Multidrug-resistant HIV viral rebound during early syphilis: a case report

Background Syphilis has been associated with an increase in HIV RNA and a temporary decline in CD4 T cell counts in people living with HIV who are not receiving antiretroviral treatment (ART), and may be associated with a transient HIV RNA rebound in those who are receiving ART. Our case is the firs...

Full description

Saved in:

Bibliographic Details
Published in:	BMC infectious diseases Vol. 20; no. 1; pp. 273 - 5
Main Authors:	Giacomelli, Andrea, Micheli, Valeria, Cattaneo, Dario, Mancon, Alessandro, Gervasoni, Cristina
Format:	Journal Article
Language:	English
Published:	London BioMed Central 07.04.2020 BioMed Central Ltd Springer Nature B.V BMC
Subjects:	Acquired immune deficiency syndrome AIDS Analysis Anti-HIV Agents - therapeutic use Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Case Report Case reports CD4 antigen Coinfection Darunavir Darunavir - therapeutic use Deoxyribonucleic acid Disease resistance Disease transmission DNA DNA polymerases DNA sequencing Dolutegravir Drug resistance Drug Resistance, Multiple, Viral - genetics Efavirenz Gene sequencing Genetic testing Genotypes Health aspects Heterocyclic Compounds, 3-Ring - therapeutic use Highly active antiretroviral therapy HIV HIV and co-infections HIV Infections - complications HIV Infections - drug therapy HIV Infections - virology HIV prevention HIV-1 - genetics Human immunodeficiency virus Humans Infections Infectious Diseases Influenza Integrase Internal Medicine Leukocytes (mononuclear) Leukocytes, Mononuclear - virology Liquid chromatography Lymphocytes Lymphocytes T Male Mass spectrometry Mass spectroscopy Medical Microbiology Medicine Medicine & Public Health Microbial drug resistance Middle Aged Multidrug resistance Multidrug resistant organisms Mutation Next-generation sequencing Nucleotide sequence Parasitology Patient compliance Patients Peripheral blood mononuclear cells Phylogenetics Phylogeny Proteases Ribonucleic acid RNA RNA, Viral - blood RNA-directed DNA polymerase Sexual and Gender Minorities Sexually transmitted disease prevention Sexually transmitted diseases STD Syphilis Syphilis - complications Syphilis - microbiology T cells Therapeutic drug monitoring Transmitted drug resistance Treponema pallidum Tropical Medicine Viral Load - drug effects Virological rebound Viruses Germany Therapeutic drug monitoring Transmitted drug resistance Case report HIV prevention Virological rebound Syphilis
ISSN:	1471-2334, 1471-2334
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Background Syphilis has been associated with an increase in HIV RNA and a temporary decline in CD4 T cell counts in people living with HIV who are not receiving antiretroviral treatment (ART), and may be associated with a transient HIV RNA rebound in those who are receiving ART. Our case is the first to highlight the risk of a multidrug-resistant HIV viral rebound during the course of early syphilis even if antiretroviral drug concentrations are within the therapeutic range. Case presentation This 50-year-old HIV-1-positive male patient with concomitant early syphilis presented with an HIV RNA rebound (8908 copies/mL) during a scheduled visit to our clinic. He was receiving a stable ART regimen consisting of darunavir/cobicistat plus dolutegravir, and had a 15-year history of viral suppression. Good short-term drug adherence could be inferred as liquid chromatography tandem mass spectrometry showed that his trough antiretroviral drug concentrations were within the therapeutic range: darunavir 2353 ng/mL (minimum effective concentration > 500 ng/mL) and dolutegravir 986 ng/mL (minimum effective concentration > 100 ng/mL). A plasma RNA genotype resistance test revealed wild-type virus in the integrase region and protease region (PR), but extensive resistance in the reverse transcriptase (RT) region (M41L, E44D, D67N, K70R, M184V, L210W and T215Y). Phylogenetic analysis of next-generation sequences (used to investigate the presence of minor viral variants), the PR and RT sequences from plasma HIV RNA and pro-viral DNA extracted from peripheral blood mononuclear cells during the viral rebound, and a Sanger sequence obtained during a previous virological failure suggested clonal viral expression because the previous PR resistance mutations had been lost or had not been archived in pro-viral DNA. Conclusions This case shows that early syphilis may cause an HIV RNA rebound in patients under stable virological control with the potential of transmitting an extensively drug-resistant virus.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Report-3 ObjectType-Case Study-4 ObjectType-Case Study-2 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	1471-2334 1471-2334
DOI:	10.1186/s12879-020-04999-4