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Adherence, resistance, and other considerations

We incorporate the following score modifications if a patient for specific circumstances.

We recognize that in order to optimize adherence, regimens with easier dosing may carry greater weight in decision making.  At baseline, we prioritize regimens that have less pill burden, smaller pill sizes, and are once per day.  Users may choose to augment these considerations based on patient considerations.

Similarly, we incorporate considerations for regimens with a higher barrier to resistance at baseline. But in some situations of a patient with intermittent adherence or a history of treatment failure, users may choose to augment these considerations further.

Finally, at baseline HIVASSIST considers the increasing evidence for the usage of 2 drug regimens (such as DTG/3TC, DTG/RPV) in the context of both ART naive patients, and in those that are virologically suppressed as part of treatment simplification regimens.  However, there may be situations in which users may wish to increase the preference for up to 3 active drugs.  Some such scenarios may include those with less genotypic data available (i.e. cannot fully evaluate the activity of the drugs in the regimen), history of treatment failure, and those in whom there is evidence of multi-class resistance.

Simplifying Dosing

Score Modification Rule
We penalized regimens with twice a day or higher dosing to simplify dosing
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We penalized regimens with larger pills to simplify dosing
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Increasing Barrier to Resistance

Score Modification Rule
We prioritized regimens containing INSTIs or PIs due to a higher barrier to resistance
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We prioritized regimens containing DTG due to a higher barrier to resistance
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We prioritized regimens containing any PIs due to a higher barrier to resistance
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Prioritizing up to 3 active drugs

Score Modification Rule
We augmented baseline penalties for less than 3 active drugs.

In viremic patients:

At baseline, we strongly penalized (+6) regimens with <= 1 active drug as these are unlikely to result in virologic suppression. We scaled penalties for increasing numbers of active drugs (+4.5 for 1 to 1.5 active drugs, +3 for 1.5 to 1.99, +1 for 2-2.5 active drugs, and 0.25 for 2.5-3 active drugs).  Given increasing evidence for INSTI and PI regimens to lead to virologic suppression as part of 2 drug regimens, we lessened the severity of these penalties if including DRV, DTG, or BIC.  In scenarios where this 'option' is checked, we augmented all of these penalties to give even stronger preference to those regimens with more active drugs.

In suppresed patients:

At baseline, we again prioritized 3 active drugs, but the degree of the penalties was less.  This was based on consideration that you may require less active drugs to maintain virologic suppression in someone who is stably suppressed.  However, if this 'option' is checked, then all of the penalties were again augmented.