1. CASO CLINICO
Il paziente naϊve con resistenze al basale

2. Viremia: >500000 copies/ml CD4: 11 cells/µl
Clinical Case ID 7036 : Patient infected with HIV-1 B subtype
Age
Sex M
Risk Factor Heterosexual
I Seropositivity October 2007
> 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: > 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

3. 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 (