Context and clinical challenge
- The report describes a critically ill, treatment-naïve person with HIV-1 infection and extensive gastrointestinal failure, including open abdomen with fistulae, short bowel syndrome, and reliance on parenteral nutrition.
- Standard oral combination antiretroviral therapy (ARV) was temporarily not feasible due to absent enteral absorption.
- A rapid virological rebound occurred despite HIV infection diagnosis and immune metrics within the first months of illness.
Study design and intervention approach
- An off-label, fully parenteral antiretroviral strategy was employed to bridge to durable viral suppression.
- The regimen combined intravenous zidovudine (AZT) with intramuscular cabotegravir/rilpivirine long-acting (CAB/RPV LA).
- This approach was implemented concurrently with ongoing intensive care support, including surgery, parenteral nutrition, antimicrobials, and anticoagulation.
Outcomes and virological response
- The mode of administration permitted continuation of antiretroviral therapy in the setting of complete enteral non-availability.
- HIV-1 RNA declined from baseline elevated levels to below the limit of detection (<20 copies/mL) within 65 days of initiation and remained suppressed thereafter.
- CD4+ lymphocytes showed recovery over the observation period.
Safety and duration of therapy
- Intravenous AZT was stopped after 35 days; CAB/RPV LA continuation served as maintenance during recovery and home parenteral nutrition.
- The regimen was overall well tolerated in the context of concurrent surgical and critical care therapies.
Implications and limitations
- The report suggests that fully parenteral ARV, incorporating CAB/RPV LA, may provide a viable bridge to sustained viral suppression when oral therapy is contraindicated.