Results
| Mutations: m184v Comorbidities: Chronic Renal (Kidney) Disease GFR 30-60 Comedications: Trimethoprim-Sulfamethoxazole, Azithromycin Treatment history: 3TC (Lamivudine/Epivir) Current regimen: FTC (Emtricitabine/Emtriva) , TAF (Tenofovir alafenamide/Vemlidy) , DRV/c (Darunavir-cobicistat/Prezcobix) |
Adherence: Pill frequency: Prioritize once daily dosing, Intermittent adherence: Prioritize drugs with higher barrier to resistance, Intermittent adherence: Prioritize at least 3 active drugs, Administration preference: Penalize IV/IM/SC dosing CD4: ≤ 200 Viral load: Suppressed (<50) for more than 6 months HLA-B5701: Negative Tropism: Dual Tropic virus |
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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.
The Score Code is a value from 1-5 that corresponds with the chart below.
| Score Code | HIV-ASSIST Score | Efficacy (likelihood of viral suppression) | Tolerability (side-effects and pill burden) | Notes |
|---|---|---|---|---|
| 1 | ≤ 1.5 | Strong evidence | Strong evidence | Reserved for fully- or near fully- active regimens. |
| 2 | 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. |
| 3 | 2.5 - 4.0 | Moderate evidence | Moderate evidence | As above. Additionally, most treatment-experienced patients will see regimens in this category. |
| 4 | 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. |
| 5 | ≥ 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.
| Score Code | Regimen | Weighted Score | Active Drugs | Total Pills | Frequency (x/day) |
|---|---|---|---|---|---|
| 1 | DTG+DRV/c/TAF/FTC | 1.01 | 3 | 2 | 1 |
| 2 | DTG+DRV/r+TAF/FTC | 1.51 | 3 | 4 | 1 |
| 2 | DRV/c+BIC/TAF/FTC | 1.71 | 3 | 2 | 1 |
| 2 | DRV/c/TAF/FTC [Current regimen] [Your preferred regimen] | 1.76 | 2 | 1 | 1 |
| 2 | BIC/TAF/FTC | 1.85 | 2 | 1 | 1 |
| 2 | DTG+DRV/c+DOR | 1.87 | 3 | 3 | 1 |
| 2 | DRV/r+BIC/TAF/FTC | 1.91 | 3 | 3 | 1 |
| 2 | DRV/c+DTG/RPV | 1.92 | 3 | 2 | 1 |
| 2 | DTG+TAF/FTC | 2 | 2 | 2 | 1 |
| 2 | DTG+DOR+DRV/c/TAF/FTC | 2.07 | 4 | 3 | 1 |
| 2 | DTG+DRV/r+DOR | 2.17 | 3 | 4 | 1 |
| 2 | DTG+DRV/c+TDF/FTC | 2.26 | 3 | 3 | 1 |
| 2 | DTG+RPV+DRV/c/TAF/FTC | 2.32 | 4 | 3 | 1 |
| 2 | DRV/r+DTG/RPV | 2.37 | 3 | 3 | 1 |
| 3 | DTG+DRV/r+TDF/FTC | 2.56 | 3 | 4 | 1 |
| 3 | DTG+DRV/r+DOR+TAF/FTC | 2.57 | 4 | 5 | 1 |
| 3 | DRV/c+DOR+BIC/TAF/FTC | 2.76 | 4 | 3 | 1 |
| 3 | DTG+DRV/r+RPV/TAF/FTC | 2.77 | 4 | 4 | 1 |
| 3 | DTG+TDF/FTC | 2.95 | 2 | 2 | 1 |
