Successful initiation of fully parenteral antiretroviral therapy in a treatment-naïve person with HIV-1 infection and intestinal failure.
Krystof Sram, Hanus Rozsypal, Stanislav Sevela et al.
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Case in brief
A 26-year-old man with newly diagnosed HIV-1 infection developed fulminant necrotizing pancreatitis, multiple surgical complications, short bowel syndrome, and intestinal failure with no gastrointestinal passage. As HIV RNA rose from 5,000 to 320,000 copies/mL and CD4+ count fell from 780 to 570 cells/µL, oral antiretroviral therapy was not feasible. He received intravenous zidovudine with intramuscular long-acting cabotegravir/rilpivirine. HIV RNA fell to <20 copies/mL within 65 days and remained suppressed with CD4+ recovery. Zidovudine was stopped after 35 days; cabotegravir/rilpivirine continued during recovery and home parenteral nutrition.
What made this case unusual
The patient was treatment-naïve and unable to absorb enteral medication, yet achieved viral suppression with a fully parenteral regimen combining intravenous zidovudine and intramuscular long-acting cabotegravir/rilpivirine.
Diagnostic / clinical pearl
When intestinal failure makes oral antiretroviral therapy impossible, a fully parenteral regimen may provide a bridge to viral suppression; this case used intravenous zidovudine with intramuscular long-acting cabotegravir/rilpivirine.
Why it matters
The report supports further evaluation of fully parenteral antiretroviral therapy for critically ill patients with an absolute contraindication to oral treatment.