1. Transmission of Human Immunodeficiency Virus I Drug Resistance - a Case Report. What are the Clinical Implications?
- Author
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Anadol E, Kaiser R, Verheyen J, Schülter E, Emmelkamp J, Schwarze-Zander C, Kupfer B, Wasmuth JC, and Rockstroh JK
- Subjects
transmitted resistance ,Drug Resistance ,Human immunodeficiency virus I ,T215 D ,Medicine - Abstract
Abstract The success of first-line antiretroviral therapy can be challenged by the acquisition of primary drug resistance. Here we report a case where baseline genotypic resistance testing detected resistance conferring nucleoside/nucleotide reverse transcriptase inhibitor (NRTI)-associated mutations, but no primary mutations for protease inhibitor (PI). Subsequent PI-based HAART with boosted saquinavir led to virological treatment success with persistently undetectable viral load. After treatment simplification from saquinavir to an atazanavir based PI-therapy and no change in backbone therapy rapid virological breakthrough occurred. Retrospective analysis displayed preexisting gag cleavage site mutations which may have reduced the genetic barrier in a clinical relevant manner in combination with the already existing NRTI resistance mutations. Alternatively, this effect could be explained with a different antiviral potency for the respective PIs used.
- Published
- 2010
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