Results

Mutations: I5I, I5V, K20K, K20R, V35I, M41L, E53D, K101Q, Q102K, K122E, I135K I135R, C162S, S163T, F171F, F171V, Q174N, V179I, T215E, V245T, A272P, V276I, R277K, Q278H, Q278N, K281K, K281R, D324E, G333E, Q334N, K358R, G359S, A371V, K374K, K374R, I375V, A376T, K385R, K390R, A400T, L10V, I13V, K14K, K14R, I15V, D30N, E35D, M36I, N37D, L63P, I72V, V75I, N88D, D6E, K14R, N27G, N27S, V32I, L45Q, V72I, L101I, V113I, K136Q, I204I, I204V, D253D, D253N
Comorbidities: Diarrhea and GI Symptoms, Peripheral Neuropathy, Depression
Comedications: Dapsone
Treatment history: LPV/r (Lopinavir-ritonavir/Kaletra) , FPV/r (Fosamprenavir-ritonavir/Lexiva and Norvir) , ATV (Atazanavir/Reyataz) , DRV (Darunavir/Prezista) , RAL (Raltegravir/Isentress) , DTG (Dolutegravir/Tivicay) , BIC (Bictegravir/Biktarvy) , TDF/FTC (Truvada) , ABC/3TC (Epzicom) , EVG/c/TAF/FTC (Genvoya)
Current regimen: None
Adherence: No options selected
CD4: ≤ 100
Viral load: High (100,000 - 500,000)
HLA-B5701: Negative
Tropism: Unknown
View results
Because there are salvage regimens in consideration, please consider seeking ID consultation or 'starting discussion' for additional input by HIV-ASSIST users and National Clinical Consultation Center partners.
Regimen Weighted Score Active Drugs Total Pills Frequency (x/day)
DTG+DOR+TAF/FTC 4.46 2.67 3 1
DTG+DRV/r+TAF/FTC 4.8 2.33 6 2
DTG+RPV/TAF/FTC [Your preferred regimen] 4.86 2.67 2 1
DTG+DRV/r+DOR 4.91 2.67 6 2
DTG+DOR 5.06 2 2 1
DOR+BIC/TAF/FTC 5.25 2.67 2 1
DRV/r+DTG/RPV 5.46 2.67 5 2
DTG+IBA+DOR 5.56 3 2 1
DRV/r+BIC/TAF/FTC 5.6 2.33 5 2
DTG/RPV 5.61 2 1 1
DTG+TAF/FTC 5.65 1.67 2 1
DTG+IBA 6 2 1 1
RAL+IBA+DOR 6.05 3 3 1
IBA+DTG/RPV 6.16 3 1 1
RPV+BIC/TAF/FTC 6.35 2.67 2 1

Report

Preferred regimen based on the HIV-ASSIST algorithm: DTG+DOR+TAF/FTC

DTG+DOR+TAF/FTC had the lowest weighted score (4.46) among all regimens HIV-ASSIST evaluated. In general, lower HIV-ASSIST weighted scores are considered preferable with respect to achieving viral suppression and maximizing tolerability. Your patient may have other considerations we did not factor and this report should not be considered a guarantee of likely success with this patient. Please use clinical judgement in making final ARV selections. Other regimens you may wish to consider are listed below. A full list of ARV regimens analyzed by the HIV-ASSIST algorithm can be found by clicking the Expert Tab above.

Regimen Weighted Score Active Drugs Total Pills Frequency (x/day)
DTG+DOR+TAF/FTC 4.46 2.67 3 1

The rationale behind why this regimen was chosen by our algorithm as the most appropriate is shown below:

Other highly ranked regimens

Other highly ranked regimens based on the HIV-ASSIST algorithm are shown below. For full details on these regimens, please click on the Expert Tab above.

Regimen Weighted Score Active Drugs Total Pills Frequency (x/day)
DTG+DRV/r+TAF/FTC 4.8 2.33 6 2
DTG+RPV/TAF/FTC [Your preferred regimen] 4.86 2.67 2 1
DTG+DRV/r+DOR 4.91 2.67 6 2
DTG+DOR 5.06 2 2 1

What about your originally preferred regimen: DTG+RPV/TAF/FTC

The rationale behind why your preferred regimen was not chosen by our algorithm as the top is shown below:

Mutations

Based on the Stanford Database, we assign penalties to various regimens based on inputted (i.e., genotypic) and assumed archived mutations. We consider drugs with summed mutation scores between 10 and 29 to have low-level resistance, scores between 30 and 59 to have intermediate-level resistance, and scores above 60 to have high-level resistance.

