Use this URL to cite or link to this record in EThOS:
Title: Investigating the development and evolution of drug resistance in the HIV-1 pol gene
Author: Martin, A. S.
Awarding Body: University College London (University of London)
Current Institution: University College London (University of London)
Date of Award: 2013
Availability of Full Text:
Access from EThOS:
Full text unavailable from EThOS. Please try the link below.
Access from Institution:
The prognosis of those infected with HIV-1 has improved significantly since the introduction of highly active antiretroviral therapy (HAART). This has led to complete suppression of HIV-1 replication and reduction of viraemia to undetectable levels. Initially HAART comprised of three classes of drugs, namely nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs), which target two important viral enzymes. Until recently, patients developing highly drug-resistant HIV-1 have had limited therapy options. This has changed in the last few years with the development and approval for use of second-generation NNRTIs and PIs, and three new classes of drugs including integrase strand transfer inhibitors (INSTIs). This means that patients undergoing INSTI-containing salvage therapy are taking drugs targeting all three HIV-1 pol genes; protease (PR), RT and IN. However, little data is available on the evolution, interaction and linkage of drug resistance mutations throughout the pol gene. In this study, we developed a single genome sequencing assay of the full-length HIV-1 pol gene and used it to investigate the development and linkage of drug resistance mutations in sequential samples from two patients failing INSTI-containing salvage therapy. Different phylogenetic methods were used to explore the evolution and dynamics of drug resistance mutations in the full-length HIV-1 pol gene. Furthermore, we examined the effect of co-evolved PR and RT on the susceptibility of patient-derived viruses to INSTIs and viral replicative fitness. Our data indicate that the development of drug resistance mutations in IN is complex and is a fine balance between attaining high levels of drug resistance and decent replicative fitness. This is to a degree influenced by mutations in other regions of the HIV-1 pol gene. Taken together, the data suggests that larger regions of patient-derived HIV-1 genome should be examined in order to get a good understanding of HIV-1 drug susceptibility.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available