Successful desensitization of enfuvirtide after a first attempt failure

In. 1989, a 27-year-old white woman was diagnosed with HIV, but only sought treatment in 1994 when her CD4 T-cell count was 230 cells/ mu l. She was placed on zidovudine monotherapy. Since then she has been treated with nine different combination regimens of nucleoside, non-nucleoside reverse transcriptase inhibitors and protease inhibitors. She has always been asymptomatic, her viral load has rarely been undetectable but has remained below 10 000 copies/ml. Her CD4 T-cell count has been, most of the time, above 200 cells/ mu l until July 2003, when it was persistently recorded below 200 cells/ mu l, despite changes in her antiretroviral regimen. In December 2004, she took a genotypic test while on didanosine, lamivudine, tenofovir and lopinavir/ritonavir. The resistance test showed K70E, K101Q, K103N, V118I, M184V, K219R, P225H and L10V, K20R, L33F, M36I, M46I, I54V, D60E, V82A, L90M in the reverse transcriptase and protease regions, respectively. Because of her intolerance to amprenavir, the fact that tipranavir is not yet provided by the public health system, and the Agence Nationale de Recherches sur la Sida algorithm did not show a high level resistance to lopinavir/ritonavir, her antiretroviral regimen was changed to zidovudine, lamivudine, tenofovir, lopinavir/ritonavir, and enfuvirtide was indicated.