Daniela Ioana Munteanu 1, Raluca Mihailescu 1, Anca Streinu Cercel 2¸ Victoria Aramă 1,2
1 National Institute of infectious Diseases Prof. Dr. Matei Bals, Bucharest
2 University of Medicine and Pharmacy Carol Davila, Bucharest
Abstract
Introduction – HAART history is a history of changes, each new antiretroviral combination represents a chance to obtain viral undetectability. Objective – case presentation of HIV multiexperienced patient with virological failure, which belongs to the Romanian cohort of children and adolescents parenterally infected before 1990. Case presentation – we report the case of a 27 year old female, HIV positive since 1998 (at the age of 15 years), F genotype. First, she was diagnosed in B2 CDC clinico-immunological stage with 380/mmc CD4 count and HIV viremia of 5120 c/ml. The antiretroviral therapy was initiated in 1998, according to that time guidelines, first IDV+AZT+DDC, then EFV+3TC+d4T, NFV+DDI+d4T, LPV/r+NFV+3TC, LPV/r+SQV+3TC. Since 2001 the viremia remained detectable all the time, despite her good compliance to multiple antiretroviral regimen. In 2006, the CD4 count declined below 200 cell/ mm3 and therefore a salvage therapy was introduced TPV/r+3TC+T20, but the viral replication persisted (HIV-RNA 243.179c/ml). The resistance tests performed in this case showed multiple mutations with decreased susceptibility to all available drugs. In 2008, new drugs became available on Romanian pharmaceutical market and other combinations were built, first RAL+DRV/r+3TC+T20 and then RAL+DRV/ r+3TC+MVC+ETR and consequently the viremia became undetectable (May 2010 HIV-RNA <150c/ml, CD4 cell count 366/mm3). Conclusions – the patient represents an HIV multiexperienced case, with virological failure, despite good adherence to therapy. This case was among the first in our country who received new molecules, such as RAL, MAR, ETR and obtained the undetectability after 11 years of persistant viral replication. The new antiretroviral drug classes represent a step forward to obtain a durable viral suppression in multiexperienced patients with several resistance mutations.