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Abstract: The patient was accidentally found to be infected with HIV during HIV screening and was referred to our hospital by CDC. Due to the patient’s advanced age, it was decided to treat him with a regimen of propofol tenofovir fumarate tablets + lamivudine tablets + dolutegravir sodium tablets in order to achieve viral suppression and control disease progression as soon as possible. After 1 year of medication review, virus suppression was successfully achieved, and the patient’s sleep quality improved significantly and his weight gradually increased.
Basic information】Male, 58 years old
Disease Type】AIDS
Hospital】The 8th Hospital of Xi’an
Date of consultation】April 2020
Treatment plan】Medication (propofol tenofovir fumarate tablets, lamivudine tablets, dolutegravir sodium tablets)
Treatment Period】Take the medication at home and review every six months
Treatment effect] Successful viral suppression, patient’s sleep quality improved significantly, weight gain gradually
I. Initial consultation
The patient had been in good health in the past, but the infection was discovered accidentally when she accompanied her friend to take a physical examination for HIV screening, and was referred to our hospital by the CDC. The results of genotypic drug resistance testing showed V179E mutation, high plasma viral load and significantly decreased CD4+ count. After discussing with the patient and her daughter, it was decided to use the regimen of propofol tenofovir fumarate tablets + lamivudine tablets + dolutegravir sodium tablets, of which dolutegravir sodium tablets had to be purchased at own expense.
II. Treatment history
Genotypic resistance testing revealed the presence of the V179E mutation in the patient, which causes a mild reduction in the sensitivity of the virus to most non-nucleoside drugs, such as efavirenz, which is widely used in China. In addition, the patient is older and may need to be combined with other drugs in the future. Antiviral drugs with lower drug interactions and fewer adverse effects should be considered. After communication with the patient and her daughter, it was decided to use an integrase inhibitor regimen, i.e., propofol tenofovir fumarate tablets + lamivudine tablets + dolutegravir sodium tablets. The combination of multiple antiviral drugs can affect different steps in the virus life cycle, thus reducing or preventing virus production and protecting cells that are not infected. Patients are advised to follow medical advice on the use of medication, as only good compliance can better ensure efficacy.
III. Treatment effect
At the first review after 5 months of home medication, the patient successfully achieved viral suppression (plasma HIV-RNA was not detected) and an increase in CD4+ count, while the rest of the test indicators were not abnormal. count was lower than before, suggesting a slight remission of immune activation, maintaining a sustained suppression of viral load, a significant improvement in the patient’s sleep quality, and a mild weight gain.
IV. Notes
We are pleased that the patient’s symptoms have improved with treatment. Antiviral therapy can significantly increase the life expectancy of patients, and now that AIDS is no longer a terminal disease, most patients have a life expectancy close to that of non-infected patients after effective treatment. However, it is still a must for patients to take medication every day. No matter what kind of medication, there are always adverse reactions, and appropriate weight gain indicates that the treatment is effective, while continuous weight gain is a burden that increases the risk of diabetes, hypertension, and cardiovascular diseases.
V. Personal insight
On the whole, although AIDS is difficult to be completely cured, it can still be well controlled and prevented from progressing with standardized antiretroviral drug treatment. In addition, for AIDS patients, the care of family and friends is very important, AIDS is not infected through daily contact, so do not discriminate against patients, do not be afraid of hearing AIDS, the main prevention of AIDS is to pay attention to sexual hygiene, avoid multiple sexual partners, if there is high-risk sexual behavior, timely take blocking drugs, the earlier you take, the better the prevention effect.