Case Report

Rapid emergence of resistance to antiretroviral treatment after undisclosed prior exposure: A case report

Theresa M. Rossouw, Gisela van Dyk, Gert van Zyl
Southern African Journal of HIV Medicine | Vol 20, No 1 | a965 | DOI: https://doi.org/10.4102/sajhivmed.v20i1.965 | © 2019 Theresa M. Rossouw, Gisela van Dyk, Gert van Zyl | This work is licensed under CC Attribution 4.0
Submitted: 08 March 2019 | Published: 30 July 2019

About the author(s)

Theresa M. Rossouw, Department of Medical Immunology, University of Pretoria, Pretoria, South Africa
Gisela van Dyk, Department of Medical Immunology, University of Pretoria, Pretoria, South Africa
Gert van Zyl, Division of Medical Virology, Stellenbosch University and National Health Laboratory Service, Bellville, South Africa


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Abstract

Introduction: Patients who disengaged from care may present as therapy naïve for antiretroviral treatment (ART) initiation at a different site, without being recognised as being at an increased risk of rapid treatment failure and HIV drug resistance.

Patient presentation: A 43-year-old woman, who gave no prior history of ART, was initiated on a standard first-line regimen of TDF, FTC and EFV. She had a poor response to treatment with evidence of treatment failure at 12 months.

Management and outcome: HIV-1 drug resistance tests showed no pre-treatment HIVDR mutations, but revealed high-level drug resistance to all component drugs at 12 months. On investigation, viral load (VL) was recorded in 2012 and 2013, providing evidence of prior ART use.

Conclusion: Linkage of patient therapy and laboratory information to unique patient identifiers may allow health-care workers to identify patients who previously received ART and disengaged from care. This will enable differentiated care when these patients reinitiate ART, which should involve expedited VL testing and more rapid transition to definitive second-line ART.


Keywords

HIV drug resistance; Antiretroviral therapy; Undisclosed prior treatment

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