Transmission of human immunodeficiency virus I drug resistance - a case report. What are the clinical implications?
The success of first-line antiretroviral therapy can be challenged by the acquisition of primary drug resistance. Here we report a case where baseline genotypic resistance testing detected resistance conferring nucleoside/nucleotide reverse transcriptase inhibitor (NRTI)-associated mutations, but no primary mutations for protease inhibitor (PI). Subsequent PI-based HAART with boosted saquinavir led to virological treatment success with persistently undetectable viral load. After treatment simplification from saquinavir to an atazanavir based PI-therapy and no change in backbone therapy rapid virological breakthrough occurred. Retrospective analysis displayed preexisting gag cleavage site mutations which may have reduced the genetic barrier in a clinical relevant manner in combination with the already existing NRTI resistance mutations. Alternatively, this effect could be explained with a different antiviral potency for the respective PIs used.
Anadol
E
E
Department of General Internal Medicine, University of Bonn, Sigmund-Freud Strasse 25, 53105 Bonn, Germany. evrim.anadol@ukb.uni-bonn.de
Kaiser
R
R
Verheyen
J
J
Schülter
E
E
Emmelkamp
J
J
Schwarze-Zander
C
C
Kupfer
B
B
Wasmuth
J C
JC
Rockstroh
J K
JK
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D000328:Adult; D024882:Drug Resistance, Viral; D005260:Female; D054303:HIV Reverse Transcriptase / Q000235:genetics*; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D009154:Mutation; D018894:Reverse Transcriptase Inhibitors / Q000494:pharmacology*; D015215:Zidovudine / Q000494:pharmacology
D018894:Reverse Transcriptase Inhibitors; D015215:Zidovudine; C514824:reverse transcriptase, Human immunodeficiency virus 1; D054303:HIV Reverse Transcriptase