Ketema Worku, Taye Kefyalew, Shibeshi Mulugeta Sitot, Tagesse Negash, Hirigo Agete Tadewos, Woubishet Kindie, Gutema Selamawit, Eifa Aberash, Toma Alemayehu
Department of Pediatrics and Child Health, College of Health Sciences, Hawassa University, Hawassa, Ethiopia.
Department of Medical Laboratory Technology, College of Health Sciences, Hawassa University, Hawassa, Ethiopia.
Res Rep Trop Med. 2021 Nov 25;12:263-266. doi: 10.2147/RRTM.S341711. eCollection 2021.
Treatment failure continues to be an impediment to the efficacy of highly active antiretroviral therapy (HART) in the treatment of human immunodeficiency virus type 1 infection (HIV-1). The World Health Organization (WHO) recommends third-line antiretroviral therapy (ART) for patients who have failed second-line ART. Darunavir (DRV) boosted with ritonavir (DRV/r) has a higher genetic barrier to resistance, is active against multidrug-resistant HIV isolates, retaining virological activity even when multiple protease mutations are present, and has been shown to be cost-effective when compared to other boosted protease inhibitors (PIs).
This is a case of a 40-year-old female known HIV/AIDS patient who has been on ART for the last 14 years with good adherence and regular follow-up, and who is now on 3rd line ART medication with TLD (tenofovir/lamivudine/dolutegravir)+DRV/r (in her 11th month) after being diagnosed with second-line treatment failure. After 6 months and 1 week of therapy, the viral load (VL) was sent, and the result was undetectable. The patient's clinical conditions had greatly improved.
Third-line ART therapy, which was once thought to be a salvageable treatment, is now the primary option for second-line ART failure. TLD in combination with ritonavir-boosted darunavir is found to be effective at lowering viral loads in the blood below detectable limits. Despite a lack of data on the use of third-line ART in Ethiopia, access to third-line ART containing ritonavir-boosted darunavir is recommended because it has been shown to be an effective alternative for patients who have failed second-line ART. We recommend that more research be done with a larger sample size, and that the findings in this paper be used with caution.
治疗失败仍然是高效抗逆转录病毒疗法（HART）治疗1型人类免疫缺陷病毒感染（HIV-1）疗效的一个障碍。世界卫生组织（WHO）建议对二线抗逆转录病毒疗法（ART）失败的患者采用三线抗逆转录病毒疗法。达芦那韦（DRV）与利托那韦联用（DRV/r）对耐药具有更高的遗传屏障，对多重耐药HIV分离株有活性，即使存在多个蛋白酶突变仍保持病毒学活性，并且与其他增强型蛋白酶抑制剂（PIs）相比已被证明具有成本效益。
这是一名40岁的已知HIV/AIDS女性患者，在过去14年中一直接受ART治疗，依从性良好且定期随访，在被诊断为二线治疗失败后，目前正在接受含替诺福韦/拉米夫定/多替拉韦（TLD）+DRV/r的三线ART药物治疗（处于第11个月）。治疗6个月零1周后，检测病毒载量（VL），结果未检测到。患者的临床状况有了很大改善。
三线ART疗法曾被认为是一种挽救性治疗，现在是二线ART失败的主要选择。发现TLD联合利托那韦增强的达芦那韦可有效将血液中的病毒载量降低到检测限以下。尽管埃塞俄比亚缺乏关于使用三线ART的数据，但建议使用含利托那韦增强的达芦那韦的三线ART，因为它已被证明是二线ART失败患者的有效替代方案。我们建议用更大样本量进行更多研究，并且本文的研究结果应谨慎使用。
