{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T06:38:19Z","timestamp":1780814299831,"version":"3.54.1"},"reference-count":65,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,9,25]],"date-time":"2023-09-25T00:00:00Z","timestamp":1695600000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH","award":["R37 AI076119"],"award-info":[{"award-number":["R37 AI076119"]}]},{"name":"NIH","award":["T32 GM008367"],"award-info":[{"award-number":["T32 GM008367"]}]},{"name":"NIH","award":["F31 AI155158"],"award-info":[{"award-number":["F31 AI155158"]}]},{"name":"NIH","award":["F31 AI172618"],"award-info":[{"award-number":["F31 AI172618"]}]},{"name":"NIH","award":["P30 AI050409"],"award-info":[{"award-number":["P30 AI050409"]}]},{"name":"NIH","award":["UL1TR000454"],"award-info":[{"award-number":["UL1TR000454"]}]},{"name":"NIH","award":["R37 AI076119"],"award-info":[{"award-number":["R37 AI076119"]}]},{"name":"NIH","award":["T32 GM008367"],"award-info":[{"award-number":["T32 GM008367"]}]},{"name":"NIH","award":["F31 AI155158"],"award-info":[{"award-number":["F31 AI155158"]}]},{"name":"NIH","award":["F31 AI172618"],"award-info":[{"award-number":["F31 AI172618"]}]},{"name":"NIH","award":["P30 AI050409"],"award-info":[{"award-number":["P30 AI050409"]}]},{"name":"NIH","award":["UL1TR000454"],"award-info":[{"award-number":["UL1TR000454"]}]},{"name":"Nahmias-Schinazi Distinguished Research Chair","award":["R37 AI076119"],"award-info":[{"award-number":["R37 AI076119"]}]},{"name":"Nahmias-Schinazi Distinguished Research Chair","award":["T32 GM008367"],"award-info":[{"award-number":["T32 GM008367"]}]},{"name":"Nahmias-Schinazi Distinguished Research Chair","award":["F31 AI155158"],"award-info":[{"award-number":["F31 AI155158"]}]},{"name":"Nahmias-Schinazi Distinguished Research Chair","award":["F31 AI172618"],"award-info":[{"award-number":["F31 AI172618"]}]},{"name":"Nahmias-Schinazi Distinguished Research Chair","award":["P30 AI050409"],"award-info":[{"award-number":["P30 AI050409"]}]},{"name":"Nahmias-Schinazi Distinguished Research Chair","award":["UL1TR000454"],"award-info":[{"award-number":["UL1TR000454"]}]},{"name":"Emory Integrated Genomics Core (EIGC)","award":["R37 AI076119"],"award-info":[{"award-number":["R37 AI076119"]}]},{"name":"Emory Integrated Genomics Core (EIGC)","award":["T32 GM008367"],"award-info":[{"award-number":["T32 GM008367"]}]},{"name":"Emory Integrated Genomics Core (EIGC)","award":["F31 AI155158"],"award-info":[{"award-number":["F31 AI155158"]}]},{"name":"Emory Integrated Genomics Core (EIGC)","award":["F31 AI172618"],"award-info":[{"award-number":["F31 AI172618"]}]},{"name":"Emory Integrated Genomics Core (EIGC)","award":["P30 AI050409"],"award-info":[{"award-number":["P30 AI050409"]}]},{"name":"Emory Integrated Genomics Core (EIGC)","award":["UL1TR000454"],"award-info":[{"award-number":["UL1TR000454"]}]},{"name":"National Center for Advancing Translational Sciences of the NIH","award":["R37 AI076119"],"award-info":[{"award-number":["R37 AI076119"]}]},{"name":"National Center for Advancing Translational Sciences of the NIH","award":["T32 GM008367"],"award-info":[{"award-number":["T32 GM008367"]}]},{"name":"National Center for Advancing Translational Sciences of the NIH","award":["F31 AI155158"],"award-info":[{"award-number":["F31 AI155158"]}]},{"name":"National Center for Advancing Translational Sciences of the NIH","award":["F31 AI172618"],"award-info":[{"award-number":["F31 AI172618"]}]},{"name":"National Center for Advancing Translational Sciences of the NIH","award":["P30 AI050409"],"award-info":[{"award-number":["P30 AI050409"]}]},{"name":"National Center for Advancing Translational Sciences of the NIH","award":["UL1TR000454"],"award-info":[{"award-number":["UL1TR000454"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Tenofovir disoproxil fumarate (TDF) and islatravir (ISL, 4\u2032-ethynyl-2-fluoro-2\u2032-deoxyadensine, or MK-8591) are highly potent nucleoside reverse transcriptase inhibitors. Resistance to TDF and ISL is conferred by K65R and M184V, respectively. Furthermore, K65R and M184V increase sensitivity to ISL and TDF, respectively. Therefore, these two nucleoside analogs