Amino acid insertions at position 35 of HIV-1 protease interfere with virus replication without modifying antiviral drug susceptibility

Among 1330 patients undergoing highly active antiretroviral therapy (HAART), 3 showed 1 or 2 amino acid (aa) insertions at position 35 of the HIV-1 protease gene. Protease genes containing aa insertions, either in the presence (ins35G+res.muts, ins35TN+res.muts) or absence (ins35G, ins35TN) of other resistance mutations, were introduced into the wild-type HIV-1 strain NL4-3. The introduction of ins35G and ins35TN in the wild-type protease confirmed that these mutations were per se not responsible of decreased drug susceptibility. The replication rate of mutant recombinant viruses was determined by HIV RNA quantification in supernatants of cell cultures in comparison with a recombinant HIV-1 strain with wild-type protease. Recombinant ins35G and ins35TN HIV-1 strains did not display increased resistance to currently used protease inhibitors (PIs). Comparison of ins35TN+res.muts and ins35G+res.muts with respect to the corresponding recombinant rescue mutants showed that ins35TN decreased the replication rate of the PI-resistant strain, while ins35G had a protective effect.