CASO CLINICO Il paziente naϊve con resistenze al basale

Viremia: >500000 copies/ml CD4: 11 cells/µl Clinical Case ID 7036 : Patient infected with HIV-1 B subtype Age 50 Sex M Risk Factor Heterosexual I Seropositivity October 2007 >500000 copies/ml Nov-07 Dec-07 Apr-08 May-08 Jul-08 Sep-08 Nov-08 May-09 Aug-09 Mar-10 Jun-10 Sep-10 Oct-10 Jan-11 Apr-11 Jul-11 Sept-11 Jan-12 May-12 50 100 150 200 250 300 350 400 450 500 550 600 650 700 750 800 850 CD4 cell count (cells/ul) 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0 6.5 Viremia (copies/ml) Undectability threshold in out in out GRT from plasma 09/11/2007 PR: L63A V77I RT: L100I K103N T215D IN: No resistance mutations GP-41: No resistance mutations GRT from CSF 09/11/2007 (HIV-RNA: 192 cps/ml) PR: L63A V77I RT: L100I K103N T215D IN: No resistance mutations GP-41: No resistance mutations On November 2007 Viremia: >500000 copies/ml CD4: 11 cells/µl Four years of viro-immunological success in highly-adherent, drug-naive patient harboring virus constitutively resistant to NRTIs and NNRTIs Nov’07- Mar’08 TDF/FTC LPV/r T20 Apr’08- Sep’10 TDF/FTC LPV/r Oct’10- May’12 TDF/FTC ATV/r

Clinical Case ID 7036 : Patient infected with HIV-1 B subtype Age 50 Sex M Risk Factor Heterosexual I Seropositivity October 2007 Mutation scoring* for the protease PR  ATV/r  DRV/r  FPV/r  IDV/r  LPV/r  NFV  SQV/r  TPV/r  Total:  GRT PLASMA Nov 2007 PR  ATV/r  DRV/r  FPV/r  IDV/r  LPV/r  NFV  SQV/r  TPV/r  Total:  GRT CFS Nov 2007 Mutation scoring* for the reverse transcriptase RT  3TC  ABC  AZT  D4T  DDI  FTC  TDF  EFV  ETR  NVP  RPV T215D 10 20 V90I L100I -4 30 15 K103N 60 Total:  16 6 90 GRT PLASMA Nov 2007 RT  3TC  ABC  AZT  D4T  DDI  FTC  TDF  EFV  ETR  NVP  RPV T215D 10 20 V90I L100I -4 30 15 K103N 60 Total: 16 6 90 GRT CFS Nov 2007 Susceptible virus Virus potential low level resistance Virus low level of resistance Virus high level of resistance * Stanford Algorithm (http:hivdb.stanford.edu)