Group Title: Genome biology
Title: Retroviral proteases
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Title: Retroviral proteases
Physical Description: Book
Language: English
Creator: Dunn, Ben
Goodenow, Maureen
Gustchina, Alla
Wlodawer, Alexander
Publisher: Genome biology
Publication Date: 2002
Abstract: SUMMARY:The proteases of retroviruses, such as leukemia viruses, immunodeficiency viruses (including the human immunodeficiency virus, HIV), infectious anemia viruses, and mammary tumor viruses, form a family with the proteases encoded by several retrotransposons in Drosophila and yeast and endogenous viral sequences in primates. Retroviral proteases are key enzymes in viral propagation and are initially synthesized with other viral proteins as polyprotein precursors that are subsequently cleaved by the viral protease activity at specific sites to produce mature, functional units. Active retroviral proteases are homodimers, with each dimer structurally related to the larger class of single-chain aspartic peptidases. Each monomer has four structural elements: two distinct hairpin loops, a wide loop containing the catalytic aspartic acid and an a helix. Retroviral gene sequences can vary between infected individuals, and mutations affecting the binding cleft of the protease or the substrate cleavage sites can alter the response of the virus to therapeutic drugs. The need to develop new drugs against HIV will continue to be, to a large extent, the driving force behind further characterization of retroviral proteases.
General Note: Periodical Abbreviation:Genome Biol.
General Note: M3: 10.1186/gb-2002-3-4-reviews3006
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Protein family review

Retroviral proteases

Ben M Dunn*, Maureen M Goodenow', Alla Gustchina* and

Alexander Wlodawer*

Addresses: Departments of *Biochemistry and Molecular Biology and 'Pathology and Experimental Medicine, University of Florida,
Gainesville, FL 32610, USA. *Macromolecular Crystallography Laboratory, National Cancer Institute, Frederick, MD 21702, USA.

Correspondence: Ben M Dunn. E-mail:

Published: 26 March 2002
Genome Biology 2002, 3(4):reviews3006.1-3006.7
The electronic version of this article is the complete one and can be
found online at
BioMed Central Ltd (Print ISSN 1465-6906; Online ISSN 1465-6914)


The proteases of retroviruses, such as leukemia viruses, immunodeficiency viruses (including the
human immunodeficiency virus, HIV), infectious anemia viruses, and mammary tumor viruses, form a
family with the proteases encoded by several retrotransposons in Drosophila and yeast and
endogenous viral sequences in primates. Retroviral proteases are key enzymes in viral propagation and
are initially synthesized with other viral proteins as polyprotein precursors that are subsequently
cleaved by the viral protease activity at specific sites to produce mature, functional units. Active
retroviral proteases are homodimers, with each dimer structurally related to the larger class of single-
chain aspartic peptidases. Each monomer has four structural elements: two distinct hairpin loops, a
wide loop containing the catalytic aspartic acid and an a helix. Retroviral gene sequences can vary
between infected individuals, and mutations affecting the binding cleft of the protease or the substrate
cleavage sites can alter the response of the virus to therapeutic drugs. The need to develop new drugs
against HIV will continue to be, to a large extent, the driving force behind further characterization of
retroviral proteases.

Gene organization and evolutionary history
Retroviral proteases are encoded by a part of the pol gene, for
example in that of the human immunodeficiency virus (HIV).
The protease gene is located between the gag gene (encoding
structural proteins) and other enzymatic genes, such as
reverse transcriptase and integrase. There are 93 sequences
belonging to the retroviral protease family A2 of the aspartic
peptidase clan AA at present, according to the Merops data-
base, which provides information on viral as well as other
proteases [1]. The A2 family includes the proteases of
leukemia viruses, immunodeficiency viruses, infectious
anemia viruses, and mammary tumor viruses, as well as those
encoded by several retrotransposons from fruit flies and
yeast, and endogenous viral sequences in humans and other
primates. Figure 1 presents a phylogenetic tree that shows the
evolutionary history of, and relationships between, selected
members of the family of retroviral proteases.

