Favorable therapeutic response with an antiretroviral salvage regimen in an HIV-1-positive subject infected with a CRF11-cpx virus

HIV drug resistance still represents a crucial problem in antiretroviral therapy. We report a case of a naive patient, harboring a CRF11-cpx virus, which showed drug resistance mutations in the reverse transcriptase. Drug resistance genotyping test was performed for pol (protease, reverse transcriptase, and integrase) and V3 regions. The initial clinical parameters results showed a 4 logs level of HIV-RNA (12,090 cp/mL) and a very low CD4+ cell count (35 cells/µL). We designed an initial HAART regimen including 3TC+ABC+DRV/r. The virus resulted highly resistant to all NRTIs and NNRTIs except to ABC, TDF, and EFV and susceptible to all PIs and INIs. A salvage regimen including RAL+DRV/r was started. Ten months after, the immuno-virological status shows CD4+ 142/µL and HIV-RNA <37 cp/mL. Our results demonstrate the effectiveness of a treatment combination that includes RAL+DRV/r in a patient infected with a complex X4-tropic CRF11-cpx virus.