Endocarditis on rifampin and oxacillin

Mutations: M184V K103N
Comorbidities: None
Comedications: Other penicillins (oxacillin, nafcillin,etc), Rifampin
Treatment history: EFV/TDF/FTC (Atripla)
Current regimen: DTG (Dolutegravir/Tivicay) , TAF/FTC (Descovy)
Adherence: Administration preference: Penalize IV/IM/SC dosing
CD4: > 200
Viral load: Suppressed (<50) for more than 6 months
HLA-B5701: Negative
Tropism: Unknown
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Submitted by maunank on

33-yr-old woman with substance use disorder and HIV admitted with fever and chest pain

‒Onset 1 wk ago in the context of relapsed IDU (ie, heroin and cocaine)

‒Previously stable on opiate replacement therapy

Past medical history: HIV on DTG + FTC/TAF with excellent adherence until relapsed IDU; most recent HIV-1 RNA < 20 copies/mL 3 mos ago

‒HCV infection previously treated with SOF/VEL, SVR (cure) confirmed

‒Endocarditis secondary to IDU

‒Underwent bioprosthetic aortic valve replacement 5 yrs before current admission

Previously failed Atripla

Now admitted with recurrent bioprosthetic MSSA endocarditis, being started on oxacillin + rifampin. What do do about ARV?

Score Code Regimen Weighted Score Active Drugs Total Pills Frequency (x/day)
2 DTG/TDF/3TC 2.5 2 2 2
3 DTG+TDF/FTC 2.7 2 3 2
3 DTG+TAF/FTC [Current regimen] 2.95 2 3 2
5 RAL+TDF/FTC 8.1 2 5 2
5 DTG+3TC/AZT 8.15 2 4 2
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