| 3 | DRV/r+TAF/FTC | 2.96 | 2 | 3 | 1 |
| 3 | DTG+DOR+TAF/FTC | 2.96 | 3 | 3 | 1 |
| 3 | DRV/r+DOR+BIC/TAF/FTC | 2.96 | 4 | 4 | 1 |
| 3 | DTG+RPV/TAF/FTC | 3.01 | 3 | 2 | 1 |
| 3 | DRV/c+RPV+BIC/TAF/FTC | 3.01 | 4 | 3 | 1 |
| 3 | DRV+EVG/c/TAF/FTC | 3.26 | 3 | 2 | 1 |
| 3 | DTG+DRV/c+DOR+TDF/FTC | 3.32 | 4 | 4 | 1 |
| 3 | DOR+BIC/TAF/FTC | 3.35 | 3 | 2 | 1 |
| 3 | DRV/r+RPV+BIC/TAF/FTC | 3.36 | 4 | 4 | 1 |
| 3 | DRV/c+TDF/FTC | 3.56 | 2 | 2 | 1 |
| 3 | DTG+DRV/c+RPV+TDF/FTC | 3.57 | 4 | 4 | 1 |
| 3 | RPV+BIC/TAF/FTC | 3.6 | 3 | 2 | 1 |
| 3 | DTG+DRV/r+DOR+TDF/FTC | 3.62 | 4 | 5 | 1 |
| 3 | DTG+DOR+TDF/FTC | 3.91 | 3 | 3 | 1 |
| 3 | RAL+DRV/c/TAF/FTC | 3.96 | 3 | 3 | 1 |
| 4 | DRV/r+TDF/FTC | 4.01 | 2 | 3 | 1 |
| 4 | DTG+DRV/r+RPV+TDF/FTC | 4.02 | 4 | 5 | 1 |
| 4 | DTG+RPV+TDF/FTC | 4.16 | 3 | 3 | 1 |
| 4 | DTG+DRV/c | 4.46 | 2 | 2 | 1 |
| 4 | RAL+DRV/c+DOR | 4.46 | 3 | 4 | 1 |
| 4 | RAL+DRV/r+TAF/FTC | 4.46 | 3 | 5 | 1 |
| 4 | DOR+DRV/c/TAF/FTC | 4.61 | 3 | 2 | 1 |
| 4 | DTG+DRV/r | 4.76 | 2 | 3 | 1 |
| 4 | RAL+DRV/r+DOR | 4.76 | 3 | 5 | 1 |
| 4 | DRV/r+DOR+TAF/FTC | 5.01 | 3 | 4 | 1 |
| 4 | DTG+IBA+DRV/c | 5.06 | 3 | 2 | 1 |
| 4 | RPV+DRV/c/TAF/FTC | 5.11 | 3 | 2 | 1 |
| 4 | DOR+EVG/c/TAF/FTC | 5.2 | 3 | 2 | 1 |
| 4 | DTG+IBA+DRV/c/TAF/FTC | 5.26 | 4 | 2 | 1 |
| 4 | RAL+DRV/c+RPV | 5.31 | 3 | 4 | 1 |
| 4 | RAL+DRV/c+TDF/FTC | 5.31 | 3 | 4 | 1 |
| 4 | DTG+IBA+DRV/r | 5.36 | 3 | 3 | 1 |
| 4 | DTG+DOR | 5.46 | 2 | 2 | 1 |
| 4 | DRV/r+RPV/TAF/FTC | 5.46 | 3 | 3 | 1 |
| 4 | DTG+LEN+DRV/c | 5.56 | 3 | 2 | 1 |
| 4 | DTG+LEN+IBA+DRV/c | 5.56 | 4 | 2 | 1 |
| 4 | DTG+LEN+DRV/r | 5.61 | 3 | 3 | 1 |
| 4 | RAL+DRV/r+TDF/FTC | 5.61 | 3 | 5 | 1 |
| 4 | DTG+LEN+IBA+DRV/r | 5.61 | 4 | 3 | 1 |
| 4 | DTG/RPV | 5.71 | 2 | 1 | 1 |
| 4 | DRV/r+DOR | 5.76 | 2 | 3 | 1 |
| 4 | RAL+DRV/r+RPV | 5.76 | 3 | 5 | 1 |
| 4 | DTG+IBA+DRV/r+TAF/FTC | 5.76 | 4 | 4 | 1 |
| 4 | DTG+IBA+DOR | 5.81 | 3 | 2 | 1 |
| 4 | DRV/c+DOR+TDF/FTC | 5.86 | 3 | 3 | 1 |
| 4 | RAL+DRV/r+EFV | 5.91 | 3 | 5 | 1 |
| 4 | RAL+DRV/r | 5.96 | 2 | 4 | 1 |
| 4 | IBA+DRV/c+BIC/TAF/FTC | 5.96 | 4 | 2 | 1 |
| 5 | DTG+LEN+DRV/c/TAF/FTC | 6.01 | 4 | 2 | 1 |
| 5 | IBA+DTG/RPV | 6.06 | 3 | 1 | 1 |
| 5 | DTG+LEN+DOR | 6.06 | 3 | 2 | 1 |
| 5 | DRV/r+DOR+TDF/FTC | 6.06 | 3 | 4 | 1 |
| 5 | DTG+IBA+DRV/c+DOR | 6.12 | 4 | 3 | 1 |
| 5 | DRV/r+EFV+TAF/FTC | 6.16 | 3 | 4 | 1 |
| 5 | IBA+DRV/r+BIC/TAF/FTC | 6.16 | 4 | 3 | 1 |
| 5 | IBA+DRV/c+DTG/RPV | 6.17 | 4 | 2 | 1 |
