Search Results (1,835)

Lenacapavir (LEN) is the first-in-class capsid inhibitor that inhibits HIV capsid function in vitro with picomolar activity. LEN has been approved for the treatment of HIV in combination with other antiretroviral agents (ARVs), as well as for the prevention of acquisition of HIV-1 in people who may benefit from pre-exposure prophylaxis (PrEP). In vitro investigations of the resistance profile of LEN have identified resistance-associated mutations (RAMs) at six residues in the HIV-1 capsid protein (CA), all found in the CA structural pocket where LEN binds and conferring LEN-resistance with various degrees of loss of susceptibility. LEN was initially evaluated in a clinical study (CAPELLA) of heavily treatment-experienced (HTE) people with HIV (PWH), in which 14 of 72 participants had emergence of in vitro-predicted LEN RAMs. Despite the presence of LEN RAMs in these participants with viral rebound, treatment with LEN led to viral suppression in a large majority of HTE PWH in CAPELLA. In treatment-naïve participants receiving subcutaneous LEN + asynchronous oral ARVs (CALIBRATE) 4 of 157 participants had emergence of LEN RAM after >2 years of study. In contrast, no cases of viral rebound with resistance to LEN have been observed in virologically suppressed PWH switching to the once-daily single-tablet regimen (STR) combining LEN with the integrase strand-transfer inhibitor (INSTI) bictegravir after up to 48 weeks in two Phase 3 studies, and for >3 years in Phase 2. Similarly, no resistance to LEN has been observed after up to 96 weeks in the Phase 2 study of once-weekly regimen of the deoxyadenosine analog RT inhibitor islatravir + LEN. Finally, in the Phase 2 study of the 6-monthly injectable LEN + 2 broadly neutralizing antibodies (bNAbs) combination, only one instance of resistance to LEN was observed in conjunction with loss of susceptibility to one of the bNAbs through 1 year of treatment. Overall, resistance to LEN in regimens using synchronous dosing (daily or weekly oral, or 6-monthly injectable) has been rare in clinical studies. As the use of LEN is predicted to increase in the near future with these potential new combinations, capabilities to test for capsid resistance are being developed through global commercial options as well as through regional health institutions. Full article

Antiretroviral therapy (ART) is essential for preventing HIV transmission and improving the health outcomes of people living with HIV (PLHIV). However, many barriers limit PLHIV from starting and adhering to ART, which explains why HIV responses in many settings, including Indonesia, have produced limited gains. This qualitative phenomenological study explored multilevel barriers to ART adherence in urban Yogyakarta (locally known as Jogja) and rural Belu, Indonesia, from the perspectives of PLHIV and healthcare professionals (HCPs). Data were collected through one-on-one in-depth interviews with 92 PLHIV and 20 HCPs. Participants were recruited using the snowball sampling technique. Data were analysed using framework analysis informed by the Access to Healthcare Framework. The findings showed that PLHIV in Belu and Jogja had different experiences in terms of the provision of and ability to access and adhere to ART or HIV treatment. In rural Belu, ART was less available and visible, harder to approach, often unaffordable, less aligned with patients’ needs, and strongly influenced by the widespread use of traditional medicine. PLHIV in Belu also reported a more limited ability to perceive the need for ART, reach services, pay costs, engage in care, and seek ART than those in urban Jogja. Personal, psychological, and social barriers were also reported to hinder PLHIV’s ART adherence in both settings. These findings highlight the need for HIV policies that promote the equitable distribution of ART services and targeted interventions to improve understanding and acceptance of HIV care among PLHIV and the wider community. Full article