NRTI Mutation(s) 3TC FTC ABC TAF TDF AZT D4T DDI
M41L 0 0 5 5 5 15 15 10
T215E 0 0 5 5 5 20 20 10
V75I 5 5 5 5 5 5 5 5
M184V* 60 60 15 -10 -10 -10 -10 10
M41L + T215ACDEILNSV 0 0 5 5 5 5 5 5
Total 65 65 35 10 10 35 35 40
NNRTI Mutation(s) EFV ETR RPV NVP DOR
Total 0 0 0 0 0
PI Mutation(s) LPVr FPVr TPVr SQVr IDVr NFV ATVr ATVc ATV DRV DRVr DRVc
D30N 0 0 0 0 0 60 0 0 0 0 0 0
N88D 0 0 0 10 0 60 10 10 10 0 0 0
V32I 15 30 5 0 15 15 15 15 15 15 15 15
Total 15 30 5 10 15 135 25 25 25 15 15 15
INSTI Mutation(s) RAL EVGc DTG BIC CAB
Total 0 0 0 0 0
EI Mutation(s) MVC IBA FOS
Total 0 0 0
* signifies an assumed archived mutation based on prior treatment experience.

Comorbidities, Side Effects, and Pregnancy Interactions

HIV-ASSIST incorporates a mathematical penalty into our algorithms for ARVs that are less preferred due to comorbidities or side-effects, based on recommendations from DHHS guidelines and HIV-ASSIST clinician and pharmacist expertise. In general, higher penalties suggest that the listed ARV is less favored in the presence of the stated comorbidity or side effect.

Diarrhea and GI Symptoms Penalty Notes
AZT 1 AZT can cause pancreatitis and severe nausea.
DDI 1 ddI can cause pancreatitis and severe nausea.
LPV/r 1 Up to 30% of patients using LPV will experience diarrhea.
TPV/r 1
SQV/r 1
ATV/r 1 Hyperbilirubinemia and diarrhea are common side effects of ATV.
ATV/c 1 Hyperbilirubinemia and diarrhea are common side effects of ATV.
ATV 1 Hyperbilirubinemia and diarrhea are common side effects of ATV.
DRV 0.5 Approximately 8-14% of adults using DRV will experience diarrhea.
DRV/r 0.5 Approximately 8-14% of adults using DRV will experience diarrhea.
DRV/c 0.5 Approximately 8-14% of adults using DRV will experience diarrhea.
EVG/c 1 EVG can cause nausea and diarrhea.
Peripheral Neuropathy Penalty Notes
D4T 2 d4T can cause peripheral neuropathy that can be irreversible.
DDI 2 ddI can cause peripheral neuropathy that can be irreversible.
Depression Penalty Notes
EFV 1.5 EFV is associated with neuropsychiatric effects and can exacerbate psychiatric symptoms. It may be associated with suicidality. Consider avoiding EFV-based regimens if possible. Symptoms usually subside or diminish after 2 to 4 weeks. Bedtime dosing may reduce symptoms. Risks include psychiatric illness, concomitant use of agents with neuropsychiatric effects, and increased EFV concentrations because of genetic factors or increased absorption with food.
RPV 0.5 RPV is associated with depression, suicidality, and sleep disturbances. DHHS guidelines suggest RPV can exacerbate psychiatric symptoms and state, "Consider avoiding RPV based regimens"
RAL 0.1 Insomnia, depression, and suicidality have been infrequently reported with INSTI use, primarily in patients with preexisting psychiatric conditions. DHHS guidance suggests 'patients with pre-existing psychiatric conditions on INSTI based regimens should be closely monitored"
EVG/c 0.1 Insomnia, depression, and suicidality have been infrequently reported with INSTI use, primarily in patients with preexisting psychiatric conditions. DHHS guidance suggests 'patients with pre-existing psychiatric conditions on INSTI based regimens should be closely monitored"
DTG 0.1 Insomnia, depression, and suicidality have been infrequently reported with INSTI use, primarily in patients with preexisting psychiatric conditions. DHHS guidance suggests 'patients with pre-existing psychiatric conditions on INSTI based regimens should be closely monitored"
BIC 0.1 Insomnia, depression, and suicidality have been infrequently reported with INSTI use, primarily in patients with preexisting psychiatric conditions. DHHS guidance suggests 'patients with pre-existing psychiatric conditions on INSTI based regimens should be closely monitored"
CAB 0.1 Insomnia, depression, and suicidality have been infrequently reported with INSTI use, primarily in patients with preexisting psychiatric conditions. DHHS guidance suggests 'patients with pre-existing psychiatric conditions on INSTI based regimens should be closely monitored"

Co-medication Interactions

We have identified the following possible drug interactions which HIV-ASSIST factors into ARV regimen selection, based on recommendations from DHHS guidelines, University of Liverpool HIV Drug Interaction Checker, and HIV-ASSIST clinician and pharmacist expertise. Penalties less than 1.0 are typically those representing minor interactions that can be mediated by dosage adjustments, whereas a penalty of 2.0 represents medically contraindicated ARVs.

Dapsone Penalty Notes
AZT 0.3 Monitor renal function and haematological parameters and consider dose reduction if required
D4T 0.25 Coadministration of both drugs may increase the risk of peripheral neuropathy (additive toxicity)
DDI 0.25 Coadministration of both drugs may increase the risk of peripheral neuropathy (additive toxicity)
SQV/r 2 Coadministration is contraindicated due to the potential for life threatening cardiac arrhythmia