| 5 | RPV+EVG/c/TAF/FTC | 6.2 | 3 | 2 | 1 |
| 5 | RAL+DOR+TAF/FTC | 6.2 | 3 | 4 | 1 |
| 5 | DTG+IBA+TAF/FTC | 6.25 | 3 | 2 | 1 |
| 5 | DTG+LEN+DRV/r+TAF/FTC | 6.26 | 4 | 4 | 1 |
| 5 | LEN+DTG/RPV | 6.31 | 3 | 1 | 1 |
| 5 | DRV/c+RPV+TDF/FTC | 6.36 | 3 | 3 | 1 |
| 5 | DTG+IBA+DRV/r+DOR | 6.42 | 4 | 4 | 1 |
| 5 | DRV/r+EFV+TDF/FTC | 6.46 | 3 | 4 | 1 |
| 5 | DTG+LEN+TAF/FTC | 6.5 | 3 | 2 | 1 |
| 5 | DTG+IBA+DRV/c+TDF/FTC | 6.51 | 4 | 3 | 1 |
| 5 | RAL+RPV/TAF/FTC | 6.6 | 3 | 3 | 1 |
| 5 | IBA+DRV/r+DTG/RPV | 6.62 | 4 | 3 | 1 |
| 5 | DTG+DRV/r+ETR | 6.66 | 3 | 6 | 2 |
| 5 | LEN+DRV/r+BIC/TAF/FTC | 6.66 | 4 | 3 | 1 |
| 5 | DRV/r+RPV+TDF/FTC | 6.71 | 3 | 4 | 1 |
| 5 | LEN+DRV/c+BIC/TAF/FTC | 6.71 | 4 | 2 | 1 |
| 5 | DRV+DOR+EVG/c/TAF/FTC | 6.71 | 4 | 3 | 1 |
| 5 | EVG/c/TAF/FTC | 6.8 | 2 | 1 | 1 |
| 5 | DTG+IBA+DRV/r+TDF/FTC | 6.81 | 4 | 4 | 1 |
| 5 | IBA+BIC/TAF/FTC | 6.85 | 3 | 1 | 1 |
| 5 | DTG+LEN+DRV/c+DOR | 6.87 | 4 | 3 | 1 |
| 5 | DRV/r+RPV | 6.91 | 2 | 3 | 1 |
| 5 | LEN+DRV/c+DTG/RPV | 6.92 | 4 | 2 | 1 |
| 5 | DTG+LEN+DRV/r+DOR | 6.92 | 4 | 4 | 1 |
| 5 | CAB/RPV | 6.95 | 2 | 0 | 0.03 |
| 5 | DTG+DRV/r+EFV | 7.01 | 3 | 5 | 2 |
| 5 | DTG+LEN+IBA+DOR | 7.06 | 4 | 2 | 1 |
| 5 | DTG+DRV/r+ETR+TAF/FTC | 7.06 | 4 | 7 | 2 |
| 5 | LEN+BIC/TAF/FTC | 7.1 | 3 | 1 | 1 |
| 5 | LEN+DRV/r+DTG/RPV | 7.12 | 4 | 3 | 1 |
| 5 | DRV/r+EFV | 7.16 | 2 | 3 | 1 |
| 5 | DTG+IBA+TDF/FTC | 7.2 | 3 | 2 | 1 |
| 5 | RAL+EFV+TAF/FTC | 7.2 | 3 | 4 | 1 |
| 5 | DTG+FTR+DRV/c | 7.21 | 3 | 4 | 2 |
| 5 | RAL+DOR+TDF/FTC | 7.25 | 3 | 4 | 1 |
| 5 | DTG+LEN+DRV/c+TDF/FTC | 7.26 | 4 | 3 | 1 |
| 5 | LEN+IBA+DTG/RPV | 7.31 | 4 | 1 | 1 |
| 5 | DTG+LEN+DRV/r+TDF/FTC | 7.31 | 4 | 4 | 1 |
| 5 | DRV/c+AZT+DTG/3TC | 7.36 | 3 | 4 | 2 |
| 5 | DTG+FTR+DRV/r | 7.36 | 3 | 5 | 2 |
| 5 | RAL+DOR+DRV/c/TAF/FTC | 7.41 | 4 | 4 | 1 |
| 5 | DTG+DRV/r+EFV+TAF/FTC | 7.41 | 4 | 6 | 2 |
| 5 | DTG+LEN+TDF/FTC | 7.45 | 3 | 2 | 1 |
| 5 | DTG+FTR+DRV/c/TAF/FTC | 7.46 | 4 | 4 | 2 |
| 5 | RAL+EFV+TDF/FTC | 7.5 | 3 | 4 | 1 |
| 5 | DTG+DRV/c+AZT+FTC | 7.56 | 3 | 5 | 2 |
| 5 | DTG+EFV+TAF/FTC | 7.65 | 3 | 4 | 2 |
| 5 | RAL+DRV/c | 7.66 | 2 | 3 | 1 |
| 5 | DRV/r+AZT+DTG/3TC | 7.66 | 3 | 5 | 2 |
| 5 | DTG+FTR+DOR | 7.71 | 3 | 4 | 2 |
| 5 | DRV+RPV+EVG/c/TAF/FTC | 7.71 | 4 | 3 | 1 |
| 5 | DTG+DRV/r+EFV+TDF/FTC | 7.71 | 4 | 6 | 2 |
| 5 | DTG+FTR+DRV/r+TAF/FTC | 7.81 | 4 | 6 | 2 |
| 5 | DTG+EFV+TDF/FTC | 7.85 | 3 | 4 | 2 |
| 5 | RAL+RPV+TDF/FTC | 7.85 | 3 | 4 | 1 |
| 5 | FTR+DTG/RPV | 7.86 | 3 | 3 | 2 |
