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Other Considerations

Comorbidity and Co-medication Interactions

We assign additional penalties to the base score of regimens that have comorbidity or co-medication interactions. These penalties are drawn from DHHS guidelines and range from 0 to less than 2. Regimens that contain comorbidity or co-medication interactions with 2 or above are excluded.

ART Interactions

We additionally assign penalties to the base score of regimens that have undesired interactions between various drugs within the regimen. These penalties are drawn from DHHS guidelines and also range from 0 to less than 2. Regimens that contain ART interactions with 2 or above are excluded.

Pill Burden Penalty

We incorporate a penalty based on total pill count and maximum dosing frequency to prioritize regimens with the lowest pill burden, as shown in the equation below. For example, a single pill combination regimen (e.g., Genvoya; TAF/FTC/EVG/c) would not have an added penalty, whereas a regimen with 3 pills with maximum bid dosing would have an added penalty of 1 to the base score.

HLA-B5701

Regimens with ABC are excluded if the HLA-B5701 status is either positive or unknown.

Tropism

We only display MVC-containing regimens if the patient has a R5 virus strain.

Less Preferred ARVs

We assign penalties to less preferred ARVs as shown below.

Score Modification Rule (Click to expand)
We gave preference to DTG and BIC over EVG, DRV over ATV, RPV over ETR (and other 2nd generation NNRTIs), and TAF over TDF
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We gave preference to TAF/TDF over ABC when ABC was not paired with DTG
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We gave preference to DTG and BIC over RAL, DRV among PI’s over LPV, and gave preference to EFV over other 1st generation NNRTI’s
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We gave preference to DRV among PI’s over older PI’s, such as IDV, NFV, SQV, FPV, or TPV
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Given toxicities, we heavily penalized older NRTIs such as AZT, D4T, and DDI
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Other Considerations

For regimens with two NRTIs, we only display regimens with combinations of TAF/FTC (or TDF/FTC) or ABC/3TC due to the availability of combination pills.

For XTC-containing regimens with only 1 NRTI, we only display the 3TC-containing regimen if both XTC-containing regimens have equal weighted scores.

For regimens that only differ in the inclusion of DTG or RAL, we only display the DTG-containing regimen if the RAL- and DTG-containing regimen have equal weighted scores.