Page 81 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 4 Case Report

A case report of untreatable HIV infection

in Harare, Zimbabwe

Authors: Introduction: Zimbabwe, like other resource limited countries, manages HIV infection using
Cleophas Chimbetete the public health approach with standard antiretroviral therapy (ART) regimens for first,
1,2
Linda Chirimuta 2
Margaret Pascoe 2 second and third-line treatment. Third-line ART is the last available treatment option and is
Olivia Keiser 1 based on dolutegravir and darunavir use after HIV drug resistance testing.
Affiliations: Patient Presentation: We report here a 17-year-old patient on dolutegravir (DTG) and
1 Institute of Global Health, Darunavir based third-line antiretroviral therapy (ART) previously exposed to raltegravir who
University of Geneva, develops multidrug resistance HIV to the four ART classes available in Zimbabwe.
Geneva, Switzerland
Management and Outcome: A trophism assay revealed that patient has CXCR4 trophic virus
2 Newlands Clinic, Harare, and hence will not benefit from Maraviroc. Patient is currently stable and receiving a holding
Zimbabwe regimen of abacavir, lamivudine and lamivudine.
Corresponding author: Conclusion: This is the first documented case of multiclass resistance to the four available ART
Cleophas Chimbetete, classes in Zimbabwe. The development and transmission of multiclass HIV drug resistance in
[email protected] resource limited settings has potential to undo the gains of national ART programs. There is
need to ensure optimum adherence to ART even in the era of DTG.
Dates:
Received: 16 July 2018 Keyowrds: Dolutegravir; Resistance; Untreatable HIV; Zimbabwe; ART programmes.
Accepted: 28 Feb. 2019
Published: 27 June 2019

How to cite this article: Background
Chimbetete C, Chirimuta L,
Pascoe M, Keiser O. A case Widespread availability of antiretroviral therapy (ART) has transformed a positive HIV diagnosis
report of untreatable HIV from being a death sentence into a chronic manageable disease. To date, no cure exists for HIV, and
infection in Harare, Zimbabwe. hence patients must remain on effective ART for the rest of their lives, that makes the development
S Afr J HIV Med. 2019;20(1), of drug resistance a major public health concern. Sustained viral suppression is of paramount
a885. https://doi.org/ 10.4102/ importance if drug resistance is to be prevented. Strategies to ensure optimal adherence to ART are,
sajhivmed.v20i1.885
therefore, an important component of HIV care and treatment. Antiretroviral therapy resistance
Copyright: limits further treatment options, increases treatment programme costs and drug resistance may
1
© 2019. The Authors. even be transmitted to others. The rising prevalence of HIV drug resistance poses a great threat to
Licensee: AOSIS. This work the HIV response and has the potential to drive increase in mortality and HIV incidence. Several
2
is licensed under the risk factors for the development of HIV drug resistance among patients on ART have been identified. 3
Creative Commons
Attribution License.
HIV treatment in Zimbabwe is based on a public health approach using standard national
treatment guidelines. Treatment guidelines have periodically changed and are guided by the
4
World Health Organization (WHO). In 2015, Zimbabwe introduced third-line ART in the national
programme. Patients failing second-line ART are referred for specialist assessment that includes
viral load (VL) and genotype testing prior to recommending third-line medicines. Adherence
needs to be reinforced at all times. 4
We report the first case of documented four-class HIV drug resistance in Zimbabwe that highlights the
possibility of third-line ART failure and transmission of untreatable HIV in resource-limited settings.
Case report

We report the case of an adolescent girl born in July 2000. She tested positive for HIV infection in
2009 and was enrolled into care at Newlands Clinic on 30 July 2009. She is the last born in a family
of three children, a paternal orphan and stays with her mother. She was vertically infected, and
her mother is accessing ART at the same treatment centre. Both her siblings are HIV negative. She
commenced first-line ART on 28 August 2009. Table 1 summarises ART regimens received over
Read online: time and the reasons for regimen changes.
Read online:
Scan this QR
Scan this QR
code with your
code with your
smart phone or Monitoring for ART treatment success was done clinically and immunologically since the
smart phone or
mobile device initiation of treatment. Routine VL monitoring was added in January 2014. Figure 1 highlights the
mobile device
to read online.
to read online.
patient’s CD4, VL and ART regimens over time.
http://www.sajhivmed.org.za 74 Open Access