@article{ajmcr2015375,
author={{Capetti, Amedeo and Carenzi, Laura and Astuti, Noemi and Cozzi, Valeria and Micheli, Valeria and Cossu, Maria Vittoria},
title={Response to a Dolutegravir-based Regimen in an HIV-Infected Woman with Multiple Comorbidities and a Highly Resistant Strain},
journal={American Journal of Medical Case Reports},
volume={3},
number={7},
pages={201--204},
year={2015},
url={http://pubs.sciepub.com/ajmcr/3/7/5},
issn={2374-216X},
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.},
doi={10.12691/ajmcr-3-7-5}
publisher={Science and Education Publishing}
}