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CASO CLINICO Il paziente n a ϊ ve ad alta viremia

CASO CLINICO Il paziente n a ϊ ve ad alta viremia Rapido sviluppo di resistenza ad EFV dopo solo 4 mesi di terapia. Clinical Case : ID 13268 Patient infected with HIV-1 CRF01_AE. Age 43. Sex F. Risk Factor Heterosex. CDC stage C3. I Seropositivity December 2011. out. in.

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CASO CLINICO Il paziente n a ϊ ve ad alta viremia

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  1. CASO CLINICO Il paziente naϊve ad alta viremia Rapido sviluppo di resistenza ad EFV dopo solo 4 mesi di terapia

  2. Clinical Case: ID 13268 Patient infected with HIV-1 CRF01_AE Age 43 Sex F Risk Factor Heterosex CDC stage C3 I Seropositivity December 2011 out in in out 650 6.5 GRT April 2012 PR:K20R, M36I, L63P, L89I, I93L RT:K103N, Y188H/Y GRT December 2011 PR:K20R, M36I, L63P, L89I, I93L RT:NONE 600 6.0 >500000 cps/ml 550 5.5 500 5.0 450 Other polmutations PR:T12I/T, I13V, E35D, N37D, R41K, K43R, H69K RT:E6D, V35T, T39K, K43E, F61F/L, D121H, K122E, I142V, S162A, K173I, Q174K, D177E, Q207A, R211S, V245E, A272P, V276I, T286A, E291D, V292I, I293V, E312T, I326V, Q334R, G335D On December 2011 Viremia: 624734 copies/ml CD4: 19 cells/µl Other polmutations PR:I13V, Q18H/Q, E35D, N37D, R41K, K43R, H69K RT:E6D, V35T, T39K, K43E, D121D/H, I142V, S162A, K173I, Q174K, D177E, G196EG, I202IV, Q207A, R211S, V245E, A272P, V276IV, T286A, E291D, V292I, I293V, E312T, I326V Viremia (log copies/ml) 4.5 CD4 cellcount(cells/ul) 400 4.0 350 300 3.5 Rapid appearance resistance to TDF and EFV after only four months of therapy 250 3.0 200 2.5 150 2.0 100 Undetectability threshold 1.5 50 0 1.0 Apr-12 Mar-12 Jan-12 Feb-12 Dec-11 DECEMBER 2011 – APRIL 2012 TDF+TFC+EFV

  3. Clinical Case: ID 13268 Patient with HIV-1 CRF01_AE subtype Age 43 Sex F Risk Factor Heterosex CDC stage C3 I Seropositivity December 2011 Mutationscoring*for the protease GRT December 2011 GRT April 2012 Mutationscoring*for the reverse transcriptase GRT December 2011 GRT April 2012 Susceptible virus Virus low level of resistance Virus intermediate resistance Virus high level of resistance * Stanford Algorithm (http:hivdb.stanford.edu)

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