Hepatitis B virus (HBV) infection remains a major concern among people living with HIV (PLWH), particularly in high-endemic settings such as Vietnam. The study evaluated the serological and molecular characteristics of HBV among PLWH receiving antiretroviral therapy (ART) in southern Vietnam. A cross-sectional study was conducted among 316 HIV-infected patients receiving ART. Serological markers (HBsAg, anti-HBs IgG, and anti-HBc IgG) and HBV DNA were assessed using highly sensitive assays, and the Pre-S1/Pre-S2/S regions were sequenced for genotype and mutation analysis. Associations were evaluated using appropriate statistical methods. HBV DNA was detected in 32.6% of the patients, whereas HBsAg was present in only 16.1%. The most common serological profile was susceptibility (36.4%), followed by occult HBV infection (OBI) (17.4%), including 6.6% with completely seronegative OBI, and chronic HBV (CHB) (15.8%). Males and older individuals showed a significantly higher risk of CHB (adjusted odds ratio [aOR] = 2.58 and aOR = 1.87, respectively). Genotype B predominated (78.4%) overall, but genotype C was significantly more frequent in OBI than in CHB patients (31.5% vs. 8.3%, p = 0.008). Moreover, the burden of surface S gene escape mutations was significantly higher in the OBI group (p = 0.023). The LASSO model showed a moderate discriminatory ability for predicting OBI status (Area Under the Receiver Operating Characteristic [ROC] Curve [AUC] = 0.76). Lamivudine-associated resistance (rtM204I/V) was the most common RT mutation detected in the overlapping RT/S region. HIV-infected individuals in southern Vietnam face a burden of both CHB and OBI, including a high proportion of seronegative OBI. The presence of seronegative OBI further supports the risk of underdiagnosis when relying only on standard serological markers, and reflects the need for integrated strategies combining highly sensitive serological assays with molecular diagnostics to improve HBV detection among high-risk populations. Full article

Persistent HIV-1 reservoirs remain a major barrier to a durable functional cure despite long-term suppressive antiretroviral therapy. Although resting memory CD4⁺ T cells constitute the best-characterized cellular reservoir, tissue microenvironments shape viral persistence and immune clearance. The rectal mucosa represents a specialized tissue niche containing HIV-susceptible target cells, antigen-presenting cells, microbial products, inflammatory cues, and local metabolic signals. Within this setting, myeloid-lineage cells, particularly tissue-resident macrophages and dendritic cells, may contribute to HIV-1 persistence through mechanisms distinct from classical T-cell latency. Here, we review how rectal mucosal macrophages may support HIV-1 persistence through longevity, resistance to apoptosis, metabolic adaptation, epigenetic regulation, and sequestration of virions within virus-containing compartments. We also discuss the dual role of mucosal dendritic cells as sentinels that capture and transfer HIV-1 to CD4⁺ T cells, while considering the limited evidence for inducible proviral persistence in selected anatomical and cellular contexts. Importantly, we further distinguish bona fide reservoir-bearing cells from reservoir-supportive mechanisms, including viral capture, trans-infection, immune suppression, and niche-mediated protection. We also highlight how mucosal dysbiosis, barrier disruption, microbial metabolites, chronic interferon signaling, and immunoregulatory myeloid programs may stabilize HIV-1 persistence in rectal tissues. Integrating intact proviral assays, functional measurements, single-cell profiling, multiplex imaging, and spatial transcriptomics will be critical for defining myeloid-associated persistence and guiding tissue-targeted HIV-1 cure strategies. Full article

As critical geopolitical and migratory hubs in Eastern Europe, the Azov and Donbas regions represent an epidemiological melting pot for HIV-1 trafficking, exacerbating the global trend of rising dolutegravir (DTG) resistance through the cross-border dissemination of drug-resistant strains. This study presents a comprehensive molecular epidemiological analysis of HIV-1 in these regions in 2025 (N = 1666), focusing on drug resistance and cross-border transmission networks using phylogenetic and molecular network approaches. The study cohort was predominantly female (53.33%) and had heterosexual transmission (78.77%). Most patients (87.64%) received antiretroviral therapy (ART). Sub-subtype A6 predominated, with the radiation’s origin traced to September 1994. Molecular network analysis identified the study area as a significant node, demonstrating viral exports towards the Russian Federation and Belarus, alongside multiple imports from Ukraine, Poland, and Russia. The overall resistance prevalence was 4.49% to integrase strand transfer inhibitors (INSTIs), 2.49% to protease inhibitors (PIs), 12.19% to nucleoside reverse transcriptase inhibitors (NRTIs), and 16.07% to non-nucleoside reverse transcriptase inhibitors (NNRTIs). Surveillance drug resistance mutations in treatment-naive individuals stood at 0.89% (INSTIs), 4.90% (PIs), 4.90% (NRTIs), and 8.82% (NNRTIs). Crucially, intermediate or high-level DTG resistance and key mutations (G118R, R263K, and Y143R) were detected in individuals without prior DTG exposure. This 4.49% integrase inhibitor resistance cannot be considered low; combined with intense cross-border viral dissemination, it may indicate the formation of a stable pool of resistant variants, potentially posing a risk of dolutegravir-based regimen failure and highlighting the need for enhanced regional molecular surveillance. Full article

