Bictegravir/emtricitabine/tenofovir alafenamide
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Virologic failure: case report A 68-year-old man exhibited virologic failure during anti-retroviral therapy with bictegravir/emtricitabine/tenofovir-alafenamide for HIV-1 infection. The man was diagnosed with HIV-1 infection subtype-B in 1985. He was initially treated with combined antiretroviral therapy comprising zidovudine/lamivudine (3TC) plus lopinavir/ritonavir in February 2007. In October 2014, he was switched to abacavir/ lamivudine/dolutegravir. Later, in July 2017, antiretroviral therapy was switched to bictegravir/emtricitabine/tenofovir-alafenamide [BIC/F/TAF; route and dosage not stated]. He exhibited optimal adherence and tolerance to the treatment; however, in June 2018, 11 months after bictegravir/emtricitabine/tenofovir alafenamide initiation, he exhibited virological failure. Subsequently, Sanger genotyping was performed on the virological failure sample, while ultra-deep-sequencing (UDS) was performed on a pretherapeutic sample from June 2001 and on the virological failure sample. Sanger sequencing revealed no selection of NRTI resistance mutation, while an A265V mutation was evident in the integrase region, as a mixture, A265A/V, on the 2016 DNA genotype. At all points, plasma drug concentrations were adequate. The UDS analysis showed the presence of an unusual integrase mutation, A265V, in virologic failure sample, which was not detected in the pre-therapeutic sample. Additionally, M50I polymerphism, as being a compensatory mutation, was detected in both pre-therapeutic and virologic failure sample. No other minority INI-resistance mutations were detected by the UDS. Andre-Garnier E, et al. Previously unreported emergence of A265V substitution in the integrase gene in association with bictegravir virological failure. International Journal of 803506965 Antimicrobial Agents 56: No. 2, Aug 2020. Available from: URL: http://doi.org/10.1016/j.ijantimicag.2020.106039
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Reactions 17 Oct 2020 No. 1826
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