have opposing resistance profiles and could present a high genetic barrier to resistance. To explore resistance to TDF and ISL in combination, we performed passaging experiments with HIV-1 WT, K65R, or M184V in the presence of ISL and TDF. We identified K65R, M184V, and S68G\/N mutations. The mutant most resistant to ISL was S68N\/M184V, yet it remained susceptible to TDF. To further confirm our cellular findings, we implemented an endogenous reverse transcriptase assay to verify in vitro potency. To better understand the impact of these resistance mutations in the context of global infection, we determined potency of ISL and TDF against HIV subtypes A, B, C, D, and circulating recombinant forms (CRF) 01_AE and 02_AG with and without resistance mutations. In all isolates studied, we found K65R imparted hypersensitivity to ISL whereas M184V conferred resistance. We demonstrated that the S68G polymorphism can enhance fitness of drug-resistant mutants in some genetic backgrounds. Collectively, the data suggest that the opposing resistance profiles of ISL and TDF suggest that a combination of the two drugs could be a promising drug regimen for the treatment of patients infected with any HIV-1 subtype, including those who have failed 3TC\/FTC-based therapies.<\/jats:p>","DOI":"10.3390\/v15101990","type":"journal-article","created":{"date-parts":[[2023,9,25]],"date-time":"2023-09-25T03:56:49Z","timestamp":1695614209000},"page":"1990","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["HIV-1 Resistance to Islatravir\/Tenofovir Combination Therapy in Wild-Type or NRTI-Resistant Strains of Diverse HIV-1 Subtypes"],"prefix":"10.3390","volume":"15","author":[{"given":"Maria E.","family":"Cilento","sequence":"first","affiliation":[{"name":"Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Wen","sequence":"additional","affiliation":[{"name":"Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron B.","family":"Reeve","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Obiaara B.","family":"Ukah","sequence":"additional","affiliation":[{"name":"CS Bond Life Sciences Center, University of Missouri, Columbia, MO 65211, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexa A.","family":"Snyder","sequence":"additional","affiliation":[{"name":"Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciro M.","family":"Carrillo","sequence":"additional","affiliation":[{"name":"Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cole P.","family":"Smith","sequence":"additional","affiliation":[{"name":"Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Edwards","sequence":"additional","affiliation":[{"name":"Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia C.","family":"Wahoski","sequence":"additional","affiliation":[{"name":"Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah R.","family":"Kitzler","sequence":"additional","affiliation":[{"name":"Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6622-2752","authenticated-orcid":false,"given":"Eiichi N.","family":"Kodama","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, International Institute of Disaster Science, Tohoku University, Sendai 980-8572, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Mitsuya","sequence":"additional","affiliation":[{"name":"Department of Refractory Viral Infections, National Center for Global Health & Medicine Research Institute, Tokyo 162-8655, Japan"},{"name":"Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA"},{"name":"Department of Clinical Sciences, Kumamoto University Hospital, Kumamoto 860-8556, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Parniak","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8151-4967","authenticated-orcid":false,"given":"Philip R.","family":"Tedbury","sequence":"additional","affiliation":[{"name":"Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan G.","family":"Sarafianos","sequence":"additional","affiliation":[{"name":"Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"W13","DOI":"10.1097\/01.aids.0000247564.73009.bc","article-title":"Global and regional distribution of HIV-1 genetic subtypes and recombinants in 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