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Human immunodeficiency virus type 1 (HIV-1) variants were selected for resistance against the (+) and (-) enantiomers of a novel nucleoside analogue, 2′-deoxy-3′-oxa-4′-thiocytidine (dOTC), using the infectious molecular clone HXB2D grown in the MT-4 line of human T cells. The variants selected with (+) dOTC were approximately 6–7-fold less sensitive than wild-type virus to this drug. Cloning and sequencing of the complete reverse transcriptase (RT) coding region of these variants identified the M184I mutation and further selection with virus containing the M184I substitution led to the appearance of an M184V mutation. In contrast, selection experiments performed with (-) dOTC yielded variants capable of growing in drug concentrations as high as 100 μM, but phenotypic analysis of these viruses revealed near wild-type 50% inhibitory concentration (IC 50 ) values for this compound. Site-directed mutagenesis experiments in which the M184I and M184V mutations were introduced into HXB2D confirmed the importance of these mutations when viruses were grown in MT4 cells. However, wild-type IC 50  values in regard to both (–) and (+) dOTC were obtained when these recombinant viruses were grown in cord blood mononuclear cells (CBMC). Clinical isolates of HIV-1 resistant to lamivudine and containing the M184V substitution also displayed low-level resistance to both (–) and (+) dOTC when grown in CBMC. Finally, cell-free RT assays were performed in the presence of either (–) dOTC triphosphate, (+) dOTC triphosphate, or the triphosphate of a racemic mixture of (+) and (–) dOTC with wild-type and mutated M184V-containing recombinant RT. The data demonstrate chain termination effects of these compounds with regard to both wild-type and mutated enzyme and that the latter was approximately twofold less sensitive than the former to these drugs.

Selection and Characterization of HIV-1 Variants Resistant to the (+) and (-) Enantiomers of 2′-Deoxy-3′-Oxa-4′-Thiocytidine (Dotc)