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A case report of clinical implications of a delayed antiretroviral therapy switch in a patient with multiple treatment interruptions

The Namibia national antiretroviral therapy guidelines recommend that patients living with HIV who interrupt antiretrovirals and in the process disengage from care be restarted on their usual antiretroviral therapy regimen upon return. We introduce a 39-year-old male patient on first-line antiretrov...

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Autores principales: Kakubu, Mireille A Mpalang, Frans, Kandali, Gibutai, Nelson, Katoto, Patrick DMC
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9772926/
https://www.ncbi.nlm.nih.gov/pubmed/36569036
http://dx.doi.org/10.1177/2050313X221144209
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author Kakubu, Mireille A Mpalang
Frans, Kandali
Gibutai, Nelson
Katoto, Patrick DMC
author_facet Kakubu, Mireille A Mpalang
Frans, Kandali
Gibutai, Nelson
Katoto, Patrick DMC
author_sort Kakubu, Mireille A Mpalang
collection PubMed
description The Namibia national antiretroviral therapy guidelines recommend that patients living with HIV who interrupt antiretrovirals and in the process disengage from care be restarted on their usual antiretroviral therapy regimen upon return. We introduce a 39-year-old male patient on first-line antiretroviral therapy, namely, tenofovir disoproxil fumarate, lamivudine and efavirenz, from 2015 to 2019 (4 years), who returned to care after the fourth episode of interrupting his treatment, though his adherence to antiretroviral therapy was deemed poor. Thus, he presented with severe immunosuppression and an AIDS-defining condition. Hence, he was switched to second-line antiretroviral therapy, treated with fluconazole for oesophageal candidiasis and reinitiated on cotrimoxazole prophylaxis. The client is currently clinically stable with a suppressed viral load. Medical and drug history taking with an emphasis on the previous history of treatment failure in patients returning to care are paramount in guiding the choice of future prescriptions of antiretrovirals. The multiple antiretroviral therapy interruptions from the patient and the delay in decision-making on the side of the clinician to switch treatments contributed to the emergence of an AIDS-defining condition.
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spelling pubmed-97729262022-12-23 A case report of clinical implications of a delayed antiretroviral therapy switch in a patient with multiple treatment interruptions Kakubu, Mireille A Mpalang Frans, Kandali Gibutai, Nelson Katoto, Patrick DMC SAGE Open Med Case Rep Case Report The Namibia national antiretroviral therapy guidelines recommend that patients living with HIV who interrupt antiretrovirals and in the process disengage from care be restarted on their usual antiretroviral therapy regimen upon return. We introduce a 39-year-old male patient on first-line antiretroviral therapy, namely, tenofovir disoproxil fumarate, lamivudine and efavirenz, from 2015 to 2019 (4 years), who returned to care after the fourth episode of interrupting his treatment, though his adherence to antiretroviral therapy was deemed poor. Thus, he presented with severe immunosuppression and an AIDS-defining condition. Hence, he was switched to second-line antiretroviral therapy, treated with fluconazole for oesophageal candidiasis and reinitiated on cotrimoxazole prophylaxis. The client is currently clinically stable with a suppressed viral load. Medical and drug history taking with an emphasis on the previous history of treatment failure in patients returning to care are paramount in guiding the choice of future prescriptions of antiretrovirals. The multiple antiretroviral therapy interruptions from the patient and the delay in decision-making on the side of the clinician to switch treatments contributed to the emergence of an AIDS-defining condition. SAGE Publications 2022-12-19 /pmc/articles/PMC9772926/ /pubmed/36569036 http://dx.doi.org/10.1177/2050313X221144209 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Case Report
Kakubu, Mireille A Mpalang
Frans, Kandali
Gibutai, Nelson
Katoto, Patrick DMC
A case report of clinical implications of a delayed antiretroviral therapy switch in a patient with multiple treatment interruptions
title A case report of clinical implications of a delayed antiretroviral therapy switch in a patient with multiple treatment interruptions
title_full A case report of clinical implications of a delayed antiretroviral therapy switch in a patient with multiple treatment interruptions
title_fullStr A case report of clinical implications of a delayed antiretroviral therapy switch in a patient with multiple treatment interruptions
title_full_unstemmed A case report of clinical implications of a delayed antiretroviral therapy switch in a patient with multiple treatment interruptions
title_short A case report of clinical implications of a delayed antiretroviral therapy switch in a patient with multiple treatment interruptions
title_sort case report of clinical implications of a delayed antiretroviral therapy switch in a patient with multiple treatment interruptions
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9772926/
https://www.ncbi.nlm.nih.gov/pubmed/36569036
http://dx.doi.org/10.1177/2050313X221144209
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