Variable antiviral activity of islatravir against M184I/V mutant HIV-1 selected during antiretroviral therapy

  • J Antimicrob Chemother. 2023 Dec 28:dkad390. doi: 10.1093/jac/dkad390.
Paula C Aulicino  1  2 ,  Suman Sharma  3 ,  Khanghy Truong  3 ,  Vindhya Kukunoor  3 ,  Karm Ghei  3 ,  Solange Arazi-Caillaud  4 ,  Moira Taicz  4 ,  Rosa Bologna  4 ,  Andrea Mangano  1  2 ,  Jason T Kimata  3
Affiliations
  • 1. Laboratory of Cellular Biology and Retroviruses, Unit of Virology and Molecular Epidemiology, Hospital de Pediatría Prof. Dr Juan P. Garrahan, Buenos Aires, Argentina.
  • 2. CONICET, Buenos Aires, Argentina.
  • 3. Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX, USA.
  • 4. Unit of Epidemiology and Infectology, Hospital de Pediatría Prof. Dr Juan P. Garrahan, Buenos Aires, Argentina.
PMID: 38153245 DOI: 10.1093/jac/dkad390
Abstract

Background: Islatravir is a new antiretroviral drug that inhibits the Reverse Transcriptase (RT) of HIV-1 through multiple mechanisms. It is proposed to be used in combination with doravirine, a new NNRTI. M184V/I mutations have been shown to reduce the in vitro Antiviral activity of islatravir, but their effect when pre-selected during ART has not been investigated.

Methods: HIV-1 rt sequences were obtained from four individuals of the Garrahan HIV cohort prior to, or during virological failure to ART. HIV-1 infectious molecular clones were constructed on an NL4-3 backbone, and infectious viruses were produced by transfection of 293T cells. Fold-changes in IC50 were calculated for each mutant versus the NL4-3 WT. HIV-1 phenotypic drug resistance was tested in vitro against NRTIs and NNRTIs.

Results: In all the cases, M184I/V, either alone or in the presence of Other mutations, was associated with reduced susceptibility to islatravir, abacavir and lamivudine. Viruses carrying M184V/I showed variable levels of resistance to islatravir (4.8 to 33.8-fold). The greatest reduction in susceptibility was observed for viruses carrying the mutations M184V + V106I (33.8-fold resistance) or M184V + I142V (25.2-fold resistance). For NNRTIs, the presence of V106I alone did not affect susceptibility to doravirine or etravirine, but showed a modest reduction in susceptibility to efavirenz (6-fold). Susceptibility to doravirine was slightly reduced only for one of the mutants carrying V106I in combination with Y181C and M184V.

Conclusions: Mutations and polymorphisms selected in vivo together with M184V/I depend on the viral genetic context and on ART history, and could affect the efficacy of islatravir once available for use in the clinic.

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