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

Amedeo Capetti^1, , 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

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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