| 5 | DTG+DRV/r+AZT+FTC | 7.86 | 3 | 6 | 2 |
| 5 | DRV/c+DOR | 7.91 | 2 | 2 | 1 |
| 5 | RAL+DRV/r+DOR+TAF/FTC | 7.91 | 4 | 6 | 1 |
| 5 | LEN+DRV/c | 7.96 | 2 | 1 | 1 |
| 5 | LEN+DRV/r | 7.96 | 2 | 2 | 1 |
| 5 | RAL+RPV+DRV/c/TAF/FTC | 8.01 | 4 | 4 | 1 |
| 5 | DTG+DRV/r+ETR+TDF/FTC | 8.11 | 4 | 7 | 2 |
| 5 | FTR+DRV/c+BIC/TAF/FTC | 8.16 | 4 | 4 | 2 |
| 5 | DTG+FTR+TAF/FTC | 8.2 | 3 | 4 | 2 |
| 5 | FTR+DRV/r+BIC/TAF/FTC | 8.21 | 4 | 5 | 2 |
| 5 | DTG+FTR+DRV/c+DOR | 8.27 | 4 | 5 | 2 |
| 5 | RAL+TAF/FTC | 8.3 | 2 | 3 | 1 |
| 5 | DRV/r+ETR+TAF/FTC | 8.31 | 3 | 5 | 2 |
| 5 | FTR+DRV/c+DTG/RPV | 8.42 | 4 | 4 | 2 |
| 5 | DRV/c+DOR+AZT+DTG/3TC | 8.42 | 4 | 5 | 2 |
| 5 | DTG+FTR+DRV/r+DOR | 8.42 | 4 | 6 | 2 |
| 5 | DTG+FTR+IBA+DRV/c | 8.46 | 4 | 4 | 2 |
| 5 | RAL+DRV/r+RPV/TAF/FTC | 8.46 | 4 | 5 | 1 |
| 5 | FTR+BIC/TAF/FTC | 8.6 | 3 | 3 | 2 |
| 5 | DTG+FTR+IBA+DRV/r | 8.61 | 4 | 5 | 2 |
| 5 | DTG+DRV/c+DOR+AZT+FTC | 8.62 | 4 | 6 | 2 |
| 5 | DRV/c+3TC+AZT+DTG/RPV | 8.67 | 4 | 5 | 2 |
| 5 | DRV/c+AZT+FTC+DTG/RPV | 8.67 | 4 | 5 | 2 |
| 5 | DTG+FTR+DRV/c+TDF/FTC | 8.71 | 4 | 5 | 2 |
| 5 | FTR+DRV/r+DTG/RPV | 8.72 | 4 | 5 | 2 |
| 5 | DRV/r+DOR+AZT+DTG/3TC | 8.72 | 4 | 6 | 2 |
| 5 | RAL+DRV/c+DOR+TDF/FTC | 8.76 | 4 | 5 | 1 |
| 5 | DTG+FTR+DRV/r+TDF/FTC | 8.86 | 4 | 6 | 2 |
| 5 | DTG+DRV/r+DOR+AZT+FTC | 8.92 | 4 | 7 | 2 |
| 5 | DTG+IBA | 8.95 | 2 | 1 | 1 |
| 5 | DTG+LEN | 8.95 | 2 | 1 | 1 |
| 5 | RAL+DRV/r+ETR | 9.06 | 3 | 6 | 2 |
| 5 | RAL+DRV/r+EFV+TAF/FTC | 9.06 | 4 | 6 | 1 |
| 5 | RAL+DRV/r+DOR+TDF/FTC | 9.06 | 4 | 6 | 1 |
| 5 | DOR+AZT+DTG/3TC | 9.11 | 3 | 4 | 2 |
| 5 | DTG+LEN+FTR+DRV/r | 9.11 | 4 | 5 | 2 |
| 5 | DRV/r+3TC+AZT+DTG/RPV | 9.12 | 4 | 6 | 2 |
| 5 | DRV/r+AZT+FTC+DTG/RPV | 9.12 | 4 | 6 | 2 |
| 5 | DTG+FTR+TDF/FTC | 9.15 | 3 | 4 | 2 |
| 5 | DTG+LEN+FTR+DRV/c | 9.21 | 4 | 4 | 2 |
| 5 | DOR+TAF/FTC | 9.3 | 2 | 2 | 1 |
| 5 | DRV/r+ETR | 9.31 | 2 | 4 | 2 |
| 5 | DRV/r+3TC+AZT | 9.31 | 2 | 5 | 2 |
| 5 | DRV/r+AZT+FTC | 9.31 | 2 | 5 | 2 |
| 5 | DTG+DOR+AZT+FTC | 9.31 | 3 | 5 | 2 |
| 5 | RAL+TDF/FTC | 9.35 | 2 | 3 | 1 |
| 5 | 3TC+AZT+DTG/RPV | 9.36 | 3 | 4 | 2 |
| 5 | AZT+FTC+DTG/RPV | 9.36 | 3 | 4 | 2 |
| 5 | DRV/r+ETR+TDF/FTC | 9.36 | 3 | 5 | 2 |
| 5 | RAL+DRV/c+RPV+TDF/FTC | 9.36 | 4 | 5 | 1 |
| 5 | RAL+DRV/r+EFV+TDF/FTC | 9.46 | 4 | 6 | 1 |
| 5 | AZT+DTG/3TC | 9.65 | 2 | 3 | 2 |
| 5 | DRV/c+RPV | 9.76 | 2 | 2 | 1 |
| 5 | RAL+DRV/r+RPV+TDF/FTC | 9.81 | 4 | 6 | 1 |
| 5 | DTG+AZT+FTC | 9.85 | 2 | 4 | 2 |
