CD4 Cell Count / Viral Load

We incorporate the following score modifications based on a patient's CD4 cell count (if provided).


Score Modification Rule

We penalized 2 NRTI + RPV if the viral load was high or unknown or CD4 is <200

Current clinical trial data suggests a higher rate of treatment failure when utilizing 2NRTI + RPV in individuals with Viral load > 100,000 or CD4 <200.  


Score Modification Rule
We penalized INSTI + PI if the viral load was >100,000 or unknown
Clinical trial data has suggested higher rates of treatment failure when utilizing 1 INSTI + 1 PI.  Much of this data was based on the usage of RAL as the INSTI in the regimen. Whether such regimens would be more effective when utilizing newer generation INSTI is unknown.
We penalized INSTI + NRTI if viral load was > 500,000 or unknown, or CD4 <200
DTG/3TC is now a recommended regimen (DHHS 2019, IAS-USA 2020) for treatment-naive patients without evidence of drug resistance. However, the guidelines indicate that such regimens are not appropriate for individuals with viral load > 500,000, based on clinical trial data in which individuals with high viral load were excluded.  IAS-USA guidelines additionally suggest that such regimens may 'possibly not be suitable for CD4+ <200'. Consequently, HIV-ASSIST assesses a mathematical penalty for such regimens when individuals have very high viral load, or low CD4 counts.