Failure to bictegravir and development of resistance mutations in an antiretroviral-experienced patient

Antiviral Res. 2020 Jul:179:104717. doi: 10.1016/j.antiviral.2020.104717. Epub 2020 Jan 23.

Abstract

We present here one of the first cases of virological failure during treatment with bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF). On March 2019, an antiretroviral-experienced HIV-infected patient was admitted to hospital because of cerebral toxoplasmosis. After undergoing treatment with sulfadiazine-pyrimethamine for two weeks, the patient initiated a BIC/FTC/TAF treatment, with 6.01 HIV RNA Log copies/mL, and 37 CD4 cells/μL. After two months under antiretroviral therapy (ART), acute neurologic deterioration with epilepsy, right hemiparesis and dysphagia occurred, leading to nasogastric nutrition and treatment. After several weeks, virological failure was confirmed with 4.01 HIV RNA Log copies/mL and R263K and M184V resistance mutations were detected.

Keywords: Bictegravir; R263K; Virological failure.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenine / analogs & derivatives
  • Adenine / therapeutic use
  • Adult
  • Alanine
  • Amides
  • Anti-HIV Agents / therapeutic use*
  • Drug Resistance, Viral / genetics*
  • Drug Therapy, Combination
  • Emtricitabine / therapeutic use
  • Female
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • HIV-1 / drug effects
  • HIV-1 / genetics*
  • Heterocyclic Compounds, 3-Ring
  • Heterocyclic Compounds, 4 or More Rings / therapeutic use*
  • Humans
  • Mutation
  • Piperazines
  • Pyridones
  • Tenofovir / analogs & derivatives
  • Toxoplasmosis, Cerebral / drug therapy
  • Treatment Failure

Substances

  • Amides
  • Anti-HIV Agents
  • Heterocyclic Compounds, 3-Ring
  • Heterocyclic Compounds, 4 or More Rings
  • Piperazines
  • Pyridones
  • bictegravir
  • Tenofovir
  • tenofovir alafenamide
  • Emtricitabine
  • Adenine
  • Alanine