American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
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American Journal of Medical Case Reports. 2015, 3(7), 201-204
DOI: 10.12691/ajmcr-3-7-5
Open AccessCase Report

Response to a Dolutegravir-based Regimen in an HIV-Infected Woman with Multiple Comorbidities and a Highly Resistant Strain

Amedeo Capetti1, , Laura Carenzi1, Noemi Astuti1, Valeria Cozzi2, Valeria Micheli3 and Maria Vittoria Cossu1

11st Division of Infectious Diseases, Luigi Sacco University Hospital, Milano, Italy

2Clinical Pharmacology Unit, Luigi Sacco University Hospital, Milano, Italy

3Clinical Microbiology Unit, Luigi Sacco University Hospital, Milano, Italy

Pub. Date: June 10, 2015

Cite this paper:
Amedeo Capetti, Laura Carenzi, Noemi Astuti, Valeria Cozzi, Valeria Micheli and Maria Vittoria Cossu. Response to a Dolutegravir-based Regimen in an HIV-Infected Woman with Multiple Comorbidities and a Highly Resistant Strain. American Journal of Medical Case Reports. 2015; 3(7):201-204. doi: 10.12691/ajmcr-3-7-5

Abstract

HIV-infected patients have a higher burden of comorbidities than the general population and drug-drug interactions limit the choice of antiretroviral compounds, also limiting the possibility of drug sequencing in case of toxicity or failure. In our patient, affected by HIV-related pulmonary hypertension (HIV-PAH), the use of sildenafil and ambrisentan excluded the possibility of using two of the main classes of antiretrovirals, protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs). Having failed a combination regimen based on raltegravir, while awaiting the results of genotypic testing for drug resistance she was switched to dolutegravir, a brand new integrase strand transfer inhibitor (INSTI) with high genetic barrier, and in one month her HIV-1 viremia dramatically dropped to undetectable levels. The genotypic test revealed resistance to all the drugs she was taking including dolutegravir. The backbone was changed to a dual regimen including rilpivirine and viral suppression was maintained at three months. Unprecedented pharmacokinetic data are provided for the two antiviral drugs in combination with sildenafil and ambrisentan.

Keywords:
HIV PAH dolutegravir sildenafil ambrisentan resistance

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