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AIDS. 2014 Sep 24;28(15):2319-22. doi: 10.1097/QAD.0000000000000419.

Novel tetra-peptide insertion in Gag-p6 ALIX-binding motif in HIV-1 subtype C associated with protease inhibitor failure in Indian patients.

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aDivision of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden bDivision of Public Health and Infection, St. John's Research Institute, Bangalore India cUnit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden dInstitute of Virology, University-Hospital, University Duisburg-Essen, Essen, Germany eDepartment of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, USA fIndian Institute of Science Education and Research, Pune, Maharashtra, India gInstitute of Virology, University of Cologne, Cologne, Germany hDepartment of Medicine, University of California, San Francisco, California, USA iDepartment of Medicine, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia jBioinformatics Institute kDepartment of Biological Sciences, National University of Singapore, Singapore.


A novel tetra-peptide insertion was identified in Gag-p6 ALIX-binding region, which appeared in protease inhibitor failure Indian HIV-1C sequences (odds ratio=17.1, P < 0.001) but was naturally present in half of untreated Ethiopian HIV-1C sequences. The insertion is predicted to restore ALIX-mediated virus release pathway, which is lacking in HIV-1C. The clinical importance of the insertion needs to be evaluated in HIV-1C dominating regions wherein the use of protease inhibitor drugs are being scaled up.

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