Complete inhibition of viral breakthrough by combination of MKC-442 with AZT during a long-term culture of HIV-1 infected cells.

We have investigated viral breakthrough during a long-term culture of HIV-1-infected cells with the non-nucleoside reverse transcriptase inhibitors (NNRTIs) 6-benzyl-1-ethoxymethyl-5-isopropyluracil (MKC-442), nevirapine and loviride (alpha-APA). When the compounds were examined for their inhibitory effects on HIV-1 (HE strain) replication in MT-4 cells on day 4 after virus infection, the 50% effective concentrations (EC50) of MKC-442, nevirapine and loviride were 9.4, 98 and 21 nM, respectively. After a 48-day culture period, MKC-442, nevirapine and loviride completely inhibited viral breakthrough at concentrations of 1, 5 and 1 microM, respectively. These concentrations were 50-100-fold higher than their EC50 values. When the cells were treated with either MKC-442 (0.04 and 0.2 microM), nevirapine (0.2 and 1 microM) or loviride (0.04 and 0.2 microM) in combination with AZT (0.005 microM), only the combination of 0.2 microM MKC-442 with 0.005 microM AZT could completely inhibit the breakthrough of HIV-1 after a 68-day culture period. Polymerase chain reaction (PCR) analysis revealed that no proviral DNA was detected in the cells treated with this combination. Except for two combinations (0.04 microM MKC-442 + 0.005 microM AZT and 0.04 microM loviride + 0.005 microM AZT), all of the viruses isolated during combination treatments had various amino acid mutations in their reverse transcriptase (RT). These results indicate that the combination treatment with a relatively high dose of MKC-442 and a low dose of AZT may have potential to suppress the emergence of drug resistance during a long-term treatment in vivo and should be further pursued in HIV-1-infected patients.