He Yaozu, Liao Baolin, Liu Yuantao, Cao Yang, Li Linghua, Cai Weiping
Guangzhou Medical Research Institute of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, No.8 Huaying Road, Guangzhou, Guangdong, 510440, China.
Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, No.8 Huaying Road, Guangzhou, Guangdong, 510440, China.
Virol J. 2025 May 19;22(1):149. doi: 10.1186/s12985-025-02794-8.
The clinical management of HIV, particularly in the context of multi-drug resistance (MDR) and co-infections such as hepatitis B virus (HBV), is notably complex. Here we present a case study of a patient with multi-drug resistant HIV who was co-infected with drug-resistant HBV and suffered from renal insufficiency. We employed an optimized regimen based on the fusion inhibitor Albuvirtide (ABT), combined with highly effective, low nephrotoxicity antiviral drugs for HBV. This approach ultimately achieved effective suppression of both HIV and HBV.
A 58-year-old male, diagnosed with HIV in 1997 and co-infected with HBV, experienced renal insufficiency. Due to poor adherence, he developed resistance to nucleoside, non-nucleoside reverse transcriptase inhibitors, and protease inhibitors over nearly two decades, necessitating frequent modifications to his ART regimen. In 2019, HIV RNA rebounded to 1120 copies/mL, prompting resistance testing that revealed high-level resistance to Elvitegravir (EVG), intermediate resistance to Raltegravir (RAL), and potential low-level resistance to Bictegravir (BIC) and dolutegravir (DTG). This led to a strategic overhaul of the ART to ABT + Emtricitabine/Tenofovir Alafenamide (FTC/TAF) + double-dose DTG, resulting in a significant suppression of the HIV. Concurrently, HBV suppression and renal function were well-maintained.
This case underscores the potential value of individualized treatment strategies for patients with multidrug-resistant HIV and HBV co-infection complicated by renal impairment. The observed virological control following the use of novel agents such as Albuvirtide (ABT), in combination with second-generation integrase strand transfer inhibitors (INSTIs) like DTG, alongside renal-sparing antivirals, highlights the importance of designing optimized regimens based on resistance profiles and renal function. This personalized and adaptive therapeutic approach may offer clinical benefits in similarly complex scenarios.
HIV的临床管理，尤其是在多重耐药（MDR）以及合并感染如乙型肝炎病毒（HBV）的情况下，显著复杂。在此，我们呈现一例多重耐药HIV患者的病例研究，该患者合并耐药HBV感染且患有肾功能不全。我们采用了基于融合抑制剂阿比朵尔（ABT）的优化方案，并联合高效、低肾毒性的抗HBV病毒药物。这种方法最终实现了对HIV和HBV的有效抑制。
一名58岁男性，1997年被诊断为HIV感染且合并HBV感染，出现了肾功能不全。由于依从性差，在近二十年里他对核苷类、非核苷类逆转录酶抑制剂以及蛋白酶抑制剂产生了耐药，这使得他的抗逆转录病毒治疗（ART）方案需要频繁调整。2019年，HIV RNA反弹至1120拷贝/毫升，促使进行耐药检测，结果显示对埃替格韦（EVG）高度耐药，对拉替拉韦（RAL）中度耐药，对比克替拉韦（BIC）和多替拉韦（DTG）可能存在低度耐药。这导致ART方案进行了策略性调整，采用阿比朵尔 + 恩曲他滨/替诺福韦艾拉酚胺（FTC/TAF） + 双倍剂量多替拉韦，从而使HIV得到了显著抑制。同时，HBV也得到了抑制，肾功能保持良好。
该病例强调了针对多重耐药HIV与HBV合并感染且伴有肾功能损害患者的个体化治疗策略具有潜在价值。使用阿比朵尔（ABT）等新型药物联合多替拉韦（DTG）等第二代整合酶链转移抑制剂（INSTIs）以及肾保护型抗病毒药物后观察到的病毒学控制情况，突出了根据耐药谱和肾功能设计优化方案的重要性。这种个性化且适应性强的治疗方法可能在类似复杂情况下带来临床益处。
