Implications and considerations of V179D mutation in a patient with HIV treated with cabotegravir/rilpivirine: A case report and mini‑review of the literature

The management of antiretroviral therapy is intricately associated with the evaluation of the viral genetic profile, a process in which infectious disease specialists play a pivotal role in both the selection and fine‑tuning of treat‑ ment protocols. The V179D aminoacidic variation within the reverse transcriptase of the human immunodeficiency virus (HIV), while not considered among major mutations, carries the potential to exert a notable effect on resistance to antiret‑ roviral agents. Notably, this influence extends specifically to the class of non‑nucleoside reverse transcriptase inhibitors, suggesting that the presence of the V179D mutation may diminish the susceptibility of the virus to certain antiretroviral drugs within this classification. The present study describes the case of a patient which delineates the management trajec‑ tory of an HIV‑positive individual, commencing from the initial diagnosis in November, 2017. A genotypic resistance test revealed the presence of the V179D mutation. Of note, notwithstanding the existence of this mutation, the patient underwent a transition to a cabotegravir and rilpivirine inject‑ able combination regimen, resulting in a favorable treatment response characterized by comprehensive and sustained viral suppression, coupled with enhancements in the immunological profile. The case described herein underscores the critical significance of a tailored approach in the management of HIV, wherein therapeutic strategies are adeptly tailored to the unique exigencies of people living with HIV.