The RNA of retroviruses is replicated through a DNA inter-
mediate, the product of the virus-encoded reverse tran-
scriptase, which is an error-prone enzyme that lacks a
proofreading function. In HIV-1 (the HIV type responsible
for most cases of the acquired immune deficiency syn-
drome, AIDS), at least one nucleotide substitution occurs
on average during every round of replication. Selective
pressures affect replication, cell tropism (the ability of a
virus to enter particular cell types), and escape from host
immunity, and contribute to genetic differences between
HIV-1 isolates within an individual and between individuals
[2]. Thus, there is no 'wild-type' HIV-1 protease, but rather
a complex mixture of related sequences [3]. Variability is
most pronounced in the HIV-1 envelope (env) gene, but is
found in virtually all regions of the viral genome, including
the protease gene. Similar variability is expected in other
retroviral sequences, but much less information is available

2 Genome Biology Vol 3 No 4 Dunn et al.

Figure I
The relationships between retroviral proteases. Protease sequences from several different immunodeficiency viruses are compared with endogenous
retroviral sequences found in various eukaryotic genomes. The numbers in brackets indicate GenBank accession numbers [18]; viral strains are indicated
by subscript letters. Nucleic-acid sequences were aligned using ClustalW [19] and a Jukes-Cantor phylogenetic tree file was generated using the PHYLIP
package and the programs DNADIST and FITCH. The tree was produced using the cladogram option and the programs TreeView. Abbreviations: BIV,
bovine immunodeficiency virus; EIAV, equine infectious anemia virus; FIV, feline immunodeficiency virus; HERV, human endogenous retrovirus; SIV, simian
immunodeficiency virus.

compared to the wealth of data that has been gathered for
the HIV system. Genetic analysis of proteases from different
individuals [4] is illustrated in Figure 2. Viruses from differ-
ent individuals form separate branches in a phylogenetic
tree of protease sequences. Each major branch develops
into multiple small branches that represent the swarm, or
quasispecies, of viruses within an individual. Protease
sequences in viruses from children who were infected peri-
natally by maternal transmission differ from one another,

found in their mother or siblings. Even when individuals
are unrelated, the relationship between their HIV-i isolates
and the history of infections can be detected; for example,
in Figure 2, children 6 and 7 were not related but were
infected by the same blood product. Individual 2 was
infected by sexual transmission of HIV-i from individual 1.
The protease from the laboratory strain HIV.. is located on
a separate branch in the tree, indicating that no HIV-i
protease from patient viruses is identical to this prototype

but are closely related to sequences in viral quasispecies protease sequence.

Mouse (m76757)
Baboon (p10272)
Human (HERV) (u12970)
Gibbon (p21414)
Silkworm (ab032718)
Drosophila (p10401)
Drosophila (p20825)
Drosophila (p04323)
FIV (p31822)
FIV (p16088)
Visna virus (p23427)
Visna virus (p35956)
Saccharomyces cerevisiae (m23367)
Schizosaccharomyces pombe (q05654)
Human (p10265)
Mouse (p11365)
Monkey (p04024)
Bird (p26315)
HIVMAL (p04588)
HIVMN (p05961)
HIVBH10 (p03366)
HIVcAM2 (p24107)
SIVK6W (p05897)
SIVsM (p12502)
SIVAGM (q02836)
SIVTyo (p05895)
SIVMAL (p27973)
EIAV (p03371)
BIV (p19561)

Child 4

Child 2 ,Mother 4
Child 3

Inf 2
Child 5 I nf 1
Mother 5 HIVLAI

Children 6 and 7
Child 1


Sibling 1

Figure 2
HIV-I protease sequences are heterogeneous. Nucleotide sequences
from protease quasispecies in peripheral blood mononuclear cells from
infected children and adults were analyzed by constructing a phylogenetic
tree. Major branches are black; colored branches represent sequences
within individuals; individuals infected by related viruses are represented
by shades of similar colors on a major branch. Infl and lnf2 are two
unrelated individuals whose closely related virus sequences suggest that
individual 2 was infected by individual I.

Characteristic structural features
Crystal and nuclear magnetic resonance (NMR) structures
are available for retroviral proteases from HIV-1 [5], HIV-2
[6], simian [7] and feline [8] immunodeficiency viruses (SIV
and FIV), rous sarcoma virus (RSV) [9] and equine infec-
tious anemia virus (EIAV) [10o]; reviewed in [11]. The sec-
ondary structures of all retroviral proteases share a
structural template (Figure 3) that was previously used to
describe non-viral aspartic proteases [12]. Retroviral pro-
teases form homodimers and the template structure shows
that a monomer is formed by the duplication of four struc-
tural elements: a hairpin (containing loop Al), a wide loop
(Bi, containing the catalytic aspartic acid), an a helix (Cl),
and a second hairpin (Di). The second monomer contains
the identical elements, named A2, B2, C2, and D2 in
Figure 3. The length of loops Al and A2 is different in
various retroviral proteases, as are the length and conforma-
tion of the connecting segments between these structural
elements. The a helix C1 is prominent only in EIAV protease,
whereas it consists of a single helical turn in RSV and FIV
proteases and is replaced by a loop in the proteases of HIV-1,
HIV-2, and SIV. The flexible P loop Di, known as a 'flap' in
non-viral proteases, is functionally very important, because

