Characterization of zidovudine resistant variants of HIV-1 isolated from patients on prolonged therapy

As part of a clinical trial to assess zidovudine related toxic effects, the authors followed 48 initially asymptomatic individuals who received prolonged therapy with this drug at several tertiary care institutions. Blood samples had been obtained for viral isolation every three months and had yielded infectious HIV-1 progeny in over 94 percent of cases. After one year of therapy, over 30 percent of individuals had developed variants of HIV-1 that displayed in vitro resistance to zidovudine. Six of these zidovudine resistant variants of HIV-1 were compared with drug sensitive isolates obtained from the same subjects prior to initiation of treatment. The drug resistant variants were generally as infectious per mg viral protein for both susceptible T cell lines and peripheral blood mononuclear cells as the corresponding parental isolates from which they were derived. The drug resistance phenotype remained stable, in that zidovudine-insensitive species could still be identified, following many viral replication cycles in the absence of drug pressure. However, the percentage of zidovudine resistant viruses appeared to diminish in culture over time under such conditions. This was demonstrated by the fact that lower percentages of cells became infected in the presence of the drug, if the viruses used for infection had been propagated in the absence of the drug. In addition, higher concentrations of such viruses were required to initiate infection in the presence of the drug, and these viruses possessed lower IC₅₀'s for zidovudine. This suggests that zidovudine resistant variants of HIV-1 may be unlikely to possess any growth advantage in the absence of the drug.