| 5 | DTG+FTR+EFV | 9.9 | 3 | 5 | 2 |
| 5 | IBA+DRV+EVG/c/TAF/FTC | 9.91 | 4 | 2 | 1 |
| 5 | DTG+FTR+IBA+DOR | 9.96 | 4 | 4 | 2 |
| 5 | IBA+DRV/c+DOR | 10.11 | 3 | 2 | 1 |
| 5 | FTR+IBA+DTG/RPV | 10.11 | 4 | 3 | 2 |
| 5 | IBA+DRV/c/TAF/FTC | 10.26 | 3 | 1 | 1 |
| 5 | RAL+IBA+DRV/c | 10.26 | 3 | 3 | 1 |
| 5 | RAL+LEN+DRV/c | 10.26 | 3 | 3 | 1 |
| 5 | IBA+DRV/r+DOR | 10.31 | 3 | 3 | 1 |
| 5 | RAL+LEN+DRV/r | 10.31 | 3 | 4 | 1 |
| 5 | RAL+ETR+TAF/FTC | 10.35 | 3 | 5 | 2 |
| 5 | LEN+DRV+EVG/c/TAF/FTC | 10.41 | 4 | 2 | 1 |
| 5 | IBA+DRV/r+TAF/FTC | 10.46 | 3 | 3 | 1 |
| 5 | DTG+LEN+FTR+DOR | 10.46 | 4 | 4 | 2 |
| 5 | EFV+TAF/FTC | 10.5 | 2 | 2 | 1 |
| 5 | DTG+IBA+EFV | 10.5 | 3 | 3 | 2 |
| 5 | RAL+DRV/c+3TC+AZT | 10.51 | 3 | 6 | 2 |
| 5 | RAL+DRV/c+AZT+FTC | 10.51 | 3 | 6 | 2 |
| 5 | DTG+FTR+DRV/r+ETR | 10.51 | 4 | 8 | 2 |
| 5 | RPV/TAF/FTC | 10.55 | 2 | 1 | 1 |
| 5 | RAL+IBA+DRV/r | 10.56 | 3 | 4 | 1 |
| 5 | LEN+FTR+DTG/RPV | 10.61 | 4 | 3 | 2 |
| 5 | RAL+IBA+DRV/c/TAF/FTC | 10.61 | 4 | 3 | 1 |
| 5 | EFV+TDF/FTC | 10.7 | 2 | 2 | 1 |
| 5 | LEN+DRV/r+TAF/FTC | 10.71 | 3 | 3 | 1 |
| 5 | DRV/r+ETR+AZT+DTG/3TC | 10.71 | 4 | 8 | 2 |
| 5 | LEN+DRV/c/TAF/FTC | 10.76 | 3 | 1 | 1 |
| 5 | LEN+RAL+IBA+DRV/c | 10.76 | 4 | 3 | 1 |
| 5 | DTG+FTR+DRV/r+EFV | 10.76 | 4 | 7 | 2 |
| 5 | LEN+DRV/r+DOR | 10.81 | 3 | 3 | 1 |
| 5 | RAL+DRV/r+3TC+AZT | 10.81 | 3 | 7 | 2 |
| 5 | RAL+DRV/r+AZT+FTC | 10.81 | 3 | 7 | 2 |
| 5 | LEN+RAL+IBA+DRV/r | 10.81 | 4 | 4 | 1 |
| 5 | IBA+DRV/c+RPV | 10.86 | 3 | 2 | 1 |
| 5 | LEN+DRV/c+DOR | 10.86 | 3 | 2 | 1 |
| 5 | DTG+IBA+DRV/r+ETR | 10.91 | 4 | 6 | 2 |
| 5 | DTG+DRV/r+ETR+AZT+FTC | 10.91 | 4 | 9 | 2 |
| 5 | RAL+DOR | 10.95 | 2 | 3 | 1 |
| 5 | IBA+EVG/c/TAF/FTC | 10.95 | 3 | 1 | 1 |
| 5 | RAL+IBA+DRV/c+DOR | 11.06 | 4 | 4 | 1 |
| 5 | DRV/r+EFV+AZT+DTG/3TC | 11.06 | 4 | 7 | 2 |
| 5 | DRV/c+3TC+AZT | 11.11 | 2 | 4 | 2 |
| 5 | DRV/c+AZT+FTC | 11.11 | 2 | 4 | 2 |
| 5 | RAL+IBA+DRV/r+TAF/FTC | 11.11 | 4 | 5 | 1 |
| 5 | DTG+EFV | 11.15 | 2 | 3 | 2 |
| 5 | DRV/c+DOR+3TC+AZT | 11.16 | 3 | 5 | 2 |
| 5 | DRV/c+DOR+AZT+FTC | 11.16 | 3 | 5 | 2 |
| 5 | LEN+EVG/c/TAF/FTC | 11.2 | 3 | 1 | 1 |
| 5 | IBA+DRV/r+RPV | 11.21 | 3 | 3 | 1 |
| 5 | DTG+IBA+DRV/r+EFV | 11.26 | 4 | 5 | 2 |
| 5 | FTR+DRV/c+AZT+DTG/3TC | 11.26 | 4 | 6 | 2 |
| 5 | DTG+DRV/r+EFV+AZT+FTC | 11.26 | 4 | 8 | 2 |
| 5 | EFV+AZT+DTG/3TC | 11.3 | 3 | 5 | 2 |
| 5 | IBA+DRV/c+TDF/FTC | 11.31 | 3 | 2 | 1 |
| 5 | DRV/r+DOR+3TC+AZT | 11.36 | 3 | 6 | 2 |
