Abstract:
INTRODUCTION: Patients who disengaged from care may present as therapy naïve for antiretroviral
treatment (ART) initiation at a different site, without being recognised as being at an increased
risk of rapid treatment failure and HIV drug resistance.
PATIENT PRESENTATION: A 43-year-old woman, who gave no prior history of ART, was initiated
on a standard first-line regimen of TDF, FTC and EFV. She had a poor response to treatment
with evidence of treatment failure at 12 months.
MANAGEMENT AND OUTCOME: HIV-1 drug resistance tests showed no pre-treatment HIVDR
mutations, but revealed high-level drug resistance to all component drugs at 12 months. On
investigation, viral load (VL) was recorded in 2012 and 2013, providing evidence of prior ART use.
CONCLUSION: Linkage of patient therapy and laboratory information to unique patient identifiers
may allow health-care workers to identify patients who previously received ART and disengaged
from care. This will enable differentiated care when these patients reinitiate ART, which should
involve expedited VL testing and more rapid transition to definitive second-line ART
