A 29-year-old female patient was diagnosed with HIV infection in June 2017 and commenced on TDF/3TC/EFV. Her baseline CD4 count and VL are unknown. Three years later, she was switched to ABC/3TC/ATZ/r following virological failure. Four weeks after treatment switch, she developed pulmonary tuberculosis and in error was given rifampicin with ATZ/r for two months. For treatment optimisation reasons, the ART regimen was switched to ABC/3TC/DTG, but DTG was dosed at 50 mg daily with rifampicin for four months instead of twice daily according to current guidelines. The VL at switch to ABC/3TC/DTG is unknown. The clinical response to treatment was poor and she was referred to Newlands Clinic. A VL taken after seven months on ABC/3TC/DTG was 6540 copies/mL, despite adherence counselling. A genotypic resistance test taken 10 months after initiation of DTG showed extensive NRTI DRMs and one major InSTI DRM (see Table 1 for mutations and sensitivity analysis). This patient admitted to inconsistent adherence both to tuberculosis treatment and ART.