Sign In

Antiretroviral Therapy.

HIV Question Bank

Evaluation and Management of Virologic FailureQuestion 10/10

Questions in Topic

A 71-year-old cisgender man with chronic HIV and a CD4 count of 136 cells/mm3 returns to clinic for follow-up on a salvage antiretroviral regimen of darunavir-cobicistat, maraviroc, fostemsavir, and tenofovir alafenamide-emtricitabine. He intermittently has encountered problems with adherence. An HIV RNA level obtained on the day of the visit shows a value of 1,860 copies/mL and HIV genotypic resistance testing is ordered.

Which one of the following is TRUE about maraviroc resistance?

If the HIV tropism assay fails to detect subpopulations of HIV that can utilize the CXCR4 receptor (X4-tropic, dual-tropic, mixed-tropic), these strains will increasingly become the dominant strain under the selective pressure of the CCR5 antagonist maraviroc.
Figure 1. Outgrowth of Pre-existing Non-R5-Tropic HIV with Selective Maraviroc Pressure.
If the HIV tropism assay fails to detect subpopulations of HIV that can utilize the CXCR4 receptor (X4-tropic, dual-tropic, mixed-tropic), these strains will increasingly become the dominant strain under the selective pressure of the CCR5 antagonist maraviroc.
Illustration: David H. Spach, MD
HIV can circumvent maraviroc blockage by mutations in the HIV gp120 region that allow for gp120 to bind to the host CCR5 receptor, even in the presence of bound maraviroc. The mutations usually occur in the V3 loop of HIV gp120.
Figure 2. Maraviroc Resistance with Alterations in HIV gp120.
HIV can circumvent maraviroc blockage by mutations in the HIV gp120 region that allow for gp120 to bind to the host CCR5 receptor, even in the presence of bound maraviroc. The mutations usually occur in the V3 loop of HIV gp120.
Illustration: David H. Spach, MD
Prev  Skip

Sign In or Register Progress Not Saved!
Since you are not signed in, your progress won't be saved.
Question Last Updated
September 22nd, 2023

Steps to Acquire CE for this Question Bank Topic:

1

Answer

Answer all questions
2

Score 80%+

Answer correctly
3

Claim CE

Choose CNE or CME
4

Give Feedback

Complete survey
5

Print Certificate

Obtain proof of CE

This question requires improvement because:


Comment further on how to improve this question or summary:



Since you've received 80% or better on this quiz, you may claim continuing education credit.

You seem to have a popup blocker enabled. If you want to skip this dialog please Always allow popup windows for the online course.