Antiretrovirals Reactions 1680, p48 - 2 Dec 2017 Development of multi-drug resistance in HIV infection: case report A 25-year old woman developed resistance to tenofovir, darunavir/ritonavir, maraviroc and raltegravir [routes not stated; not all dosages stated], while receiving it for HIV (human immunodeficiency virus) infection. The woman was diagnosed with HIV infection possibly acquired through injections with inadequately sterilized equipment in 1996. Two years before pregnancy, she started antiretroviral therapy with darunavir/ritonavir 600/100mg twice daily, maraviroc 150mg twice daily and tenofovir 300mg once daily with CD4 T-cell count above 700 cells/µL and stable viral suppression. In June 2015, she discontinued antiretroviral therapy as she moved to her birthplace. In November 2015, she found to be pregnant when she came back from her birthplace. Blood examination showed plasma HIV RNA of 21770 copies/mL and decreased CD4 T-cell count. She decided to continue her pregnancy and her prior antiretroviral therapy was restarted with addition of raltegravir. In March 2016, her HIV RNA gradually decreased. In April 2016, her HIV RNA was increased, genotypic resistance test (GRT) revealed R5 tropic virus with the presence of resistance mutations which were identified earlier; however, in addition to these mutations an accessory integrase mutation L74M was also noted. In May 2016, she was hospitalised due to suspected bacterial pneumonia two weeks prior to planned caesarean section. Her HIV RNA was 2894 copies/mL and CD4 T-cell count was 222 cells/µL. Her prior resistance pattern was confirmed by an additional GRT and the accumulation of new accessory integrase T97A mutation was noted. The woman’s therapy was switched from raltegravir to dolutegravir 50mg twice daily due to near term of pregnancy and the other antiretroviral therapy was continued in order to reach viral suppression and to delay caesarean delivery as long as possible. Twelve days later her HIV RNA dropped below the quantification limit and at 39 weeks she underwent caesarean delivery. She delivered a healthy baby and no adverse events or peripartum complications were noted. Author comment: "In April 2016 [during treatment with tenofovir, darunavir/ritonavir, maraviroc and raltegravir] an increase in HIV RNA was observed (534 copies/ml); genotypic resistance test (GRT) showed a R5 tropic virus and the presence of previously detected resistance mutations, but revealed the addition of the accessory integrase mutation L74M." Simonetti FR, et al. Pregnancy-related changes of antiretroviral pharmacokinetics: An argument for therapeutic drug monitoring. Antiviral Therapy 22: 361-363, No. 4, 2017. Available from: URL: - Italy 803284020 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680 Reactions Weekly Springer Journals


Reactions Weekly , Volume 1680 (1) – Dec 2, 2017
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Springer International Publishing
Copyright © 2017 by Springer International Publishing AG, part of Springer Nature
Medicine & Public Health; Drug Safety and Pharmacovigilance; Pharmacology/Toxicology
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