{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T20:31:07Z","timestamp":1782160267389,"version":"3.54.5"},"reference-count":51,"publisher":"American Society for Microbiology","issue":"2","license":[{"start":{"date-parts":[[2016,2,1]],"date-time":"2016-02-01T00:00:00Z","timestamp":1454284800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2016,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            In clinical trials of coformulated elvitegravir (EVG), cobicistat (COBI), emtricitabine (FTC), and tenofovir disoproxil fumarate (TDF), emergent drug resistance predominantly involved the FTC resistance substitution M184V\/I in reverse transcriptase (RT), with or without the tenofovir (TFV) resistance substitution K65R, accompanied by a primary EVG resistance substitution (E92Q, N155H, or Q148R) in integrase (IN). We previously reported that the RT-K65R, RT-M184V, and IN-E92Q substitutions lacked cross-class phenotypic resistance and replicative fitness compensation. As a follow-up, the\n            <jats:italic>in vitro<\/jats:italic>\n            characteristics of mutant HIV-1 containing RT-K65R and\/or RT-M184V with IN-Q148R or IN-N155H were also evaluated, alone and in combination, for potential interactions. Single mutants displayed reduced susceptibility to their corresponding inhibitor classes, with no cross-class resistance. Viruses with IN-Q148R or IN-N155H exhibited reduced susceptibility to EVG (137- and 40-fold, respectively) that was not affected by the addition of RT-M184V or RT-K65R\/M184V. All viruses containing RT-M184V were resistant to FTC (&gt;1,000-fold). Mutants with RT-K65R had reduced susceptibility to TFV (3.3- to 3.6-fold). Without drugs present, the viral fitness of RT and\/or IN mutants was diminished relative to that of the wild type in the following genotypic order: wild type &gt; RT-M184V \u2265 IN-N155H \u2248 IN-Q148R \u2265 RT-M184V + IN-N155H \u2265 RT-M184V + IN-Q148R \u2265 RT-K65R\/M184V + IN-Q148R \u2248 RT-K65R\/M184V + IN-N155H. In the presence of drug concentrations approaching physiologic levels, drug resistance counteracted replication defects, allowing single mutants to outcompete the wild type with one drug present and double mutants to outcompete single mutants with two drugs present. These results suggest that during antiretroviral treatment with multiple drugs, the development of viruses with combinations of resistance substitutions may be favored despite diminished viral fitness.\n          <\/jats:p>","DOI":"10.1128\/aac.02096-15","type":"journal-article","created":{"date-parts":[[2015,11,17]],"date-time":"2015-11-17T02:33:37Z","timestamp":1447727617000},"page":"757-765","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":6,"title":["Drug Susceptibility and Viral Fitness of HIV-1 with Integrase Strand Transfer Inhibitor Resistance Substitution Q148R or N155H in Combination with Nucleoside\/Nucleotide Reverse Transcriptase Inhibitor Resistance Substitutions"],"prefix":"10.1128","volume":"60","author":[{"given":"Kristen N.","family":"Andreatta","sequence":"first","affiliation":[{"name":"Gilead Sciences, Inc., Foster City, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Miller","sequence":"additional","affiliation":[{"name":"Gilead Sciences, Inc., Foster City, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten L.","family":"White","sequence":"additional","affiliation":[{"name":"Gilead Sciences, Inc., Foster City, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3181e9a87a"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/nar\/gkn1050"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1128\/JVI.00695-14"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e328331c81e"},{"key":"e_1_3_1_6_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0065631","article-title":"Resistance mutations outside the integrase coding region have an effect on human immunodeficiency virus replicative fitness but do not affect its susceptibility to integrase strand transfer inhibitors","volume":"8","author":"Weber J","year":"2013","unstructured":"Weber J, Rose JD, Vazquez AC, Winner D, Margot N, McColl DJ, Miller MD, Quinones-Mateu ME. 2013. Resistance mutations outside the integrase coding region have an effect on human immunodeficiency virus replicative fitness but do not affect its susceptibility to integrase strand transfer inhibitors. 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Longitudinal resistance analysis of the phase 3 EVG\/COBI\/FTC\/TDF studies, poster O_12, p 1. 12th Eur Meet HIV Hepatitis Treatment Strategies Antiviral Drug Resistance, Barcelona, Spain."},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00040-15"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.41.12.2781"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e31817bbe93"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e31823aca74"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02568-12"},{"key":"e_1_3_1_24_2","volume-title":"8th Annu Symp Antiviral Drug Resistance Targets Mechanisms","author":"Cavanaugh J","year":"2007","unstructured":"Cavanaugh J, Svarovskaia ES, Goodman DD, Myrick F, Hluhanich R, McColl DJ, Miller MD, Borroto-Esoda K. 2007. Reduction in HIV-1 fitness associated with the E92Q integrase inhibitor resistance mutation: accumulation of additional IN mutations increases resistance to elvitegravir without rescuing viral fitness, poster 32. 8th Annu Symp Antiviral Drug Resistance Targets Mechanisms, Richmond, VA."},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/B978-012465330-6\/50003-8"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.antiviral.2011.12.008"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01512-06"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1128\/JVI.80.5.2380-2389.2006"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1310\/hct1304-228"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e31828ace69"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(11)70196-7"},{"key":"e_1_3_1_32_2","first-page":"65","article-title":"Patterns of resistance development with integrase inhibitors in HIV","volume":"4","author":"Mbisa JL","year":"2011","unstructured":"Mbisa JL, Martin SA, Cane PA. 2011. 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