title: Favorable therapeutic response with an antiretroviral salvage regimen in an HIV-1-positive subject infected with a CRF11-cpx virus.
abstract: HIV drug resistance still represents a crucial problem in antiretroviral therapy. We report a case of a naive patient, harboring a CRF11-cpx virus, which showed drug resistance mutations in the reverse transcriptase. A drug resistance genotyping test was performed for the pol (protease, reverse transcriptase, and integrase) and V3 regions. The initial clinical parameter results showed a 4 log level of HIV-RNA (12,090 cp/ml) and a very low CD4(+) cell count (35 cells/μl). We designed an initial highly active antiretroviral therapy (HAART) regimen including lamivudine (3TC)+abacavir (ABC)+booster ritonavir (DRV/r). The virus was highly resistant to all nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs) and nonnucleoside reverse transcriptase inhibitors (NNRTIs) except for ABC, tenofovir (TDF), and efavirenz (EFV) and was susceptible to all protease inhibitors (PIs) and integrase inhibitors (INIs). A salvage regimen including raltegravir (RAL)+DRV/r was started. Ten months later, the immunovirological status shows CD4(+) 142/μl and HIV-RNA <37 cp/ml. Our results demonstrate the effectiveness of a treatment combination that includes RAL+DRV/r in a patient infected with a complex X4-tropic CRF11-cpx virus.
authors.affiliation: 1 Third Infectious Diseases Division, DIBIC "Luigi Sacco," University of Milan , Milan, Italy .
authors.forename: Pamela
authors.initials: P
authors.lastname: Tau
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mancon
authors.forename: Davide
authors.initials: D
authors.lastname: Mileto
authors.forename: Silvia
authors.initials: S
authors.lastname: Di Nardo Stuppino
authors.forename: Giulia
authors.initials: G
authors.lastname: Bottani
authors.forename: Maria Rita
authors.initials: MR
authors.lastname: Gismondo
authors.forename: Massimo
authors.initials: M
authors.lastname: Galli
authors.forename: Valeria
authors.initials: V
authors.lastname: Micheli
authors.forename: Stefano
authors.initials: S
authors.lastname: Rusconi
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D024882:Drug Resistance, Viral; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D015497:HIV-1 / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008969:Molecular Sequence Data; D020125:Mutation, Missense; D016879:Salvage Therapy / Q000379:methods*; D017422:Sequence Analysis, DNA; D016896:Treatment Outcome; D019562:Viral Load; D054302:pol Gene Products, Human Immunodeficiency Virus / Q000235:genetics
chemical_list: D044966:Anti-Retroviral Agents; D054302:pol Gene Products, Human Immunodeficiency Virus