| 5 | DRV/r+DOR+AZT+FTC | 11.36 | 3 | 6 | 2 |
| 5 | LEN+RAL+DRV/c/TAF/FTC | 11.36 | 4 | 3 | 1 |
| 5 | RAL+IBA+DRV/r+DOR | 11.36 | 4 | 5 | 1 |
| 5 | RAL+ETR+TDF/FTC | 11.4 | 3 | 5 | 2 |
| 5 | FTR+DRV/r+AZT+DTG/3TC | 11.41 | 4 | 7 | 2 |
| 5 | IBA+DRV/r+EFV | 11.46 | 3 | 3 | 1 |
| 5 | DTG+FTR+DRV/c+AZT+FTC | 11.46 | 4 | 7 | 2 |
| 5 | RAL+IBA+DOR | 11.5 | 3 | 3 | 1 |
| 5 | DTG+EFV+AZT+FTC | 11.5 | 3 | 6 | 2 |
| 5 | IBA+DRV/r+TDF/FTC | 11.51 | 3 | 3 | 1 |
| 5 | LEN+DRV/c+RPV | 11.61 | 3 | 2 | 1 |
| 5 | IBA+DRV/c+AZT+DTG/3TC | 11.61 | 4 | 4 | 2 |
| 5 | LEN+RAL+DRV/r+TAF/FTC | 11.61 | 4 | 5 | 1 |
| 5 | DTG+FTR+DRV/r+AZT+FTC | 11.61 | 4 | 8 | 2 |
| 5 | DOR+TDF/FTC | 11.65 | 2 | 2 | 1 |
| 5 | DTG+FTR | 11.65 | 2 | 3 | 2 |
| 5 | LEN+DRV/r+RPV | 11.71 | 3 | 3 | 1 |
| 5 | LEN+RAL+DOR | 11.75 | 3 | 3 | 1 |
| 5 | RAL+LEN+TAF/FTC | 11.75 | 3 | 3 | 1 |
| 5 | RAL+IBA+TAF/FTC | 11.75 | 3 | 3 | 1 |
| 5 | LEN+DRV/r+TDF/FTC | 11.76 | 3 | 3 | 1 |
| 5 | LEN+IBA+DRV/r+DOR | 11.76 | 4 | 3 | 1 |
| 5 | FTR+AZT+DTG/3TC | 11.8 | 3 | 5 | 2 |
| 5 | LEN+DRV/c+TDF/FTC | 11.81 | 3 | 2 | 1 |
| 5 | LEN+IBA+DRV/c+DOR | 11.81 | 4 | 2 | 1 |
| 5 | LEN+RAL+DRV/c+DOR | 11.81 | 4 | 4 | 1 |
| 5 | DTG+IBA+DRV/c+AZT+FTC | 11.81 | 4 | 5 | 2 |
| 5 | FTR+DRV+EVG/c/TAF/FTC | 11.86 | 4 | 4 | 2 |
| 5 | LEN+RAL+DRV/r+DOR | 11.86 | 4 | 5 | 1 |
| 5 | DRV/c+RPV+3TC+AZT | 11.91 | 3 | 5 | 2 |
| 5 | DRV/c+RPV+AZT+FTC | 11.91 | 3 | 5 | 2 |
| 5 | RAL+FTR+DRV/c | 11.91 | 3 | 5 | 2 |
| 5 | RAL+IBA+DRV/c+RPV | 11.91 | 4 | 4 | 1 |
| 5 | IBA+DRV/r+AZT+DTG/3TC | 11.91 | 4 | 5 | 2 |
| 5 | RAL+IBA+DRV/c+TDF/FTC | 11.96 | 4 | 4 | 1 |
| 5 | DTG+FTR+AZT+FTC | 12 | 3 | 6 | 2 |
| 5 | FTR+DRV/c/TAF/FTC | 12.01 | 3 | 3 | 2 |
| 5 | RAL+RPV | 12.05 | 2 | 3 | 1 |
| 5 | RAL+FTR+DRV/r | 12.06 | 3 | 6 | 2 |
| 5 | LEN+DRV/c+AZT+DTG/3TC | 12.11 | 4 | 4 | 2 |
| 5 | DTG+IBA+DRV/r+AZT+FTC | 12.11 | 4 | 6 | 2 |
| 5 | DTG+FTR+IBA+EFV | 12.15 | 4 | 5 | 2 |
| 5 | DRV/r+ETR+3TC+AZT | 12.16 | 3 | 7 | 2 |
| 5 | DRV/r+ETR+AZT+FTC | 12.16 | 3 | 7 | 2 |
| 5 | LEN+DRV/r+AZT+DTG/3TC | 12.16 | 4 | 5 | 2 |
| 5 | RAL+EFV | 12.2 | 2 | 3 | 1 |
| 5 | RAL+DRV/r+ETR+TAF/FTC | 12.21 | 4 | 7 | 2 |
| 5 | RPV+TDF/FTC | 12.25 | 2 | 2 | 1 |
| 5 | FTR+DRV/c+DOR | 12.26 | 3 | 4 | 2 |
| 5 | FTR+DRV/r+TAF/FTC | 12.26 | 3 | 5 | 2 |
| 5 | DRV/r+RPV+3TC+AZT | 12.26 | 3 | 6 | 2 |
| 5 | DRV/r+RPV+AZT+FTC | 12.26 | 3 | 6 | 2 |
| 5 | RAL+IBA+DRV/r+TDF/FTC | 12.26 | 4 | 5 | 1 |
| 5 | FTR+DRV/r+DOR | 12.31 | 3 | 5 | 2 |