it changes orientation during binding of the ligand (sub-
strate or inhibitor) and forms numerous interactions with it.
Two such flaps are present in the symmetric dimers of retro-
viral proteases. The hairpin D2 is substituted by a p strand in
all retroviral proteases for which structural information is
available. In addition to the four core structural elements,
the amino and carboxyl termini in a dimer form a four-
stranded p-sheet interface. The amino-acid sequences of
retroviral proteases are significantly similar, particularly in
the locations of residues that are important in preserving
both structure and function.

The active site of each retroviral protease contains a pair of
aspartic acid residues (Asp25 and Asp25'; amino acids are
numbered according to their positions in HIV-1 protease).
The conserved active-site residues Asp25, Thr26 (replaced
by Ser38 in RSV protease), and Gly27 are located in a loop,
the structure of which is stabilized by a network of hydrogen
bonds similar to that found in the eukaryotic proteases
(Figure 4; for a review, see [13]). The carboxylate groups of
the Asp25 residues from both chains are nearly co-planar and
make close contacts via their Oi1 atoms. The network is quite
rigid as the result of a set of interactions called the 'fireman's
grip', in which the Oy atom of each Thr26 accepts a hydrogen
bond from the main-chain NH group of the Thr26 in the
opposing loop; Thr26 also donates a hydrogen bond to the
oxygen atom of the carbonyl group of residue 24 on the oppo-
site loop. Identical interactions have been observed in all
retroviral proteases thus far examined by crystallographic
methods. The carboxylate residues are bridged by a water
molecule, located within hydrogen-bonding distance of the
oxygen atoms of the Asp25 carboxylates. Water molecules
forming similar bridges have also been reported in non-viral
proteases [13]; they might correspond to the catalytic water
molecule required for hydrolysis of the peptide bond in the
substrate. The distances between the inner oxygen atoms of
the co-planar carboxylates are 2.8 to 3 A, indicating the pres-
ence of an acidic proton in the bridge.

Binding of inhibitors is accompanied by a large shift in the
flaps of both subunits (Figure 3c). In some enzymes (for
example, RSV protease), the flaps are disordered and there-
fore are not seen in the X-ray structure [9]. In other
enzymes, the flaps are seen in an 'open' conformation when
no ligands (substrates and/or inhibitors) are present.
Binding to the active site induces a downward movement of
the flap residues; this allows additional interactions with the
ligand and strengthens the binding of both substrates (by
inference) and inhibitors.

Localization and function
Translation of the retroviral gag-pol mRNA produces in
most cases a Gag protein of 55 kDa, ending before the pro-
tease gene. In about 5% of the gag-pol transcripts, a transla-
tional frameshift occurs slightly upstream of the protease

4 Genome Biology Vol 3 No 4 Dunn et al.

Figure 3
Structural template for (a) retroviral proteases compared to that for (b) the aspartic protease family. In the symmetrical retroviral dimer (a), loops A I
and A2 are shown in yellow in each monomer, shown as stereo pairs. In the single-chain aspartic protease (b), the corresponding loops are labeled AI
and A2 in the left-side domain and A3 and A4 in the right-side domain. Likewise, loops BI and B2 in (a) are shown in blue in each monomer of the
retroviral dimer, and the analogous loops in blue are labeled BI, B2, B3, and B4 in the single-chain enzymes. Loops BI in the retroviral enzymes and BI
and B3 in the single-chain enzymes contain the catalytic residues. Helical segments C I and C2 (red) in (a) are mirrored by segments C I-C4 in (b). Finally,
loop D I in the retroviral monomers provides a double flap structure in (a), whereas the 'half loops' D2' provide the four strands that form a P sheet at
the bottom of the dimer. In (b), loop D I provides the flap on one side only, whereas D3 on the other side is pointing outward. Loops D2 and D4
provide the center of the P sheet at the bottom of these enzymes. (c) Movement of flaps in the retroviral protease during ligand binding. This stereo pair
shows the movement that occurs upon binding of a ligand to the active site of HIV- I protease. The 'empty' enzyme structure is shown as a green ribbon
and the enzyme following binding is shown as an orange ribbon. The flap residues move downward by approximately 8 A.

