Rezvilutamide combined with ADT in an HIV-positive patient with high-volume mHSPC on efavirenz-based antiretroviral therapy: a case report.

This case report describes a patient with metastatic hormone-sensitive prostate cancer (mHSPC), high tumor burden, and concurrent HIV infection receiving continuous efavirenz (a potent CYP3A4 inducer), who was treated with an intensified regimen based on androgen deprivation therapy (ADT) combined with the novel androgen receptor inhibitor rezvilutamide. Under rigorous multidisciplinary monitoring, this regimen achieved a rapid and profound response, characterized by a decline in prostate-specific antigen (PSA) levels from 21,788.320 ng/mL to 4.315 ng/mL, significant clinical improvement, sustained HIV viral suppression, and a favorable short-term tolerability profile. This case directly addresses the controversies and challenges regarding the use of intensified therapy in patients with comorbidities in current clinical practice, suggesting that key drug-drug interaction barriers may be manageable through personalized strategies and proactive management. This case provides a practical reference for implementing guideline-recommended treatment intensification principles in similar complex clinical scenarios, offering clinically relevant insights.