Background: Doravirine (DOR) is a new-generation non-nucleoside reverse transcriptase inhibitor, which has emerged as an option for people living with HIV (PLWH) owing to its favorable efficacy and safety profile, unique resistance pathway and limited potential for drug-drug interactions. Methods: This retrospective chart review study aimed to better understand DOR-based treatment use in Greece, PLWH characteristics, and drivers of treatment switch. Eligible individuals were adult PLWH who were switched to a DOR-based regimen based on the physician’s decision. Individuals exposed to DOR at any time prior to switching to the DOR-based regimen were excluded. Results: From 12 July 2023 to 31 October 2023, 110 PLWH were consecutively enrolled across 6 public hospital clinics. At baseline (closest prior to or on the date of first DOR prescription), the mean age of PLWH was 49.3 years, 90.9% were males, 88.2% were asymptomatic, 86.5% were virologically suppressed, 33.6% were suffering from multimorbidity (excluding infections/infestations), 45.5% were receiving comedications for their comorbidities, and 5.5% were co-infected with Hepatitis C virus. Most PLWH (98.2%) were prescribed DOR plus two nucleoside reverse transcriptase inhibitors; 87.3% were prescribed DOR/Lamivudine/Tenofovir Disoproxil Fumarate fixed-dose combination. PLWH started DOR a median of 11.7 years after first-ever antiretroviral therapy initiation, corresponding to 2nd/3rd/≥4th antiretroviral line in 33.6%/33.6%/32.7% of participants, respectively; 60.9% of them were proactively switched to a DOR-based regimen. The most common reasons for switching were ‘regimen simplification’ (42.7%), ‘tolerability’ (26.4%) and ‘prevention of toxicities’ (18.2%). Conclusions: This study highlights the patterns of DOR use in real-life clinical practice in Greece among treatment-experienced PLWH. Physicians switch HIV-1-infected individuals from prior ART to DOR-based regimens to offer a simplified regimen or to avoid or prevent toxicity. Full article

Antiretroviral therapy (ART) has proven effective in suppressing HIV-1 replication, but further development of HIV-1 inhibitors is continually driven by the challenge of drug resistance and viral adaptation. The HIV-1 capsid is a promising target for treatment due to its high sequence conservation as well as its crucial role in the viral life cycle. Recently, we have developed a novel capsid-targeting biologic that prevents HIV-1 replication by efficient degradation of newly synthesized capsid. Here, we have investigated the sensitivity to viral escape as well as the breadth of this biologic against HIV-1 subtypes. The capsid-targeting biologic efficiently blocked replication of different primary HIV-1 isolates, and continuous exposure of these viruses to the biologic resulted in viral breakthrough of two out of ten primary HIV-1 isolates tested. Notably, the breakthrough variants did not have amino acid changes in the nanobody epitope but primarily in the matrix region. The breakthrough variants remained sensitive to the biologic albeit to a lesser extent. In the absence of the biologic, breakthrough variants showed increased replication kinetics when compared to their parental virus, suggesting that adaption to the biologic is likely due to the increased viral production and that the target area of the biologic is too conserved for actual escape. This is further underscored by the broad specificity of the biologic as importantly the biologic blocked infection of different HIV-1 subtypes that occur worldwide (A, B, C, D, CRF01_AE, CRF02_AG). These results demonstrate the broad neutralization potential of anti-capsid biologics with a high barrier to resistance, making capsid-targeting inhibitors important for novel antiretroviral drug strategies worldwide. Full article

This study investigated the impact of human immunodeficiency virus (HIV) infection and combination antiretroviral therapy (cART) on adipokine concentrations, which are bioactive molecules secreted by adipose tissue and involved in the regulation of metabolism and inflammation. Alterations in adipokine levels may contribute to the metabolic disturbances observed in people living with HIV. The analyzed adipokine panel included resistin, visfatin, chemerin, angiopoietin-like protein 2 (ANGPTL2), lipocalin-2 (LCN2), Wnt family member 5A (Wnt5a), adiponectin, omentin, vaspin, secreted frizzled-related protein 5 (SFRP5), and apelin. Blood samples were collected from people living with HIV and HIV-negative control participants. Adipokine concentrations were measured using an enzyme-linked immunosorbent assay (ELISA). Patients were further stratified according to their cART regimen, including either protease inhibitor (PI)-based or integrase strand transfer inhibitor (INSTI)-based therapy. Plasma concentrations of ANGPTL2 and vaspin were significantly higher, whereas concentrations of visfatin, SFRP5, and adiponectin were significantly lower in HIV-infected patients compared with controls. Comparison of patients receiving INSTI- or PI-based regimens with the control group revealed significant differences in visfatin, SFRP5, and adiponectin concentrations. Notably, adiponectin concentrations were significantly lower in the INSTI-treated subgroup than in patients receiving PI-based therapy. These findings suggest that five of the examined adipokines may be associated with HIV infection and cART exposure, potentially contributing to the development of metabolic disturbances in this population. Further studies involving larger cohorts of individuals with HIV receiving long-term cART are required to better elucidate the relationship between adipokine alterations and the risk of treatment-related metabolic complications. Full article