gene and the stop codon after the gag locus is no longer in
frame, producing a Gag-Pol fusion polyprotein (Figure 5).
The protease embedded within the Gag-Pol polyprotein
cleaves itself out by specifically cutting peptide bonds at
either end of its sequence. The protease then cleaves addi-
tional bonds within the remaining fragment of the Gag-Pol
polyprotein to yield reverse transcriptase and integrase, two
other important enzymes of the virus [14]. Cleavage of Gag-
Pol occurs sequentially and with high fidelity at nine sepa-
rate, unrelated cleavage sites. The rates of cleavage can differ

by up to 40oo-fold between sites [15]. These differences may
be related to different steps in assembly of virions.

Important mutants
Viral species with altered protease sequences arise as a result
of the high nucleotide-substitution rate during viral replica-
tion. The functional properties of these variant proteases
have been the subject of intense study. Some changes occur
in regions exposed at the enzyme's surface without signifi-
cant alteration of the enzymatic properties of the protease;

rtO -,_ / I.D,- -

^ -' C:

X~r^"^ ^rD2'

C1 D3^

\jr ~ ~ v\ 4



Gly217 Gly217


Gly27' Gly27 Gly27' b Gly27

Thr26' Thr26 Thr26' Thr26

Figure 4
The 'fireman's grip', a stereotypical rigid network structure involving the Asp-Thr-Gly signature sequence in (a) the classical aspartic peptidases and (b)
the retroviral proteases. Amino acids are identified by three-letter codes. In each case, the catalytic aspartic acid residue (Asp) is hydrogen-bonded to
the backbone NH group of the glycine (Gly) two amino acids further along in the sequence. In addition, the OH groups of threonine (Thr) are hydrogen-
bonded to two points on the opposite domain or monomer, the backbone NH group (blue) of the threonine and to the carbonyl oxygen (red) of the
residue before the catalytic aspartic acid.

other changes occur within the binding cavity, leading to
changes in the binding of both substrates and inhibitors. The
balance between the ability to bind substrates and the inter-
actions with inhibitors will determine the success or failure of
the variant protease and hence of the variant virus. If the viral
protease has lost the ability to bind an inhibitor tightly, the
virus might be able to survive drug therapy with that com-
pound; if, on the other hand, the viral protease has also lost
the ability to bind to and cleave the polyprotein, the virus will
be unable to replicate successfully. (Figure 6 shows those
mutations that have well-defined consequences for function,
leading to reduced susceptibility to protease inhibitors.)

In addition to direct effects on the binding of inhibitors to
HIV protease, mutations in other positions along the
polyprotein sequence can have consequences for polyprotein
processing (Figure 7). These events can impact the viability
of the virus in both positive and negative ways [16]. For

example, it is becoming apparent that mutations in cleavage
sites can compensate for changes within the binding cleft of
HIV protease. Alterations in the active site will alter the cleav-
age specificity; alterations in the cleavage site to better match
the variant protease could allow the virus to escape inhibition
by antiviral compounds, while also maintaining the necessary
points of cleavage to produce structural proteins.

Understanding protease function in polyprotein processing
and viral replication remains important. Despite the early
successes with the development of drugs that control HIV
infection by blocking proteolytic processing, the poor
bioavailability of inhibitors in vivo leads to suboptimal drug
levels. The high turnover of the virus (two or three cycles of
replication per day) coupled with the high viral load in
infected individuals, and the mutation rate has led to the

6 Genome Biology Vol 3 No 4 Dunn et al.



Figure 5
Translational products from the retroviral gag-pol mRNA. In most cases,
translation of the gag-pol transcript results in a Gag polyprotein including
structural proteins. A translational frameshift within the p6 region allows
translation beyond the p6 gag gene, resulting in a Gag-Pol fusion protein.
The Gag-Pol fusion protein contains a p6* protein, the sequence of which
differs from the p6 protein as a result of the frameshift. Abbreviations:
MA, p 17 matrix protein; CA, p24 capsid protein; NC, p7 nucleocapsid
protein; PR, protease; RT, reverse transcriptase; IN, integrase.



