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Treatment-Emergent Bictegravir Resistance in a Treatment-Naive Individual With HIV Infection: A Case Report
Iya Dubson1, Aahana Gaur1, Jasmin Jose1
1Infectious Disease, Department of Veterans Affairs Medical Center, New York Harbor Healthcare System, Brooklyn Campus, Brooklyn, USA.
None:
Bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) is a highly potent antiretroviral regimen with a high genetic barrier to resistance. Clinical trials have not reported treatment-emergent resistance in treatment-naive individuals. We describe a rare case of virologic failure with an emergent R263K integrase mutation in a treatment-naïve, adherent individual maintained on BIC/FTC/TAF. The patient achieved initial suppression for nearly two years before rebound viremia with R263K and D67N mutations. Following the regimen change and treatment of concurrent syphilis, viral suppression was re-established. This case highlights that emergent bictegravir resistance can occur in adherent, treatment-naïve patients, emphasizing the importance of continued resistance monitoring.
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