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, Maria Mazzitelli Infectious and Tropical Diseases Unit, Padua University Hospital , Padua , Italy Corresponding author. E-mail: m.mazzitelli88@gmail.com Search for other works by this author on: Oxford Academic Antonio Avolio Laboratory and Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin , Turin , Italy Search for other works by this author on: Oxford Academic Riccardo Carandina Radiodiagnostic Unit, University Hospital of Padua , Padua , Italy Search for other works by this author on: Oxford Academic Saverio Parisi Department of Molecular Medicine, Padua University Hospital , 35128 Padua , Italy Search for other works by this author on: Oxford Academic Annemarie Wensing Translational Virology, Department of Medical Microbiology, University Medical Center Utrecht , Utrecht , The Netherlands Search for other works by this author on: Oxford Academic Annamaria Cattelan Infectious and Tropical Diseases Unit, Padua University Hospital , Padua , Italy Search for other works by this author on: Oxford Academic
https://orcid.org/0000-0003-0263-0703 Journal of Antimicrobial Chemotherapy, dkae187, https://doi.org/10.1093/jac/dkae187
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21 June 2024
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Maria Mazzitelli, Antonio Avolio, Riccardo Carandina, Saverio Parisi, Annemarie Wensing, Annamaria Cattelan, Characterization of a case of virological failure after switch to long-acting cabotegravir and rilpivirine, Journal of Antimicrobial Chemotherapy, 2024;, dkae187, https://doi.org/10.1093/jac/dkae187
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In 2020, the European Drug Agency licensed injectable cabotegravir and rilpivirine (LACR) as a treatment for people with HIV with stable virological suppression. Eligibility criteria include the absence of rilpivirine or integrase inhibitor resistance mutations, no history of virological failures (VF) to these classes and no hepatitis B. Other VF risk factors for virological failure were identified, such as a BMI ≥ 30 kg/m² and A6 subtype.1,2 However, data suggested that a single risk factor is insufficient to predict VF, with each factor contributing unequally and that it also crucial to correctly classify HIV subtype, with a particular regard to subtype A6.3,4 Here, we present a detailed case of VF with LACR.
A 51-year-old post-menopausal woman diagnosed with HIV in April 2007 [B subtype, nadir CD4+ T cell count 387 cells/mm³, zenith viral load (VL) 12 815 copies/mL]. A baseline genotypic resistance test (GRT) revealed a minor resistance mutation for protease inhibitors (77I). She had no comorbidities or coinfections and received all the scheduled vaccinations during follow-up. Antiretroviral therapy (ART) with darunavir/cobicistat and tenofovir/emtricitabine was initiated in 2017 and simplified soon after to elvitegravir/cobicistat/tenofovir alafenamide/emtricitabine, with a sustained viral suppression <50 copies/mL.
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