Background: Despite substantial progress in prevention of mother-to-child transmission (PMTCT) programmes and widespread access to antiretroviral therapy (ART), maternal HIV infection remains associated with adverse maternal and neonatal outcomes in many high HIV-burden settings. This study compared maternal and perinatal outcomes among women living with HIV and HIV-negative women delivering at a tertiary referral hospital in the Eastern Cape Province, South Africa. Methods: A retrospective comparative cohort study was conducted using routinely collected clinical records of 600 women (300 HIV-positive and 300 HIV-negative) who delivered at Nelson Mandela Academic Hospital between January and December 2019. Maternal, obstetric, and neonatal characteristics were compared according to maternal HIV status. Associations were evaluated using chi-square tests, multivariable logistic regression, Kaplan–Meier survival analysis, and Cox proportional hazards regression models. Results: Women living with HIV were older, had higher parity, and were more likely to have documented anaemia and delayed antenatal care attendance than HIV-negative women. HIV-exposed pregnancies had higher frequencies of preterm birth (26.3% vs. 20.3%) and low birthweight (LBW). In adjusted analyses, maternal HIV-positive status remained independently associated with increased odds of LBW (AOR = 1.88; 95% CI: 1.18–3.00; p = 0.008). LBW was independently associated with neonatal intensive care unit (NICU) admission (AOR = 2.45; 95% CI: 1.46–4.11; p < 0.001) and an increased hazard of in-hospital neonatal mortality (HR = 2.40; 95% CI: 1.55–3.70; p < 0.001). Maternal HIV-positive status (HR = 1.75; 95% CI: 1.12–2.71; p = 0.015) and unsuppressed maternal viral load (HR = 2.05; 95% CI: 1.13–3.73; p = 0.018) were also associated with increased hazards of neonatal mortality. However, these findings should be interpreted cautiously, given the limited number of neonatal mortality events (n = 32). Among HIV-exposed infants with documented HIV test results, the observed mother-to-child transmission rate was 1.7%. However, incomplete infant follow-up and HIV testing data limited the precision of this estimate. Among women living with HIV, birthweight did not differ significantly according to the timing of ART initiation. Conclusions: In this tertiary referral hospital cohort, maternal HIV infection was associated with adverse maternal and neonatal outcomes, particularly anemia, preterm birth, and LBW. LBW emerged as an important predictor of neonatal morbidity and mortality. These findings support continued efforts to strengthen integrated HIV and maternal healthcare services, promote early antenatal care engagement, maintain maternal viral suppression, and improve monitoring and care of high-risk neonates. Given the retrospective observational design, incomplete follow-up for selected outcomes, limited numbers of neonatal mortality events, and the tertiary referral setting, the findings should be interpreted as associations rather than evidence of causal relationships and may not be generalizable to lower-level healthcare facilities or community-based obstetric populations. Full article

HIV-tuberculosis (HIV-TB) co-infection remains a leading cause of morbidity and mortality among people living with HIV and disproportionately affects immigrant and refugee communities in the United States. While antiretroviral therapy has improved HIV outcomes, cultural, social, and psychological barriers hinder timely diagnosis and sustained HIV-TB co-infection care in these populations. This integrative review aims to synthesize evidence on cultural, social, and psychological factors influencing access to diagnosis, treatment, and management of HIV, TB, and HIV-TB co-infection among immigrant and refugee populations in the United States. This study is an integrative review guided by Whittemore and Knafl’s framework. We conducted a systematic search of PubMed, Scopus, and CINAHL for peer-reviewed, mixed-methods, quantitative, qualitative, and review articles published in English between 2015 and 2025. After duplications were removed and dual screening of 107 retrieved records, 16 articles met inclusion criteria for this study. Findings were thematically categorized and synthesized. The themes generated were placed into three main categories: cultural factors including stigma and misperceptions about disease transmission; social factors such as limited healthcare access, lack of insurance, and socioeconomic marginalization; and psychological factors including fear of deportation, trauma, and mistrust of healthcare systems. Addressing HIV-TB co-infection in immigrant and refugee populations requires holistic, trauma-informed, and community-engaged strategies that integrate mental health support, culturally and linguistically tailored education, and policy reforms to remove structural obstacles. Future research should employ culturally validated measures to co-create sustainable interventions and advance health equity. Full article

