel

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  • Rosangela Rodrigues,

    Affiliation: Instituto Adolfo Lutz, Sao Paulo, Brazil

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  • Africa Holguin,

    Affiliation: Hospital Carlos III, Madrid, Spain

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  • Koya Ariyoshi,

    Affiliation: National Institute of Infectious Diseases, Tokyo, Japan

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  • Maria Belen Bouzas,

    Affiliation: Fundación Huesped, Buenos Aires, Argentina

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  • Pedro Cahn,

    Affiliation: Fundación Huesped, Buenos Aires, Argentina

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  • Wataru Sugiura,

    Affiliation: National Institute of Infectious Diseases, Tokyo, Japan

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  • Vincent Soriano,

    Affiliation: Hospital Carlos III, Madrid, Spain

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  • Luis F Brigido,

    Affiliation: Instituto Adolfo Lutz, Sao Paulo, Brazil

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  • Zehava Grossman,

    Affiliation: Central Virology, Public Health Laboratories, Ministry of Health, Tel-Hashomer, Israel

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  • Lynn Morris,

    Affiliation: National Institute of Communicable Diseases, Johannesburg, South Africa

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  • Anne-Mieke Vandamme,

    Affiliation: Rega Institute for Medical Research, Leuven, Belgium

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  • Amilcar Tanuri,

    Affiliation: Universidade Federal do Rio de Janeiro, Brazil

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  • Praphan Phanuphak,

    Affiliation: Chulalongkorn University, Bangkok, Thailand

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  • Jonathan N Weber,

    Affiliation: Wright Fleming Institute, Imperial College, St. Mary's Hospital, London, United Kingdom

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  • Deenan Pillay,

    Affiliation: University College London and Health Protection Agency, London, United Kingdom

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  • P. Richard Harrigan,

    Affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada

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  • Ricardo Camacho,

    Affiliation: Hospital Egas Moniz, Lisbon, Portugal

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  • Jonathan M Schapiro,

    Affiliation: Division of Infectious Disease and Center for AIDS Research, Stanford University, Stanford, California, United States of America

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  • Robert W Shafer

    Affiliation: Division of Infectious Disease and Center for AIDS Research, Stanford University, Stanford, California, United States of America

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  • Published: April 26, 2005
  • DOI: 10.1371/journal.pmed.0020112

Reader Comments (2)

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Role for Geographical Location and Founder Effects in Describing HIV-1 Subtype-Specific Polymorphisms

Posted by plosmedicine on 31 Mar 2009 at 00:01 GMT

Author: Akinyemi Ojesina
Position: Harvard School of Public Health
Institution: Fogarty Fellow and PhD Candidate, Division of Biological Sciences
E-mail: aojesina@hsph.harvard.edu
Additional Authors: Phyllis J. Kanki
Submitted Date: October 31, 2006
Published Date: November 1, 2006
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Dear Editor,

In a previous issue of PLoS Medicine, Kantor et al (1) published very impressive results from an international multi-center collaboration in which they reported significant overlap between subtype B drug resistance mutations and mutations associated with at least one non-B isolate in HIV-1 reverse transcriptase (RT) and protease. This information is very useful for planning large-scale global surveys for antiretroviral drug resistance.

The authors described subtype-specific polymorphisms as mutations that were significantly more prevalent in each non-B subtype than in subtype B viruses from untreated persons. Amongst these was an A98S mutation in HIV-1 reverse transcriptase (RT), which was described as a subtype G-specific polymorphism.

In Nigeria, the predominant variants of HIV-1 are the circulating recombinant form CRF02_AG and subtype G. The 98S polymorphism was not found in 35 of 35 sequences obtained from a group of HIV-1-infected drug-naive Nigerians, and the consensus at this position was A98 (2).

Kantor et al (Table 1 and Figure 4) describes 207 out of 294 (70%) of the subtype G samples were obtained from Portugal and Spain, while approximately half of the subtype G samples had polymorphisms (with respect to subtype B consensus) at RT position 98. We hypothesized that a significant correlation exists between the samples from Portugal and Spain and the presence of the A98S polymorphism in HIV-1 reverse transcriptase reported by the authors. It is however possible that this polymorphism is similarly prevalent in subtype G sequences from other countries.

We therefore interrogated the Stanford HIV Drug Resistance Database (3), where the updated results from this international collaboration maintains detailed RT mutation data for subtype G isolates. The output has detailed information on GenBank accession numbers and publication data, from which we deduced the country of sampling. In all, amino acid residue information for RT position 98 was available for 500 subtype G isolates from both drug-naive and treated persons: 351 isolates (70%) with the A98S polymorphism, 143 isolates (29%) with the wild type A98A residue, and 6 isolates (1%) with the A98G mutation.

In order to determine if A98S is a subtype G-specific polymorphism, only the 165 isolates obtained from drug-naive persons with either A98S or A98A were used in this analysis. Fifty-seven (34.5%) of these selected isolates were from Portugal and Spain. Fifty-one (89.5%) of the isolates from Portugal and Spain had the A98S polymorphism, compared with only 10 (9.3%) of the 108 isolates from other countries combined. Therefore, a very strong association exists between the presence of the A98S polymorphism and sampling from Portugal and Spain (p is less than than 0.0001). This suggests that the A98S polymorphism in HIV-1 subtype G is not subtype-specific, but may be the consensus amino acid residue for samples from Portugal and Spain. Indeed, this polymorphism has been previously reported as being unique to samples from these countries (4).

Considering that various HIV-1 variants have geographical bias (5), it is possible that patterns of subtype-specific polymorphisms may be differentially predominant in certain geographical locations with respect to others. The presence of specific mutations in drug-naive individuals may influence decisions on the choice of therapeutic regimens (6). Therefore, the description of subtype-specific polymorphisms without stratifying by geographical location, or controlling for the role of closely related founder viruses, may result in misleading generalizations. Examination of the role of the source of samples in multi-center studies may be pertinent in assigning the tag of subtype-specific polymorphisms, especially for HIV-1 variants with significant trans-continental distribution, for example, HIV-1 subtypes C and G.

References
1. Kantor R, Katzenstein DA, Efron B, Carvalho AP, Wynhoven B, Cane P, et al. Impact of HIV-1 subtype and antiretroviral therapy on protease and reverse transcriptase genotype: results of a global collaboration. PLoS Med 2005; 2(4):e112.
2. Ojesina AI, Sankale J, Odaibo G, Langevin S, Meloni ST, Sarr AD, et al. Subtype-Specific Patterns in HIV Type 1 Reverse Transcriptase and Protease in Oyo State, Nigeria: Implications for Drug Resistance and Host Response. AIDS Res Hum Retroviruses 2006;22(8):770-779.
3. http://hivdb.stanford.edu.... Accessed October 13, 2006.
4. Thomson MM, Delgado E, Manjon N, Ocampo A, Villahermosa ML, Marino A, et al. HIV-1 genetic diversity in Galicia Spain: BG intersubtype recombinant viruses circulating among injecting drug users. AIDS 2001;15(4):509-16.
5. Wainberg MA. HIV-1 subtype distribution and the problem of drug resistance. AIDS 2004;18 Suppl 3:S63-8.
6. Hirsch MS, Brun-Vezinet F, Clotet B, Conway B, Kuritzkes DR, D'Aquila RT, et al. Antiretroviral drug resistance testing in adults infected with human immunodeficiency virus type 1: 2003 recommendations of an International AIDS Society-USA Panel. Clin Infect Dis 2003;37(1):113-28.

Competing interests declared: We the authors have no competing interests