Skill Checkup: A 28-Year-Old Man With Treated HIV Is Experiencing Increase in Viremia Back to Detectable Levels

Antonio Di Biagio, MD


August 24, 2023

The Skill Checkup series provides a quick, case-style interactive quiz, highlighting key guideline- and evidence-based information to inform clinical practice.

A 28-year-old man in France was diagnosed with HIV infection when he visited his primary care physician for his annual physical examination and screening for sexually transmitted infections 2 years ago. At diagnosis, his CD4 count was 276 cells/µL, and his plasma HIV-1 RNA viral load was 193,000 copies/mL. Screening for hepatitis B, hepatitis C, cryptococcal antigen and tuberculosis was negative.

The patient has a hectic schedule as a restaurant manager and requests a regimen that is simple to take. Baseline genotype testing reveals no HIV drug-resistant mutations. Antiretroviral therapy (ART) was initiated, consisting of the nucleotide/nucleoside reverse transcriptase inhibitors (NRTIs) tenofovir disoproxil fumarate (TDF) and lamivudine (3TC), in combination with the nonnucleoside reverse transcriptase inhibitor (NNRTI) doravirine (DOR).

After an initial response to ART with declining HIV RNA levels and CD4 count, he experienced an unexpected increase in viremia back to detectable levels, which was confirmed by a second test of viremia load measuring 383 copies/mL 18 months into treatment. Adherence to his ART regimen was confirmed.


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