******** ****

Figure 7
The impact of mutations in the Gag-Pol polyprotein on protease activity.
The letters above the diagram indicate cleavage sites; cleavage at sites E
and F release the protease; subsequent cleavage at sites C, A, and B
produce mature structural proteins. Regions in Gag that impact protease
processing have been defined by deletion analysis (underlined). Specific
mutations (indicated by dots), particularly at the sites between
nucleocapsid (p7NC) and p6 or p6* (depending on the reading frame), can
alter the rates of protease processing at different cleavage sites (green
circles: our unpublished data; black circles: summary of published data.
For abbreviations see Figure 5.

Amino-acid positions in the protease

8 10 20 24 30 32 33 36 46 47 48 50 54 63 71 73 77 82 84 88 90 91

Protease inhibitors


Inhibitor-naive patients

8%-----------------------------------------J ...

Figure 6
Drug-resistance amino-acid profiles of HIV- I protease. Protease-inhibitor treatment leads to growth of viruses with changes in specific amino-acid
positions. The numbers across the top designate amino-acid positions in HIV- I protease; the solid line indicates the flap region. Filled boxes indicate
mutations that occur in treated patients; red boxes indicate that mutation is seen in patients both before therapy starts (bottom panel) and in patients
after therapy has begun (top panel); hatched boxes indicate mutations that occur during passage of virus cultured in the presence of a drug. The
percentages in the bottom panel refer to the percentage of clones that contain the mutation indicated in the corresponding row. In the top panel, each
row displays the profile of amino-acid changes related to high-level resistance to protease inhibitors that are approved by the US Food and Drugs
Administration (FDA) for treatment of HIV- I-infected adults. Abbreviations: APV, amprenavir; IDV, indinavir; LPV, loprinavir; NFV, nelfinavir; RTV,
ritonavir; SQV, saquinavir. Only RTV, NFV, and IDV have FDA approval for treatment of children and adolescents.

emergence of viruses resistant to all approved drugs [17].
The variant forms of drug-resistant protease have been
expressed and studied biochemically and structurally, and a
new round of drug design is underway to target variant
forms. One can imagine that this cycle will continue until a
universal inhibitor is found that binds tightly to all forms of
the viral enzyme. Other approaches, such as the develop-
ment of peptides that bind to the dimerization interface and
block assembly of functional proteases, are also under exten-
sive investigation.

I. The Merops database []
A compilation of protease sequence information organized into mecha-
nistic classes. The database provides information on literature, align-
ments, and links to other databases.
2. Barrie KA, Perez E, Lamers SL, Sleasman JW, Dunn BM, Goodenow
MM: Natural variation in HIV-I protease, Gag p7 and p6, and
protease cleavage sites within Gag/Pol polyproteins: amino
acid substitutions in the absence of protease inhibitors in
mothers and children infected by human immunodeficiency
virus type I. Virology 1996, 219:407-416.
A description of the nucleotide sequence variation present in clones
derived from HIV- I -infected patients.
3. Stanford HIV RT and protease sequence database
A compilation of RNA and protein sequences derived from patients in
clinical trials undergoing anti-retroviral therapy. These data show the
development of resistant protease sequences in response to treatment
with specific drugs.
4. Goodenow MM, Perez EE, Sleasman JW: Genetic variability in
HIV-1 in children treated by protease inhibitors. In Human
Retroviral Infection: Immunological and Molecular Theories. Edited by
Friedman H, Ugen K, Bendinelli M. New York: Plenum Press; 2000,
An analysis of variation in protease sequence in patients infected with
HIV-1I in relation to their clinical and immunological status.
5. Wlodawer A, Miller M, Jask61lski M, Sathyanarayana B K, Baldwin E,
Weber IT, Selk L M, Clawson L, Schneider J, Kent SBH: Conserved
folding in retroviral proteases: crystal structure of a syn-
thetic HIV-I protease. Science 1989, 245:616-621.
This paper describes the first three-dimensional structure of HIV- I pro-
tease, or any protein, produced from chemically synthesized protein. It
established the correct protein fold and gave the first glimpse of the
active-site pocket.
6. Mulichak AM, Hui JO, Tomasselli AG, Heinrikson RL, Curry KA,
Tomich CS, Thaisrivongs S, Sawyer TK, Watenpaugh KD: The crys-
tallographic structure of the protease from human immun-
odeficiency virus type 2 with two synthetic peptidic
transition state analog inhibitors. J Biol Chem 1993, 268:13103-
A comparison of the free protease structure with the inhibitor-bound
enzyme structure to illustrate changes in enzyme conformation upon
ligand binding.
7. Rose RB, Rose ] R, Salto R, Craik C S, Stroud RM: Structure of the
protease from simian immunodeficiency virus: complex
with an irreversible nonpeptide inhibitor. Biochemistry 1993,
This paper presents the crystallographic structure of the retroviral
enzyme that infects non-human primates. This structure is notable as it
presents a complex with a large inhibitor
8. Wlodawer A, Gustchina A, Reshetnikova L, Lubkowski J, Zdanov A,
Hui KY, Angleton EL, Farmerie WG, Goodenow MM, Bhatt D, et al.:
Structure of an inhibitor complex of the proteinase from
feline immunodeficiency virus. Nat Struct Biol 1995, 2:480-488.
The three-dimensional structure of the enzyme from the virus that
infects cats. The structure is compared with that of HIV- I and RSV pro-
9. Miller M, Jask6lski M, Rao JKM, Leis J, Wlodawer A: Crystal struc-
ture of a retroviral protease proves relationship to aspartic
protease family. Nature 1989, 337:576-579.

