Case report: Emergence of dolutegravir resistance in a patient on second-line antiretroviral therapy
Introduction: The integrase strand transfer inhibitor dolutegravir (DTG) has a high genetic barrier to resistance. Only rare cases of resistance to DTG have been reported when it is used as a component of antiretroviral therapy regimens in treatment-experienced patients unless there was prior use of...
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| Format: | Article |
| Language: | English |
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AOSIS
2020-07-01
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| Series: | Southern African Journal of HIV Medicine |
| Subjects: | |
| Online Access: | https://sajhivmed.org.za/index.php/hivmed/article/view/1062 |
| _version_ | 1818149716295155712 |
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| author | Kairoonisha Mahomed Carole L. Wallis Liezl Dunn Shavani Maharaj Gary Maartens Graeme Meintjes |
| author_facet | Kairoonisha Mahomed Carole L. Wallis Liezl Dunn Shavani Maharaj Gary Maartens Graeme Meintjes |
| author_sort | Kairoonisha Mahomed |
| collection | DOAJ |
| description | Introduction: The integrase strand transfer inhibitor dolutegravir (DTG) has a high genetic barrier to resistance. Only rare cases of resistance to DTG have been reported when it is used as a component of antiretroviral therapy regimens in treatment-experienced patients unless there was prior use of a first-generation integrase inhibitor.
Patient presentation: A 38-year-old woman diagnosed with tuberculosis was switched to a second-line antiretroviral regimen of zidovudine, lamivudine and dolutegravir 50 mg 12-hourly together with rifampicin-based TB treatment. Based on treatment history and a previous resistance test there was resistance to lamivudine but full susceptibility to zidovudine. The patient did not suppress her viral load on this regimen and later admitted to only taking dolutegravir 50 mg in the morning because of insomnia.
Management and outcome: A second resistance test was performed which showed intermediate level of resistance to dolutegravir. Her regimen was changed to tenofovir, emtricitabine and ritonavir-boosted atazanavir with rifabutin replacing rifampicin for the remainder of her TB treatment. She achieved viral suppression on this regimen.
Conclusion: To our knowledge this is the first case report from South Africa of emergent dolutegravir resistance in a treatment-experienced, integrase inhibitor-naïve patient. Factors that may have contributed to resistance emergence in this patient were that there was only one fully active nucleoside reverse transcriptase inhibitor in the regimen and lower exposure to dolutegravir because of the reduced dosing frequency while on rifampicin. |
| first_indexed | 2024-12-11T13:11:27Z |
| format | Article |
| id | doaj.art-158c96895d76468d8c9e5c9f633ef73d |
| institution | Directory Open Access Journal |
| issn | 1608-9693 2078-6751 |
| language | English |
| last_indexed | 2024-12-11T13:11:27Z |
| publishDate | 2020-07-01 |
| publisher | AOSIS |
| record_format | Article |
| series | Southern African Journal of HIV Medicine |
| spelling | doaj.art-158c96895d76468d8c9e5c9f633ef73d2022-12-22T01:06:09ZengAOSISSouthern African Journal of HIV Medicine1608-96932078-67512020-07-01211e1e210.4102/sajhivmed.v21i1.1062686Case report: Emergence of dolutegravir resistance in a patient on second-line antiretroviral therapyKairoonisha Mahomed0Carole L. Wallis1Liezl Dunn2Shavani Maharaj3Gary Maartens4Graeme Meintjes5Private practice, JohannesburgDepartment of Molecular Pathology, BARC-SA and Lancet Laboratories, JohannesburgAid for AIDS Management (Pty) Ltd, Cape TownAid for AIDS Management (Pty) Ltd, Cape TownDepartment of Medicine, Faculty of Health Sciences, University of Cape Town, Cape TownDepartment of Medicine, Faculty of Health Sciences, University of Cape Town, Cape TownIntroduction: The integrase strand transfer inhibitor dolutegravir (DTG) has a high genetic barrier to resistance. Only rare cases of resistance to DTG have been reported when it is used as a component of antiretroviral therapy regimens in treatment-experienced patients unless there was prior use of a first-generation integrase inhibitor. Patient presentation: A 38-year-old woman diagnosed with tuberculosis was switched to a second-line antiretroviral regimen of zidovudine, lamivudine and dolutegravir 50 mg 12-hourly together with rifampicin-based TB treatment. Based on treatment history and a previous resistance test there was resistance to lamivudine but full susceptibility to zidovudine. The patient did not suppress her viral load on this regimen and later admitted to only taking dolutegravir 50 mg in the morning because of insomnia. Management and outcome: A second resistance test was performed which showed intermediate level of resistance to dolutegravir. Her regimen was changed to tenofovir, emtricitabine and ritonavir-boosted atazanavir with rifabutin replacing rifampicin for the remainder of her TB treatment. She achieved viral suppression on this regimen. Conclusion: To our knowledge this is the first case report from South Africa of emergent dolutegravir resistance in a treatment-experienced, integrase inhibitor-naïve patient. Factors that may have contributed to resistance emergence in this patient were that there was only one fully active nucleoside reverse transcriptase inhibitor in the regimen and lower exposure to dolutegravir because of the reduced dosing frequency while on rifampicin.https://sajhivmed.org.za/index.php/hivmed/article/view/1062hiv drug resistanceantiretroviral therapyregimensdolutegravirrifampicin |
| spellingShingle | Kairoonisha Mahomed Carole L. Wallis Liezl Dunn Shavani Maharaj Gary Maartens Graeme Meintjes Case report: Emergence of dolutegravir resistance in a patient on second-line antiretroviral therapy Southern African Journal of HIV Medicine hiv drug resistance antiretroviral therapy regimens dolutegravir rifampicin |
| title | Case report: Emergence of dolutegravir resistance in a patient on second-line antiretroviral therapy |
| title_full | Case report: Emergence of dolutegravir resistance in a patient on second-line antiretroviral therapy |
| title_fullStr | Case report: Emergence of dolutegravir resistance in a patient on second-line antiretroviral therapy |
| title_full_unstemmed | Case report: Emergence of dolutegravir resistance in a patient on second-line antiretroviral therapy |
| title_short | Case report: Emergence of dolutegravir resistance in a patient on second-line antiretroviral therapy |
| title_sort | case report emergence of dolutegravir resistance in a patient on second line antiretroviral therapy |
| topic | hiv drug resistance antiretroviral therapy regimens dolutegravir rifampicin |
| url | https://sajhivmed.org.za/index.php/hivmed/article/view/1062 |
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