Results
| Mutations: V101I,D67N,K70R,RT_L74I,M184V,K219Q,L33F,I50V,I54L,D67N,K70R,M184I,T97A,N155H, K101E,V106L,V108I Comorbidities: None Comedications: None Treatment history: None Current regimen: None |
Adherence: Patients who prefer once daily dosing, Patients with intermittent adherence, Penalize regimens with IV/IM dosing CD4: ≤ 200 Viral load: Low (200 - 100,000) HLA-B5701: Negative Tropism: Unknown |
View results |
to help us improve HIV-ASSIST.
HIV-ASSIST calculates a regimen's weighted score on a scale of 1 to 10, in which lower values represent preferred regimens based upon current IAS and DHHS guidelines, while factoring in treatment history, comorbidities, co-medications, and other factors entered on the input page. The weighting system utilizes standardized utility weights based on current literature evidence and expert opinion. HIV-ASSIST is an educational tool and not a substitute for clinical judgement. Click on a regimen and 'Rationale' to see all steps leading to the presented weighted score. Please note that rankings would differ if if some factors were weighed more or less than those applied within HIV-ASSIST algorithms.
| HIV-ASSIST Score | Efficacy (likelihood of viral suppression) | Tolerability (side-effects and pill burden) | Notes |
| ≤ 1.5 | Strong evidence | Strong evidence | Reserved for fully- or near fully- active regimens. |
| 1.5 - 2.5 | Strong or moderate evidence | Strong or moderate evidence | Includes regimens that started at better rank but were impacted by mutations, comorbidities, and drug interactions. |
| 2.5 - 4.0 | Moderate evidence | Moderate evidence | As above. Additionally, most treatment-experienced patients will see regimens in this category. |
| 4.0 - 6.0 | Moderate to poor evidence | Moderate or poor evidence | As above. Additionally, most treatment-experienced patients will see regimens in this category. |
| ≥ 6.0 | Poor evidence | Poor evidence | As above. Additionally, these represent salvage regimens in patients with limited options. |
| | | | Signifies that there may be additional regimen warnings. |
Note: We do not show regimens for which there is evidence against usage.
| Regimen | Weighted Score | Active Drugs | Total Pills | Frequency (x/day) |
|---|---|---|---|---|
| BIC/TAF/FTC | 4.9 | 1.67 | 1 | 1 |
| DTG+ATV/c+TAF/FTC | 5.65 | 2.33 | 4 | 2 |
| DTG+ATV/r+TAF/FTC | 5.95 | 2.33 | 5 | 2 |
| DTG+TAF/FTC | 6.85 | 1.67 | 3 | 2 |
| DOR+BIC/TAF/FTC | 7.15 | 2.33 | 2 | 1 |
| DTG+FOS+ATV/c+TAF/FTC | 7.15 | 3.33 | 6 | 2 |
| DTG+FOS+ATV/r+TAF/FTC | 7.45 | 3.33 | 7 | 2 |
| DTG+FOS+ATV/c | 7.9 | 2.67 | 5 | 2 |
| DTG+ATV/c+DOR | 8.01 | 2.33 | 4 | 2 |
| DTG+DRV/r+TAF/FTC | 8.15 | 2 | 7 | 2 |
| DTG+FOS+ATV/r | 8.2 | 2.67 | 6 | 2 |
| DTG+ATV/c+DOR+TAF/FTC | 8.26 | 3 | 5 | 2 |
| DTG+ATV/r+DOR | 8.31 | 2.33 | 5 | 2 |
| DRV/r+BIC/TAF/FTC | 8.5 | 2 | 5 | 2 |
| ATV/c+DOR+TAF/FTC | 8.55 | 2 | 3 | 1 |
Report
Preferred regimen based on the HIV-ASSIST algorithm: BIC/TAF/FTC
BIC/TAF/FTC had the lowest weighted score (4.9) 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) |
|---|---|---|---|---|
| BIC/TAF/FTC | 4.9 | 1.67 | 1 | 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+ATV/c+TAF/FTC | 5.65 | 2.33 | 4 | 2 |
| DTG+ATV/r+TAF/FTC | 5.95 | 2.33 | 5 | 2 |
| DTG+TAF/FTC | 6.85 | 1.67 | 3 | 2 |
| DOR+BIC/TAF/FTC | 7.15 | 2.33 | 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 |
|---|---|---|---|---|---|---|---|---|
| D67N | 0 | 0 | 5 | 5 | 5 | 15 | 15 | 5 |
| K70R | 0 | 0 | 5 | 5 | 5 | 30 | 15 | 10 |
| L74I | 0 | 0 | 30 | 5 | 5 | 0 | 0 | 60 |
| M184V | 60 | 60 | 15 | -10 | -10 | -10 | -10 | 10 |
| K219Q | 0 | 0 | 5 | 5 | 5 | 10 | 10 | 5 |
| M184I | 60 | 60 | 15 | -10 | -10 | -10 | -10 | 10 |
| D67EGN + K70R + M184IV + K219ENQR | 0 | 0 | 20 | 0 | 0 | 0 | 0 | 0 |
| D67EGN + K70R + K219ENQR | 10 | 10 | 10 | 10 | 10 | 10 | 10 | 10 |
| K70EGNQST + M184IV | 0 | 0 | 0 | 10 | 10 | 0 | 10 | 0 |
| L74IV + M184IV | 0 | 0 | 15 | 0 | 0 | 0 | 0 | 0 |
| Total | 130 | 130 | 120 | 20 | 20 | 45 | 40 | 110 |
| NNRTI Mutation(s) | EFV | ETR | RPV | NVP | DOR |
|---|---|---|---|---|---|
| K101E | 15 | 15 | 45 | 30 | 15 |
| V108I | 10 | 0 | 0 | 15 | 10 |
| K101E + M184I | 0 | 0 | 15 | 0 | 0 |
| Total | 25 | 15 | 60 | 45 | 25 |
| PI Mutation(s) | LPVr | FPVr | TPVr | SQVr | IDVr | NFV | ATVr | ATVc | ATV | DRV | DRVr | DRVc |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| L33F | 5 | 10 | 10 | 5 | 5 | 10 | 5 | 5 | 5 | 5 | 5 | 5 |
| I50V | 30 | 60 | -5 | 15 | 0 | 15 | 0 | 0 | 0 | 20 | 20 | 20 |
| I54L | 20 | 60 | -10 | 15 | 10 | 20 | 15 | 15 | 15 | 20 | 20 | 20 |
| Total | 55 | 130 | -5 | 35 | 15 | 45 | 20 | 20 | 20 | 45 | 45 | 45 |
| INSTI Mutation(s) | RAL | EVGc | DTG | BIC | CAB |
|---|---|---|---|---|---|
| T97A | 10 | 10 | 0 | 0 | 0 |
| N155H | 60 | 60 | 10 | 10 | 25 |
| Total | 70 | 70 | 10 | 10 | 25 |
| 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.