title: An unusual case of underlying rilpivirine resistance in an antiretroviral-naïve man with AIDS.
abstract: Primary resistance mutations to second generation HIV non-nucleoside reverse transcriptase inhibitors are rare in HIV-infected persons in the US (estimated at 1.8%). We report an antiretroviral treatment (ART)-naïve patient with acquired immunodeficiency syndrome (AIDS) (CD4 cell count 20 cells/mm3, viral load 8439 copies/mL), who was infected with HIV-1 sub-type B virus containing a reverse transcriptase mutation, E138A, associated with rilpivirine resistance. Subsequently, he was initiated on a single tablet ART regimen containing an integrase inhibitor and developed immune reconstitution inflammatory syndrome (IRIS), presenting as Mycobacterium avium cervical adenitis. The patient went on to develop rifamycin-induced neutropenia during treatment of his opportunistic infection but later recovered his counts, and remains well on an integrase-based HIV regimen. His case illustrates the growing importance of archived resistance mutations including the less common E138A mutation, as well as the risk and rapid occurrence of IRIS in AIDS patients initiated on integrase inhibitors.
authors.affiliation: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA marion.skalweit@va.gov.
authors.forename: Marion J
authors.initials: MJ
authors.lastname: Skalweit
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D024882:Drug Resistance, Viral / Q000235:genetics*; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology; D054303:HIV Reverse Transcriptase / Q000235:genetics*; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000150:complications* / Q000188:drug therapy; D019429:Integrase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009154:Mutation; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D000068696:Rilpivirine / Q000627:therapeutic use*; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications*
chemical_list: D019380:Anti-HIV Agents; D019429:Integrase Inhibitors; D018894:Reverse Transcriptase Inhibitors; C514824:reverse transcriptase, Human immunodeficiency virus 1; D054303:HIV Reverse Transcriptase; D000068696:Rilpivirine
keywords: AIDS; HIV; Mycobacterium avium cervical adenitis; immune reconstitution inflammatory syndrome; non-nucleoside reverse transcriptase inhibitors; primary resistance; rilpivirine; treatment