{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T05:58:34Z","timestamp":1775455114069,"version":"3.50.1"},"reference-count":12,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2026,4]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Long\u2010acting injectable cabotegravir\/rilpivirine (LA\u2010CAB\/RPV) is an effective maintenance strategy for virologically suppressed people with HIV, though virologic failure with resistance remains uncommon and incompletely understood.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We describe a case of virologic failure in an HIV\u2010infected patient receiving LA\u2010CAB\/RPV who developed intensive daily intravenous (IV) chemsex. Clinical history, virologic data, resistance testing, and potential contributing factors were reviewed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The patient had sustained viral suppression on prior oral antiretroviral therapy and remained on time with all LA\u2010CAB\/RPV injections. Despite this, viral rebound occurred with emergence of the Y181C mutation, conferring high\u2010level resistance to RPV, leading to treatment discontinuation. No clinically relevant drug\u2013drug interactions were identified. Plasma concentrations of CAB and RPV were not available. Severe behavioural dysregulation associated with intensive IV stimulant use may have contributed, although causality cannot be established and alternative explanations cannot be excluded.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This case highlights that unexpected resistance can emerge during adequately administered LA\u2010CAB\/RPV therapy. Careful clinical evaluation is warranted when virologic failure occurs, particularly in the presence of extreme behavioural or physiological stressors.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/hiv.70199","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T12:02:17Z","timestamp":1769169737000},"page":"649-652","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Y181C<\/scp>\n \u2010associated virologic failure during long\u2010acting injectable cabotegravir\/Rilpivirine in a patient engaged in intensive intravenous Chemsex"],"prefix":"10.1111","volume":"27","author":[{"given":"V\u00edctor","family":"Asensi","sequence":"first","affiliation":[{"name":"Infectious Diseases\u2013HIV Unit Hospital Universitario Central de Asturias (HUCA), and Oviedo University School of Medicine Oviedo Spain"},{"name":"Microbiology and Infectious Diseases Group Instituto de Investigaci\u00f3n Sanitaria del Principado de Asturias (ISPA\u2010FINBA) Oviedo Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebeca","family":"Cabo","sequence":"additional","affiliation":[{"name":"Infectious Diseases\u2013HIV Unit Hospital Universitario Central de Asturias (HUCA), and Oviedo University School of Medicine Oviedo Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rita","family":"Garc\u00eda","sequence":"additional","affiliation":[{"name":"Infectious Diseases\u2013HIV Unit Hospital Universitario Central de Asturias (HUCA), and Oviedo University School of Medicine Oviedo Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorena","family":"Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Infectious Diseases\u2013HIV Unit Hospital Universitario Central de Asturias (HUCA), and Oviedo University School of Medicine Oviedo Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda","family":"Rivas\u2010Carmenado","sequence":"additional","affiliation":[{"name":"Infectious Diseases\u2013HIV Unit Hospital Universitario Central de Asturias (HUCA), and Oviedo University School of Medicine Oviedo Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Santiago","family":"Mel\u00f3n","sequence":"additional","affiliation":[{"name":"Microbiology and Infectious Diseases Group Instituto de Investigaci\u00f3n Sanitaria del Principado de Asturias (ISPA\u2010FINBA) Oviedo Spain"},{"name":"Microbiology Service, Hospital Universitario Central de Asturias Oviedo Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000002883"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(21)00184-3"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1904398"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1909512"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaf120"},{"key":"e_1_2_7_7_1","article-title":"Chemsex and its impact on HIV treatment outcomes among men who have sex with men: a systematic review","volume":"17","author":"Lagden K","year":"2025","journal-title":"Cureus"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/hiv.12574"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2017.0263"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1071\/SH22140"},{"key":"e_1_2_7_11_1","volume-title":"Consolidated Guidelines on HIV, Viral Hepatitis and STI Prevention. Long\u2010Acting Antiretroviral Therapy Considerations","author":"WHO","year":"2023"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.05487-11"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40262-021-01005-1"}],"container-title":["HIV Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hiv.70199","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/hiv.70199","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hiv.70199","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T05:10:00Z","timestamp":1775452200000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/hiv.70199"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,23]]},"references-count":12,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1111\/hiv.70199"],"URL":"https:\/\/doi.org\/10.1111\/hiv.70199","archive":["Portico"],"relation":{},"ISSN":["1464-2662","1468-1293"],"issn-type":[{"value":"1464-2662","type":"print"},{"value":"1468-1293","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,23]]},"assertion":[{"value":"2025-12-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}