| 5 | DTG+LEN+DRV/c+AZT+FTC | 12.31 | 4 | 5 | 2 |
| 5 | RAL+IBA+RPV | 12.35 | 3 | 3 | 1 |
| 5 | IBA+DRV/c | 12.36 | 2 | 1 | 1 |
| 5 | RAL+IBA+DRV/r+RPV | 12.36 | 4 | 5 | 1 |
| 5 | DTG+LEN+DRV/r+AZT+FTC | 12.36 | 4 | 6 | 2 |
| 5 | IBA+AZT+DTG/3TC | 12.4 | 3 | 3 | 2 |
| 5 | LEN+AZT+DTG/3TC | 12.4 | 3 | 3 | 2 |
| 5 | FTR+EVG/c/TAF/FTC | 12.45 | 3 | 3 | 2 |
| 5 | RAL+IBA+EFV | 12.5 | 3 | 3 | 1 |
| 5 | DRV/r+EFV+3TC+AZT | 12.51 | 3 | 6 | 2 |
| 5 | DRV/r+EFV+AZT+FTC | 12.51 | 3 | 6 | 2 |
| 5 | RAL+IBA+DRV/r+EFV | 12.51 | 4 | 5 | 1 |
| 5 | RAL+DOR+3TC+AZT | 12.55 | 3 | 6 | 2 |
| 5 | RAL+DOR+AZT+FTC | 12.55 | 3 | 6 | 2 |
| 5 | LEN+IBA+DRV/c+RPV | 12.56 | 4 | 2 | 1 |
| 5 | LEN+RAL+RPV | 12.6 | 3 | 3 | 1 |
| 5 | DTG+LEN+AZT+FTC | 12.6 | 3 | 4 | 2 |
| 5 | DTG+IBA+AZT+FTC | 12.6 | 3 | 4 | 2 |
| 5 | IBA+DRV/r | 12.61 | 2 | 2 | 1 |
| 5 | LEN+IBA+DRV/r+RPV | 12.66 | 4 | 3 | 1 |
| 5 | LEN+RAL+DRV/c+RPV | 12.66 | 4 | 4 | 1 |
| 5 | LEN+RAL+IBA+DOR | 12.7 | 4 | 3 | 1 |
| 5 | LEN+RAL+DRV/c+TDF/FTC | 12.71 | 4 | 4 | 1 |
| 5 | LEN+RAL+DRV/r+TDF/FTC | 12.76 | 4 | 5 | 1 |
| 5 | RAL+LEN+TDF/FTC | 12.8 | 3 | 3 | 1 |
| 5 | RAL+IBA+TDF/FTC | 12.8 | 3 | 3 | 1 |
| 5 | RAL+FTR+DRV/c/TAF/FTC | 12.81 | 4 | 5 | 2 |
| 5 | LEN+RAL+DRV/r+RPV | 12.86 | 4 | 5 | 1 |
| 5 | DTG+LEN+DRV/r+ETR | 13.06 | 4 | 6 | 2 |
| 5 | FTR+DRV/c+RPV | 13.11 | 3 | 4 | 2 |
| 5 | RAL+FTR+DRV/r+TAF/FTC | 13.16 | 4 | 7 | 2 |
| 5 | FTR+DRV/r+ETR | 13.21 | 3 | 6 | 2 |
| 5 | RAL+FTR+DRV/c+DOR | 13.21 | 4 | 6 | 2 |
| 5 | FTR+DRV/c+TDF/FTC | 13.26 | 3 | 4 | 2 |
| 5 | FTR+DRV/r+TDF/FTC | 13.31 | 3 | 5 | 2 |
| 5 | FTR+DRV/r+RPV | 13.31 | 3 | 5 | 2 |
| 5 | RAL+FTR+DRV/r+DOR | 13.36 | 4 | 7 | 2 |
| 5 | RAL+DRV/r+ETR+TDF/FTC | 13.36 | 4 | 7 | 2 |
| 5 | RAL+FTR+DOR | 13.4 | 3 | 5 | 2 |
| 5 | RAL+RPV+3TC+AZT | 13.4 | 3 | 6 | 2 |
| 5 | RAL+RPV+AZT+FTC | 13.4 | 3 | 6 | 2 |
| 5 | RAL+FTR+TAF/FTC | 13.45 | 3 | 5 | 2 |
| 5 | FTR+DRV/r+EFV | 13.46 | 3 | 5 | 2 |
| 5 | RAL+EFV+3TC+AZT | 13.55 | 3 | 6 | 2 |
| 5 | RAL+EFV+AZT+FTC | 13.55 | 3 | 6 | 2 |
| 5 | LEN+RAL+IBA+RPV | 13.55 | 4 | 3 | 1 |
| 5 | IBA+DRV/r+ETR | 13.61 | 3 | 4 | 2 |
| 5 | RAL+FTR+IBA+DRV/c | 13.66 | 4 | 5 | 2 |
| 5 | RAL+FTR+IBA+DRV/r | 13.81 | 4 | 6 | 2 |
| 5 | RAL+IBA | 13.9 | 2 | 2 | 1 |
| 5 | RAL+DRV/c+DOR+3TC+AZT | 13.96 | 4 | 7 | 2 |
| 5 | RAL+DRV/c+DOR+AZT+FTC | 13.96 | 4 | 7 | 2 |
| 5 | RAL+LEN | 13.99 | 2 | 2 | 1 |
| 5 | RAL+FTR+DRV/c+RPV | 14.16 | 4 | 6 | 2 |
| 5 | RAL+FTR+DRV/c+TDF/FTC | 14.16 | 4 | 6 | 2 |
