Ioana D. Olaru 1, Adriana Hristea 1,2, Victoria Aramă 1,2, Raluca Mihăilescu 1, Daniela I. Munteanu 1
1 The National Institute of Infectious Diseases “Prof. Dr. Matei Bals”
2 “Carol Davila” University of Medicine and Pharmacy
Abstract
Virological failure in treatment-experienced HIV patients is often due to the presence of resistance mutations acquired during therapy. With the discovery of new antiretroviral (ARV) drugs new options for the management of these patients emerged. Case presentation. We present the case of a 45-year-old treatment-experienced, female patient diagnosed with HIV infection in 1997. Throughout almost the entire duration of her follow-up, her HIV viral loads were consistently detectable. Her CD4 count was relatively stable and she did not experience any significant clinical events. Resistance tests performed predicted reduced response to all 3 major ARV classes. Adherence to therapy was reportedly inadequate during the first years. Only when novel treatment options became available, could our patient finally attain virological suppression and an increase in CD4 count was observed. The treatment regimen on which undetectability was reached comprised the integrase inhibitor, raltegravir, boosted darunavir and enfuvirtide. Additionally, an improvement in the patient’s lipid profile was also noted after switching from the previous regimen which had included 2 boosted protease inhibitors. Conclusions. Novel agents can prove extremely useful for treatment-experienced patients, allowing them to attain virological suppression in the setting of multi-class resistance. Adherence to therapy is essential. Additionally, the beneficial effect on lipids of these agents vs. other ARVs is not to be neglected.