The first retroviral protease structure to be determined. This structure
established the similarity of the retroviral enzymes to the larger single-
chain proteases from other species such as fungi and animals.
10. Gustchina A, Kervinen J, Powell DJ, Zdanov A, Kay J, Wlodawer A:
Structure of equine infectious anemia virus proteinase com-
plexed with an inhibitor. Protein Sci 1996, 5:1453-1465.
The crystal structure of the enzyme from the virus that infects horses.
This enzyme has interesting variations when compared to HIV- I pro-
tease, such as the size of surface loops and the presence of a helix at a
certain position in the structure.
I I. Wlodawer A, Gustchina A: Structural and biochemical studies
of retroviral proteases. Biochim Biophys Acta 2000, 1477:16-34.
A review of the structural organization of retroviral protease and dis-
cussion of drug-resistant forms.
12. Andreeva N: A consensus template of the aspartic proteinase
fold. In Structure and Function of the Aspartic Proteinases. Edited by
Dunn BM. New York: Plenum Press; 1991, 559-572.
The first description of the common structural organization of the
aspartic proteinase class of enzymes. This work pre-dated the discovery
of HIV- I protease and other retroviral enzymes.
13. Davies DR: The structure and function of the aspartic pro-
teinases. Annu Rev Biophys Biophys Chem 1990, 19:189-215.
A general review of all aspects of the aspartic protease family, including
structure, catalytic mechanism, and inhibition.
14. Goodenow MM, Bloom G, Rose SL, Pomeroy SM, O'Brien PO, Perez
EE, Sleasman JW, Dunn BM: Naturally occurring amino acid
polymorphisms in human immunodeficiency virus type I
(HIV-1) Gag NC p7 and the C-cleavage site impact GagPol
processing by HIV- I protease. Virology 2002, 292:137-149.
A description of alterations in the pathway by which HIV-1I protease
cuts itself out of a Gag-Pol polyprotein and sequentially cleaves the
other sites within the polyprotein.
15. Erickson-Viitanen S, Manfredi J, Viitanen P, Tribe DE, Tritch R,
Hutchison CA, Loeb DD, Swanstrom R: Cleavage of HIV-1 gag
polyprotein synthesized in vitro sequential cleavage by the
viral protease. Aids Res Hum Retroviruses 1989, 5:577-591.
This paper presents analysis of the cleavage of multiple sites within the
Gag-Pol polyprotein. This work established the principle of sequential
cleavage of the different cleavage junctions.
16. Perez EE, Rose SL, Peyser B, Lamers SL, Burkhardt B, Dunn BM,
Hutson AD, Sleasman JW, Goodenow: HIV-I protease genotype
predicts immune and viral response to combination therapy
with protease inhibitors [PI] in PI-naive patients. J Inf Dis
2001, 183:579-588.
An analysis of the relationship between the HIV-1I sequence in infected
patients and the success or failure of combination therapy. Sequences
within the gag-pol region were analyzed.
17. HIV Resistance and Implications for Therapy. Edited by Larder B,
Richman D, Vella S. Second Edition, Atlanta: Medicom Inc; 2001.
A study of all sequence variation found in patients undergoing
therapy with analysis of the differences that occur depending on the
drugs utilized.
18. GenBank []
Database of protein and DNA sequences.
19. ClustalW []
A computer program used to align sequences and calculate relatedness.

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