Hematological abnormalities are frequent in newly diagnosed people living with HIV (PLWH), yet their prognostic significance remains incompletely defined. We conducted a retrospective single-center cohort study including newly diagnosed PLWH evaluated between 2018 and 2024 and analyzed hematological, immunological, virological, and inflammatory parameters at diagnosis and after 12 months of antiretroviral therapy (ART). Most patients presented with advanced HIV disease and severe immunosuppression. Anemia was the most frequent hematological abnormality and was associated with lower CD4 counts, higher HIV viral load, and reduced survival. Elevated C-reactive protein (CRP) levels and the presence of multiple cytopenias were also associated with poorer outcomes. Notably, patients with two or more cytopenias had significantly reduced overall survival, suggesting that multilineage hematopoietic impairment may reflect advanced systemic disease. Significant hematological and immunological recovery was observed after 12 months of ART. These findings indicate that hematological abnormalities in newly diagnosed HIV infection reflect the interplay between immune dysfunction, systemic inflammation, and impaired hematopoiesis. Multiple cytopenias may serve as readily accessible prognostic biomarkers and could improve early risk stratification in PLWH. Full article

Objectives: Despite successful antiretroviral treatment (ART), people living with HIV (PWH) continue experiencing chronic immune activation and comorbidities. We analysed whether the Fibrosis 4 index (FIB-4) is associated with monocyte–macrophage activation in PWH with non-severe hepatic disease. Materials and Methods: We performed a cross-sectional analysis about factors associated with monocyte–macrophage activation among PWH either on triple or dual ART. Background measurements, comorbid conditions and FIB-4 values were correlated with plasmatic markers of monocyte–macrophage activation (sCD163 and sCD14) using univariate and linear regression analysis. Results: We included 366 subjects (age 60.5, 75% male, years of HIV infection 24.5, mean FIB-4 1.52, 8% with FIB-4 > 2.67, Body Mass Index 24.5). In univariate analysis, FIB-4 was associated with older age, years of HIV infection, ART duration, lower CD4/CD8 ratio at inclusion, lower nadir CD4, higher sCD14 and sCD163 values, living alone, dyslipidaemia, high blood pressure and diabetes (p < 0.05 for all). In multivariate analysis FIB-4 ≥ 1.3 was associated with sCD163 values ≥ 782 ng/mL [AdjOR 1.85, 95% CI [1.05; 3.33] p = 0.035], independently from CD4 count, ART duration, living alone, hepatitis C, high blood pressure and alcohol. Conclusions: The FIB-4 is a simple tool reliable for monocyte–macrophage activation in PWH, able to define subjects with higher risks of complications. Full article

Despite the success of modern antiretroviral therapy in achieving virological suppression, people living with HIV face an elevated risk of cardiovascular diseases, particularly heart failure with preserved ejection fraction. This study evaluates the cardiometabolic phenotype and functional capacity in a Romanian HIV cohort to delineate the metabolic footprint of chronic infection. In this cross-sectional study based on prospectively collected, protocol-driven phenotyping, we evaluated 50 consecutive outpatients from a university-affiliated infectious diseases clinic in Timisoara. Eligibility strictly required clinical stability and sustained virological suppression (plasma HIV-RNA < 50 copies/mL for ≥12 months). The analysis revealed widespread metabolic dysregulation, with 52% exhibiting excess weight and 64% showing atherogenic dyslipidemia. Integrase strand transfer inhibitor-based regimens were significantly correlated with an increased body mass index (p = 0.034) and elevated LDL cholesterol (aOR = 2.4, 95% CI [1.18–4.95], p = 0.022). Furthermore, we observed a pronounced metabolic age gap (+4.5 ± 2.8 years), defined as the deviation of bioimpedance-estimated metabolic age from the patients’ chronological age. This gap (p = 0.028), alongside historical immunodeficiency indicated by a low nadir CD4+ count (aOR = 0.998, 95% CI [0.991–0.999], p = 0.021), strongly predicted exercise intolerance, independent of current immune reconstruction. Sarcopenic obesity (present in 18% of the cohort) and an elevated triglycerides-to-HDL ratio (aOR = 2.14, 95% CI [1.15–3.98], p = 0.016) emerged as robust independent negative predictors of functional capacity. Additionally, subclinical myocardial remodeling, evidenced by impaired Global Longitudinal Strain, significantly predicted reduced aerobic capacity (aOR = 0.72, 95% CI [0.58–0.89], p = 0.003). Consequently, contemporary HIV management must transition beyond virological control to integrated cardiometabolic screening. Utilizing cardiopulmonary exercise testing, echocardiography, and metabolic biomarkers is critical for the early identification of subclinical “functional HIV-associated frailty” and mitigating the trajectory toward overt cardiovascular diseases. Full article

