CASO CLINICO
Il paziente naϊve
ad alta viremia
Rapido sviluppo di resistenza ad
EFV dopo solo 4 mesi di terapia
Clinical Case: ID 13268 Patient
Age
43
infected with HIV-1 CRF01_AE
in
650
550
500
450
350
150
GRT December 2011
>500000
cps/ml
PR:
K20R,
M36I,
L63P, L89I, I93L
RT: NONE
GRT April 2012
PR: K20R, M36I,
L63P, L89I, I93L
RT: K103N, Y188H/Y
Other pol mutations
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,
Undetectability threshold
E312T,
I326V
Other pol mutations
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
Viremia: 624734 copies/ml
Rapid appearance
resistance to TDF and
CD4: 19 cells/µl
EFV after only four months of therapy
100
50
Feb-12
Jan-12
0
Dec-11
CDC stage
C3
out
DECEMBER 2011 – APRIL 2012
TDF+TFC+EFV
Apr-12
200
I Seropositivity
December 2011
6.5
Mar-12
250
in
out
On December 2011
400
300
Risk Factor
Heterosex
6.0
5.5
5.0
4.5
4.0
3.5
3.0
2.5
2.0
1.5
1.0
Viremia (log copies/ml)
CD4 cell count (cells/ul)
600
Sex
F
Clinical Case: ID 13268 Patient
with HIV-1 CRF01_AE subtype
Age
43
Sex
F
Risk Factor
Heterosex
I Seropositivity
December 2011
CDC stage
C3
Mutation scoring* for the protease
PR
Total:
PR
Total:
ATV/r
DRV/r
FPV/r
IDV/r
LPV/r
NFV
SQV/r
TPV/r
0
0
0
0
0
0
0
DRV/r
FPV/r
IDV/r
LPV/r
NFV
SQV/r
TPV/r
0
0
0
0
0
0
0
0
ATV/r
0
GRT December 2011
GRT April 2012
Mutation scoring* for the reverse transcriptase
RT
3TC
Total:
RT
ABC
0
3TC
AZT
0
ABC
D4T
0
AZT
DDI
0
D4T
FTC
0
DDI
TDF
0
FTC
EFV
0
TDF
ETR
0
EFV
0
ETR
NVP
0
NVP
RPV
0
RPV
K103N
-
-
-
-
-
-
-
60
0
60
0
Y188H
-
-
-
-
-
-
-
30
0
60
0
Total:
0
0
0
52
0
0
29
90
0
120
0
Susceptible virus
Virus low level of resistance
Virus intermediate resistance
Virus high level of resistance
GRT December 2011
GRT April 2012
* Stanford Algorithm (http:hivdb.stanford.edu)