title: Successful virological outcome in an HIV-infected individual with a three-class resistant variant and an insertion in the protease genome with a Tipranavir based regimen.
abstract: BACKGROUND
  Multi-class HIV-1 resistant variants are not rare nowadays. Genotypic and phenotypic resistance testing (including virtual phenotype) constitutes an important tool for optimizing antiretroviral treatment.
  
  
  OBJECTIVE
  To report a case of discrepancy between resistance interpretation and virological outcome.
  
  
  METHODS
  A case of a multi-drug experienced patient is presented. Genotypic and/or virtual phenotypic testing analysis was used.
  
  
  RESULTS
  The patient after 10 years of antiretroviral therapy with 11 different regimens unable to produce full virological suppression and with a rapidly declining CD4 count, achieved a successful virological outcome with a scheme containing Tipranavir boosted with low dose of ritonavir. Of note, the patient was screened for Tipranavir 1182.48 study and was found ineligible after genotypic analysis.
  
  
  CONCLUSIONS
  Virologic suppression was achieved despite the fact that neither an active agent was included in the backbone regimen nor the resistance profile could ensure the effectiveness of Tipranavir.
authors.affiliation: Attikon University General Hospital, Athens, Greece. ppanag@med.uoa.gr
authors.forename: P
authors.initials: P
authors.lastname: Panagopoulos
authors.forename: D
authors.initials: D
authors.lastname: Paraskevis
authors.forename: A
authors.initials: A
authors.lastname: Antoniadou
authors.forename: A
authors.initials: A
authors.lastname: Papadopoulos
authors.forename: G
authors.initials: G
authors.lastname: Poulakou
authors.forename: A
authors.initials: A
authors.lastname: Hatzakis
authors.forename: H
authors.initials: H
authors.lastname: Giamarellou
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D024921:Drug Resistance, Multiple, Viral / Q000187:drug effects / Q000235:genetics; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D008297:Male; D016254:Mutagenesis, Insertional / Q000187:drug effects* / Q000235:genetics; D010447:Peptide Hydrolases / Q000235:genetics; D010641:Phenotype; D011725:Pyridines / Q000627:therapeutic use*; D011753:Pyrones / Q000627:therapeutic use*; D013449:Sulfonamides; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D011725:Pyridines; D011753:Pyrones; D013449:Sulfonamides; D010447:Peptide Hydrolases; C107201:tipranavir
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