title: Very early virological failure and drug resistance mutations in a woman on antiretroviral therapy in Eastern Cape, South Africa: a case report.
abstract: BACKGROUND
  Rapid scale-up of antiretroviral therapy rollout in Sub-Saharan African countries faces the challenge of virological failure. This could be the consequence of transmitted drug-resistant human immunodeficiency virus strains at the population level. While a pre-antiretroviral therapy genotypic test has been a major component of the human immunodeficiency virus management programme in developed nations, it is yet to be incorporated into the antiretroviral therapy programme in resource-poor countries.
  
  
  METHODS
  A 32-year-old Black African woman was seen for her six-month routine review. Her viral load after initiation of fixed drug combination of tenofovir, emtricitabine and efavirenz was 31,397 RNA copies/mL. Adherence was assessed to be good based on pharmacy pick-up dates, on-time clinic appointment records, medical file review, self-reporting and treatment supporter's report. Her viral load was repeated after another two months of close monitoring; the result showed viral load of 31,159 RNA copies/mL. She was assessed as virological failure to her first-line antiretrovirals and commenced on second-line antiretrovirals: zidovudine/lamivudine/Aluvia(®) (lopinavir and ritonavir). A human immunodeficiency virus drug genotypic testing showed she was only susceptible to zidovudine and protease inhibitors. At third month on the new regimen, her viral load was suppressed.
  
  
  CONCLUSIONS
  This case report demonstrates the possibility of a silent epidemic within the human immunodeficiency virus pandemic in resource-poor settings like Eastern Cape, South Africa. We described a case of early virological failure in a highly motivated young woman. Although, a pre-antiretroviral therapy genotypic test is yet to be incorporated into a human immunodeficiency virus programme in resource-poor countries, the need for it might become evident as the programme expands. Close monitoring of the viral load of patients according to national guidelines will enable early detection of a failing regimen and prompt intervention can be instituted to prevent morbidity and mortality. There is an urgent need to strengthen the human immunodeficiency virus programme in resource-poor countries to prevent the emergence of an epidemic of transmitted drug-resistant human immunodeficiency virus strains within the existing human immunodeficiency virus pandemic.
authors.affiliation: Department of Family Medicine, Division of HIV Care, Cecilia Makiwane Hospital, East London Hospital Complex, East London, Eastern Cape Province, South Africa. dudumela@yahoo.com.
authors.forename: Olufunso Oladipo
authors.initials: OO
authors.lastname: Sogbanmu
authors.affiliation: Department of Family Medicine, Division of HIV Care, Cecilia Makiwane Hospital, East London Hospital Complex, East London, Eastern Cape Province, South Africa. vincoladele@gmail.com.
authors.forename: Oladele Vincent
authors.initials: OV
authors.lastname: Adeniyi
authors.affiliation: Department of Family Medicine, Division of HIV Care, Cecilia Makiwane Hospital, East London Hospital Complex, East London, Eastern Cape Province, South Africa. yusilanof@gmail.com.
authors.forename: Yusimi Ordaz
authors.initials: YO
authors.lastname: Fuentes
authors.affiliation: School of Health Sciences, University of Fort Hare, East London, South Africa. dgoon@ufh.ac.za.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ter Goon
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D024921:Drug Resistance, Multiple, Viral / Q000235:genetics*; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D006801:Humans; D009154:Mutation; D013019:South Africa; D017211:Treatment Failure; D019562:Viral Load; D015215:Zidovudine / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D015215:Zidovudine