Department of Medicine and the Duke Global Health Institute, Duke University Medical Center, Durham, North Carolina 27710, USA.
J Clin Invest. 2013 Sep;123(9):3704-5. doi: 10.1172/JCI71784. Epub 2013 Aug 27.
A 29-year-old man with recently diagnosed HIV infection and a CD4 cell count of 225/mm³ began treatment with atazanavir (300 mg), ritonavir (100 mg), emtricitabine (200 mg), and tenofovir (300 mg) daily. For 18 months, he was treatment adherent and his plasma HIV RNA level was below the limit of detection. He then began a relationship with a new partner, who introduced him to methamphetamines. His medication adherence became erratic, and he missed appointments in clinic. Eventually. he was hospitalized for rehabilitation, and he resumed taking his medications on schedule. Following his discharge, he was found to have a plasma HIV RNA level of 11,400 copies/ml. Genotypic resistance testing revealed only an M184V mutation associated with emtricitabine resistance. A decision regarding his next treatment regimen needs to be made.
一位 29 岁的男性，新近诊断为 HIV 感染，CD4 细胞计数为 225/mm³，开始接受每日一次的阿扎那韦（300mg）、利托那韦（100mg）、恩曲他滨（200mg）和替诺福韦（300mg）治疗。18 个月来，他坚持治疗，血浆 HIV RNA 水平低于检测下限。然后，他开始与新伴侣建立关系，新伴侣向他介绍了冰毒。他的服药依从性变得不稳定，错过了诊所的预约。最终，他因康复而住院，并按时重新开始服用药物。出院后，他的血浆 HIV RNA 水平为 11400 拷贝/ml。基因型耐药性检测仅显示与恩曲他滨耐药相关的 M184V 突变。需要就他的下一个治疗方案做出决定。
