title: Transmission of human immunodeficiency virus I drug resistance - a case report. What are the clinical implications?
abstract: 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.
authors.affiliation: Department of General Internal Medicine, University of Bonn, Sigmund-Freud Strasse 25, 53105 Bonn, Germany. evrim.anadol@ukb.uni-bonn.de
authors.forename: E
authors.initials: E
authors.lastname: Anadol
authors.forename: R
authors.initials: R
authors.lastname: Kaiser
authors.forename: J
authors.initials: J
authors.lastname: Verheyen
authors.forename: E
authors.initials: E
authors.lastname: Schülter
authors.forename: J
authors.initials: J
authors.lastname: Emmelkamp
authors.forename: C
authors.initials: C
authors.lastname: Schwarze-Zander
authors.forename: B
authors.initials: B
authors.lastname: Kupfer
authors.forename: J C
authors.initials: JC
authors.lastname: Wasmuth
authors.forename: J K
authors.initials: JK
authors.lastname: Rockstroh
mesh_terms: 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
chemical_list: D018894:Reverse Transcriptase Inhibitors; D015215:Zidovudine; C514824:reverse transcriptase, Human immunodeficiency virus 1; D054303:HIV Reverse Transcriptase