Background and Clinical Significance: Tenofovir disoproxil fumarate (TDF) is a widely prescribed nucleotide reverse transcriptase inhibitor (NtRTI) for HIV-1 infection. Though generally well-tolerated, proximal renal tubulopathy resulting in full-blown Fanconi syndrome remains a rare but severe complication (<0.1%). Case Presentation: We present the case of a 52-year-old female living with HIV-1 (diagnosed in 1999, CDC stage A3) who had been treated with a TDF-based antiretroviral regimen for 12 years. Upon admission, she complained of progressive bone pain and polyuria over the preceding six months. Laboratory investigations revealed profound hypokalemia, severe hypophosphatemia, hypouricemia, elevated alkaline phosphatase (ALP) and a decline in renal function (creatinine 1.3 mg/dL from a baseline of 0.7 mg/dL). Arterial blood gas (ABG) analysis showed a normal anion gap hyperchloremic metabolic acidosis alongside respiratory acidosis. Urinalysis demonstrated profound glycosuria in the setting of normal blood glucose levels, coupled with increased 24 h urinary excretion of potassium and phosphorus. A bone scintigraphy demonstrated a “super scan” pattern of metabolic etiology, establishing secondary osteomalacia driven by renal phosphate wasting. Secondary hyperparathyroidism and severe vitamin D3 deficiency were also recorded. The diagnosis of TDF-induced Fanconi syndrome was established. TDF was discontinued, and her antiretroviral regimen was modified to tenofovir alafenamide fumarate (TAF), emtricitabine (FTC), darunavir, and ritonavir, combined with vitamin D supplementation. Over a 6-month follow-up period, renal function normalized, electrolyte wasting resolved, and metabolic acidosis completely reversed. Conclusions: This case highlights that TDF-induced proximal tubulopathy can manifest even after a decade of uneventful therapy, particularly when co-administered with a boosted protease inhibitor. Full article

Transmitted HIV drug resistance can compromise treatment outcomes in children with vertically acquired infection, particularly when baseline resistance testing is unavailable. This case report describes the longitudinal clinical, virological, immunological, and molecular course of a male child diagnosed with vertically acquired HIV-1 subtype C infection, most consistent with mother-to-child transmission. Clinical history, viral load, CD4/CD8 profiles, HIV-1 pol sequencing, phylogenetic analysis, and interpretation were performed using the Stanford HIV Drug Resistance Database (HIVdb). The baseline viral load was 240,993 copies/mL, with a CD4:CD8 ratio of 0.40. Genotypic analysis identified major protease inhibitor resistance mutations V82A and I84I/V, together with M184V. Stanford HIVdb predicted high-level resistance to lopinavir/ritonavir, atazanavir/ritonavir, lamivudine, and emtricitabine; low-level resistance to darunavir/ritonavir and abacavir; and preserved susceptibility to tenofovir, zidovudine, and the evaluated NNRTIs. Initial lopinavir/ritonavir-based regimens failed to achieve sustained virological suppression. Following treatment optimization with an integrase inhibitor-based regimen and subsequent transition to bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF), HIV-1 RNA became Target Not Detected (TND) from November 2024 onward. At the latest follow-up, the CD4 count was 877 cells/µL, the CD8 count was 722 cells/µL, and the CD4:CD8 ratio had improved to 1.21, indicating substantial immune recovery. This single-patient case highlights the clinical value of baseline genotypic resistance testing and individualized, genotype-guided antiretroviral therapy in achieving durable virological suppression in pediatric HIV. Full article