52 y/o diagnose dx 30 years ago:
ZDV/3TC, then ZDV/3TC/NVP, later TDF/FTC/EFV-->K103N, M184V, Y181C, D67N
Later RAL, ETR, TDF/FTC (didn't want DRV)-->generaly suppressed, but occasional LLV. Develops N155H. He wants a once/daily regimen
CCO audience:
BIC/TAF/FTC 32%, DRV/c/TAF/FTC 11%, DRV/c+TAF/FTC+DOR 26%, DTG/RPV+DTG 5%, DRV/c/TAF/FTC+DTG BID 5%, 11% IBA regimens
| Score Code | Regimen | Weighted Score | Active Drugs | Total Pills | Frequency (x/day) |
|---|---|---|---|---|---|
| 1 | DRV/c/TAF/FTC | 0.35 | 2 | 1 | 1 |
| 1 | DRV/c+TDF/FTC | 0.45 | 2 | 2 | 1 |
| 1 | DRV/r+TAF/FTC | 0.55 | 2 | 3 | 1 |
| 1 | DRV/r+TDF/FTC | 0.65 | 2 | 3 | 1 |
| 1 | DRV/c+BIC/TAF/FTC | 1 | 3 | 2 | 1 |
BIC: very little data on 2nd line usage, particularly in setting of an INSTI mutation. By guidelines and package insert, if using an INSTI in this situation, it likely would be DTG BID. Patient has some underlying NRTI resistance. A boosted PI with continuation of NRTI (EARNEST, SECOND-LINE, SELECT) should be able to suppress, and may improve adherence with one tablet once/day. DRV/c/TAF/FTC was the consensus of CCO panel as well.