Results

Mutations: M184V, M41L, K103N, L63P, V77I, I93L, K101Q
Comorbidities: None
Comedications: None
Treatment history: None
Current regimen: ATV/c (Atazanavir-cobicistat/Evotaz) , DRV/c/TAF/FTC (Symtuza)
Adherence: Patients with pill aversion (prioritize smaller pills), Patients who prefer once daily dosing, Patients with intermittent adherence, Increase prioritization of at least 3 active drugs, Penalize regimens with IV/IM dosing
CD4: ≤ 50
Viral load: High (100,000 - 500,000)
HLA-B5701: Positive (or unknown)
Tropism: Unknown
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Regimen Weighted Score Active Drugs Total Pills Frequency (x/day)
DTG+DRV/c/TAF/FTC 0.05 3 2 1
DRV/c+BIC/TAF/FTC 0.15 3 2 1
DRV/r+BIC/TAF/FTC 0.25 3 3 1
DTG+DRV/r+TAF/FTC 0.45 3 4 1
DRV+EVG/c/TAF/FTC 0.9 3 2 1
RAL+DRV/c/TAF/FTC 1.3 3 3 1
DTG+TAF/FTC 1.3 2 2 1
BIC/TAF/FTC 1.45 2 1 1
RAL+DRV/r+TAF/FTC 1.7 3 5 1
DOR+BIC/TAF/FTC 2.05 3 2 1
DTG+RPV/TAF/FTC 2.06 3 2 1
DTG+DRV/c+DOR 2.26 3 3 1
DTG+DOR+TAF/FTC 2.26 3 3 1
DRV/c/TAF/FTC 2.45 2 1 1
DRV/r+TAF/FTC 2.55 2 3 1

Report

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

DTG+DRV/c/TAF/FTC had the lowest weighted score (0.05) 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+DRV/c/TAF/FTC 0.05 3 2 1

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

Score (Change) Explanation
3 (+3) Base score for this regimen
3 (+0) Pill burden: All regimens with more than one pill once per day incur a pill burden penalty.
3.1 (+0.1) Mutations: A mathematical mutation penalty was incorporated based on mutation scores from the Stanford Database. M184V penalties were ignored for this regimen.
3.6 (+0.5) Poor adherence: We penalized regimens with larger pills to simplify dosing.
3.3 (-0.3) Poor adherence: We prioritized regimens with ARVs with higher barrier for resistance in the setting of intermittent adherence.
1.55 (-1.75) Non-suppressed viral load: In general, we penalized regimens with fewer than three active drugs with multi-class resistance. To prioritize regimens with at least 3 active drugs, we multiplied existing active drug penalties by 3.5
1.3 (-0.25) Non-suppressed viral load: We prioritized switching to 2 NRTI + PI +/- another ARV after treatment failure on an NNRTI regimen
0.8 (-0.5) Non-suppressed viral load: We prioritized switching to 2 NRTI + INSTI +/- another ARV after treatment failure on an NNRTI regimen
0.55 (-0.25) Non-suppressed viral load: We prioritized switching to PI + INSTI +/- another ARV after treatment failure on an NNRTI regimen
0.3 (-0.25) Non-suppressed viral load: We prioritized remaining on a 2 NRTI + PI +/- another ARV regimen after treatment failure on an PI regimen
0.05 (-0.25) Non-suppressed viral load: We prioritized switching to a 2 NRTI + INSTI +/- another ARV regimen after treatment failure on an PI regimen
0.05 (Final) Final weighted score

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)
DRV/c+BIC/TAF/FTC 0.15 3 2 1
DRV/r+BIC/TAF/FTC 0.25 3 3 1
DTG+DRV/r+TAF/FTC 0.45 3 4 1
DRV+EVG/c/TAF/FTC 0.9 3 2 1

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.

* signifies an assumed archived mutation based on prior treatment experience.
NRTI Mutation(s) 3TC FTC ABC TAF TDF AZT D4T DDI
M184V 60 60 15 -10 -10 -10 -10 10
M41L 0 0 5 5 5 15 15 10
Total 60 60 20 -5 -5 5 5 20
NNRTI Mutation(s) EFV ETR RPV NVP DOR
K103N 60 0 0 60 0
Total 60 0 0 60 0
PI Mutation(s) LPVr FPVr TPVr SQVr IDVr NFV ATVr ATVc ATV DRV DRVr DRVc
Total 0 0 0 0 0 0 0 0 0 0 0 0
INSTI Mutation(s) RAL EVGc DTG BIC CAB
Total 0 0 0 0 0
EI Mutation(s) MVC IBA FOS
Total 0 0 0

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.

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.