USE OF A COMBINATION OF THE ANTIRETROVIRAL DRUGS DARUNAVIR ® AND ETRAVIRINE ® IN A PATIENT WITH A RESISTANT HIV STRAIN

The treatment of patients with resistant HIV is a complex problem requiring the use of nonstandard antiretroviral therapy (ARVT) regimens, an individual regimen for observation by an interdisciplinary team of specialists, and more frequent clinical and laboratory monitoring. Objective. To evaluate the efficiency and tolerability of a ritonavir and etravirine (ETR) (intelens ®)-boosted darunavir (prezista ®) regimen in a patient who previously received ARVT and developed antiretroviral drug (ARVD)-resistance in HIV and had low adherence to therapy. Materials and methods. A clinical case of HIV infection with developed ARVT resistance with low therapy adherence was described. Results. The HIVARVD (Moscow) resistance test established susceptibility to two ARVDs: DRV/r and ETR. When the optimized ARVT regimen was used, the level of CD4+-lymphocytes in the patient was 4 cells/ßl (1%) and the viral load was 228 765 copies/ml. Three weeks after the use of DRV/r in a dose of600/100 mg and ETR 200 mg bid, there were positive virological and immunological changes: the viral load decreased to 9108 copies/ml and CD4+-lymphocyte counts were increased by 80 cells/ßl of the baseline level. The therapy was well tolerated. There were no adverse reactions. There was an improvement in blood indicators (Hb, 113 g/l; red blood cells, 3.2 x 10 12/l; white Blood cells, 4.8 x 10 9/l) and normalization of the levels of liver transaminases (ALT, 41 U/l; AST, 59 U/l). At the 1-year follow-up (April 2014), positive changes remained: the patent felt satisfactory, had no complaints, and gained 14 kg. CD4 +-lymphocyte count was 180 cells/μl (9%) and the viral load was not detectable (less than 50 copies/ml). Conclusion. To create conditions for the systematic use of ARVDs is a necessary factor for the effective treatment for HIV infection in injection narcotic drug users. The optimized ARVT regimen made in terms of the HIVARVD resistance test demonstrated its high efficiency, safety, and ease-to-use in the patient who had a low ARVT adherence at Baseline.

antiretroviral therapy, adherence, darunavir (prezista ), etravirine (intelens )