Towne Trent G, Hays Travis R
Parkview Specialty Pharmacy, Parkview Regional Medical Center, Fort Wayne, IN, USA.
PPG Infectious Diseases, Parkview Regional Medical Center, Fort Wayne, IN, USA.
Am J Health Syst Pharm. 2025 Jun 26;82(13):e596-e599. doi: 10.1093/ajhp/zxaf078.
Cabotegravir/rilpivirine (CAB/RPV) is the first long-acting antiretroviral therapy for patients with human immunodeficiency virus (HIV). It is administered via intramuscular injection into the gluteal muscle, requiring precise technique. We report the case of a patient living with HIV who developed resistance to CAB despite on-time administration of all doses.
A 34-year-old man with a body mass index (BMI) of 38.42 kg/m2 who received therapy with CAB/RPV 600 mg/900 mg intramuscularly every other month for 15 months presented to the clinic for routine HIV care. An HIV viral load obtained just before the visit demonstrated a significant elevation in his viral load, which was previously undetectable. Further testing demonstrated the development of a G118R resistance-associated mutation in the virus with a class-wide effect on integrase inhibitors. Upon review, it was determined that the patient had received all doses of his medication with a 1.5-inch needle rather than the recommended 2-inch needle based on his BMI. He was subsequently switched to darunavir/cobicistat/emtricitabine/tenofovir alafenamide and quickly achieved viral suppression.
This case demonstrates the potential for patients living with HIV to develop resistance to CAB/RPV despite on-time administration of the medication. Proper administration and timing of antiretroviral therapy for these patients is essential to ensure efficacy and safety in the management of HIV but does not completely prevent development of resistance.
卡博特韦/利匹韦林（CAB/RPV）是首款用于人类免疫缺陷病毒（HIV）患者的长效抗逆转录病毒疗法。它通过肌内注射至臀肌给药，需要精确的技术。我们报告了一例HIV感染者的病例，该患者尽管按时服用了所有剂量的药物，但仍对CAB产生了耐药性。
一名34岁男性，体重指数（BMI）为38.42kg/m²，接受CAB/RPV 600mg/900mg每两个月一次的肌内注射治疗15个月，前来诊所进行常规HIV护理。就诊前测得的HIV病毒载量显示其病毒载量显著升高，而此前该病毒载量一直检测不到。进一步检测显示病毒中出现了G118R耐药相关突变，对整合酶抑制剂具有全类效应。经检查，确定该患者基于其BMI使用1.5英寸针头而非推荐的2英寸针头注射了所有剂量的药物。随后他改用了达芦那韦/考比司他/恩曲他滨/替诺福韦艾拉酚胺，并迅速实现了病毒抑制。
该病例表明，HIV感染者即使按时服药，仍有可能对CAB/RPV产生耐药性。对这些患者进行抗逆转录病毒治疗时，正确的给药方式和时机对于确保HIV管理的疗效和安全性至关重要，但并不能完全防止耐药性的产生。
