Confronting Dual Therapeutic Hurdles in Advanced HIV: A Case Report on INSTIs Resistance and Talaromyces marneffei Coinfection.

BACKGROUND

Treating patients with human immunodeficiency virus (HIV) integrase strand transfer inhibitors (INSTIs) resistance and concurrent Talaromyces marneffei (T. marneffei) infection poses a significant clinical challenge, requiring precise antiretroviral adjustments, timely anti-infection, and management of complex drug interactions.

CASE PRESENTATION: Interrupted antifungal therapy and INSTIs resistance in an HIV patient coinfected with T. marneffei resulted in severe immunosuppression. Initial voriconazole/imipenem treatment improved peritonitis. However, the symptoms recurred. Antiretroviral therapy (ART) was switched from elvitegravir to zidovudine, lamivudine, dolutegravir, and albuvirtide. Antifungal therapy adjusted from voriconazole to itraconazole. During the follow-up process, HIV RNA turned negative and the CD4+ T cell count increased, but fungal antigens persisted until the 10-month follow-up period.

CONCLUSION

This case emphasizes genotype resistance testing-guided ART modification and rigorous opportunistic infection management in drug-resistant HIV patients. Coordinated care and timely interventions can enhance the outcomes in high-risk cases.