Phylogenetic analysis of reverse transcriptase in antiretroviral drug-naive Korean HIV type 1 patients

To study whether genotypic antiretroviral resistance testing (GART) is need ed to guide initial antiretroviral therapy in Korea, we determined partial pol sequences in peripheral blood mononuclear cells (PBMCs) obtained from 2 9 antiretroviral drug-naive HIV-1 patients. Phylogenetic analysis revealed four subtypes: B (23 patients), D (1 patient), recombinant strain (2 patien ts), and "untyped" (3 patients). Eighteen (78.3%) of the 23 subtype B isola tes formed a distinct monophyletic cluster. The average genetic distances o f 23 subtype B compared with reference strain HXB2 were 2.7% (range, 1.5-4. 6%). Only one patient harbored variant virus containing a V179D mutation ca using resistance to efavirenz. These data derived from therapy-naive patien ts suggest that potential use of primary resistance testing to guide initia l antiretroviral therapy should be considered in Korea. This is the first r eport on the molecular nature of HIV-1 RT in Korea.