Rapid emergence of resistance to antiretroviral treatment after undisclosed prior exposure: a case report
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Date
Authors
Rossouw, Theresa M.
Van Dyk, Gisela
Van Zyl, Gert
Journal Title
Journal ISSN
Volume Title
Publisher
AOSIS OpenJournals
Abstract
INTRODUCTION: Patients who disengaged from care may present as therapy naïve for antiretroviral
treatment (ART) initiation at a different site, without being recognised as being at an increased
risk of rapid treatment failure and HIV drug resistance.
PATIENT PRESENTATION: A 43-year-old woman, who gave no prior history of ART, was initiated
on a standard first-line regimen of TDF, FTC and EFV. She had a poor response to treatment
with evidence of treatment failure at 12 months.
MANAGEMENT AND OUTCOME: HIV-1 drug resistance tests showed no pre-treatment HIVDR
mutations, but revealed high-level drug resistance to all component drugs at 12 months. On
investigation, viral load (VL) was recorded in 2012 and 2013, providing evidence of prior ART use.
CONCLUSION: Linkage of patient therapy and laboratory information to unique patient identifiers
may allow health-care workers to identify patients who previously received ART and disengaged
from care. This will enable differentiated care when these patients reinitiate ART, which should
involve expedited VL testing and more rapid transition to definitive second-line ART
Description
Keywords
HIV drug resistance, Undisclosed prior treatment, Human immunodeficiency virus (HIV), Antiretroviral therapy (ART)
Sustainable Development Goals
Citation
Rossouw TM, Van Dyk G,
Van Zyl G. Rapid emergence
of resistance to antiretroviral
treatment after undisclosed
prior exposure: A case report.
Southern African Journal of HIV Medicine 2019;20(1),
a965. https://doi.org/10.4102/sajhivmed.v20i1.965.