We report on a 46-year-old woman who tested HIV positive in 2005 and was initiated onto IDV/r and EFV in October of the same year. in the private sector. In October 2007, her ARV regimen was changed to AZT/3TC/LPV/r for reasons not clearly elucidated. Furthermore, in June 2009, it was again switched to TDF/3TC/EFV. She deteriorated on this regimen. In September 2012, due to inability to meet medical expenses in private sector, she self-transferred to the government clinic ART managed by medical doctors. Her CD4 counts were at 282 cells/mm3, VL of 220 126 copies/mL of blood and she was diagnosed with pulmonary tuberculosis (PTB), for which she was treated and cured. On the 24 of January 2013, her VL was at 374 783 copies/mL of blood with a CD4 count of 413 cells/mm3, and seven months later, on the 10 of September 2013, the VL was still high at 5129 copies/mL of blood despite consistent adherence to her ARVs. In April 2014, her CD4 counts dropped to 307 cells/mm3, and she was switched to the second line ART, TDF/AZT/3TC/LPV/r and six months later, for the first time, she suppressed her VL to < 20 copies/mL of blood. However, despite her excellent adherence to ART, assessed through pill count and clinic follow-ups, she presented with ranges of VLs > 3 logs for two consecutive years: 11789 9 copies/mL (April 2016), 1695 copies/mL (July 2016), 1364 copies/mL (October 2016). In March 2017, she presented with a low-level viraemia of 192 copies/mL followed by high VLs of 2916 copies/mL in February 2018 and 17 135 in May 2018 and was referred to be seen by an HIV clinical mentor. At the time of referral, on 31 May 2018, her hepatitis B Surface antigen was non-reactive, and her creatinine clearance was at 90 ml/minutes/1.73 m2, her CD4 counts were 441 cells/mm3, the clinical examen was unremarkable and an HIV-1 Genotyping Resistance Test (GRT) was ordered. The GRT results confirmed the presence of mutations and provided drug susceptibility results (Table 1) as per the Stanford HIV drug resistance database  
The choice of the ART regimen was guided by the drug activity estimated by the Stanford HIV drug resistance database. AZT was susceptible with a total   drug activity, DTG was never used in this patient and was estimated to be fully active,   DRV/r had a low-level resistance and was estimated at 0.75 activity. 3TC was kept in the regimen to benefit from the crippling effect of the M184V mutation on viral multiplication. The drug activity of the third-line regimen was estimated at 2.75. In July 2018, the patient was started on the third-line ART, namely DTG/AZT/DRV/r/3TC. She has suppressed her VL at six months, and 24 months later, she is still suppressed (VL < 20 copies/mL and her latest CD4 improved to 502 cells/mm3 (January 2019) (Figure 1).