Late emergence of A594V and L595W mutations related to ganciclovir resistance in a patient with HCMV retinitis and long-term HIV progression.
The emergence of ganciclovir (GCV) resistance during the treatment of human cytomegalovirus (HCMV) infection is a serious clinical challenge, and is associated with high morbidity and mortality. In this case report, we describe the emergence of two consecutive mutations (A594V and L595W) related to GCV resistance in a patient with HCMV retinitis and long-term HIV progression after approximately 240 days of GCV use. Following the diagnosis of retinitis, the introduction of GCV did not result in viral load reduction. The detected mutations appeared late in the treatment, and we propose that other factors (high initial HCMV load, previous GCV exposure, low CD4+ cell count), in addition to the presence of resistance mutations, may have contributed to the treatment failure of HCMV infection in this patient.
Hemocentro de Ribeirão Preto, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, BR.
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Slavov
Divisão de Moléstias Infecciosas e Tropicais, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, BR.
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Vilar
Laboratório de Hematologia Experimental, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, BR.
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Wagatsuma
Divisão de Moléstias Infecciosas e Tropicais, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, BR.
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Santana
Divisão de Moléstias Infecciosas e Tropicais, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, BR.
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Machado
Divisão de Moléstias Infecciosas e Tropicais, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, BR.
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Fonseca
Hemocentro de Ribeirão Preto, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, BR.
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Kashima
Hemocentro de Ribeirão Preto, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, BR.
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Covas
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000235:genetics* / Q000821:virology; D000998:Antiviral Agents / Q000627:therapeutic use*; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy / Q000235:genetics*; D004279:DNA, Viral / Q000235:genetics; D018450:Disease Progression; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D009154:Mutation; D017211:Treatment Failure; D019562:Viral Load / Q000187:drug effects
D000998:Antiviral Agents; D004279:DNA, Viral; D015774:Ganciclovir