| 5 | RAL+ETR+3TC+AZT | 14.2 | 3 | 7 | 2 |
| 5 | RAL+ETR+AZT+FTC | 14.2 | 3 | 7 | 2 |
| 5 | RAL+DRV/r+DOR+3TC+AZT | 14.26 | 4 | 8 | 2 |
| 5 | RAL+DRV/r+DOR+AZT+FTC | 14.26 | 4 | 8 | 2 |
| 5 | LEN+RAL+FTR+DRV/r | 14.31 | 4 | 6 | 2 |
| 5 | RAL+FTR+DRV/r+TDF/FTC | 14.31 | 4 | 7 | 2 |
| 5 | RAL+FTR+RPV | 14.35 | 3 | 5 | 2 |
| 5 | RAL+FTR+EFV | 14.4 | 3 | 5 | 2 |
| 5 | LEN+RAL+FTR+DRV/c | 14.41 | 4 | 5 | 2 |
| 5 | FTR+IBA+DRV/c+DOR | 14.46 | 4 | 4 | 2 |
| 5 | RAL+FTR+DRV/r+RPV | 14.46 | 4 | 7 | 2 |
| 5 | RAL+FTR+TDF/FTC | 14.5 | 3 | 5 | 2 |
| 5 | FTR+IBA+DRV/r+DOR | 14.51 | 4 | 5 | 2 |
| 5 | RAL+FTR+DRV/r+EFV | 14.51 | 4 | 7 | 2 |
| 5 | ETR+TAF/FTC | 14.6 | 2 | 3 | 2 |
| 5 | RAL+DRV/c+RPV+3TC+AZT | 14.81 | 4 | 7 | 2 |
| 5 | RAL+DRV/c+RPV+AZT+FTC | 14.81 | 4 | 7 | 2 |
| 5 | RAL+FTR+ETR | 15.15 | 3 | 6 | 2 |
| 5 | RAL+3TC+AZT | 15.25 | 2 | 5 | 2 |
| 5 | RAL+AZT+FTC | 15.25 | 2 | 5 | 2 |
| 5 | LEN+FTR+DRV/r+DOR | 15.26 | 4 | 5 | 2 |
| 5 | RAL+FTR+DRV/r+ETR | 15.26 | 4 | 8 | 2 |
| 5 | RAL+DRV/r+RPV+3TC+AZT | 15.26 | 4 | 8 | 2 |
| 5 | RAL+DRV/r+RPV+AZT+FTC | 15.26 | 4 | 8 | 2 |
| 5 | FTR+IBA+DRV/c+RPV | 15.31 | 4 | 4 | 2 |
| 5 | RAL+ETR | 15.35 | 2 | 4 | 2 |
| 5 | FTR+DRV/c | 15.4 | 2 | 3 | 2 |
| 5 | FTR+IBA+DRV/r+ETR | 15.41 | 4 | 6 | 2 |
| 5 | RAL+DRV/r+EFV+3TC+AZT | 15.41 | 4 | 8 | 2 |
| 5 | RAL+DRV/r+EFV+AZT+FTC | 15.41 | 4 | 8 | 2 |
| 5 | FTR+DRV/r | 15.45 | 2 | 4 | 2 |
| 5 | LEN+FTR+DRV/c+DOR | 15.46 | 4 | 4 | 2 |
| 5 | FTR+IBA+DRV/r+RPV | 15.51 | 4 | 5 | 2 |
| 5 | ETR+TDF/FTC | 15.55 | 2 | 3 | 2 |
| 5 | RAL+FTR+IBA+DOR | 15.6 | 4 | 5 | 2 |
| 5 | RAL+IBA+ETR | 15.65 | 3 | 4 | 2 |
| 5 | FTR+IBA+DRV/r+EFV | 15.66 | 4 | 5 | 2 |
| 5 | RAL+IBA+DRV/r+ETR | 15.66 | 4 | 6 | 2 |
| 5 | LEN+DRV/r+ETR | 15.76 | 3 | 4 | 2 |
| 5 | FTR+DRV/c+3TC+AZT | 16.01 | 3 | 6 | 2 |
| 5 | FTR+DRV/c+AZT+FTC | 16.01 | 3 | 6 | 2 |
| 5 | FTR+DRV/r+3TC+AZT | 16.06 | 3 | 7 | 2 |
| 5 | FTR+DRV/r+AZT+FTC | 16.06 | 3 | 7 | 2 |
| 5 | RAL+DRV/r+ETR+3TC+AZT | 16.06 | 4 | 9 | 2 |
| 5 | RAL+DRV/r+ETR+AZT+FTC | 16.06 | 4 | 9 | 2 |
| 5 | LEN+RAL+FTR+DOR | 16.1 | 4 | 5 | 2 |
| 5 | LEN+FTR+DRV/r+RPV | 16.26 | 4 | 5 | 2 |
| 5 | LEN+FTR+DRV/c+RPV | 16.31 | 4 | 4 | 2 |
| 5 | RAL+FTR+IBA+RPV | 16.55 | 4 | 5 | 2 |
| 5 | RAL+FTR+IBA+EFV | 16.6 | 4 | 5 | 2 |
| 5 | IBA+DRV/c+3TC+AZT | 16.61 | 3 | 4 | 2 |
| 5 | IBA+DRV/c+AZT+FTC | 16.61 | 3 | 4 | 2 |
| 5 | RAL+FTR | 16.64 | 2 | 4 | 2 |
| 5 | LEN+IBA+DRV/r+ETR | 16.71 | 4 | 4 | 2 |
| 5 | IBA+DRV/r+3TC+AZT | 16.81 | 3 | 5 | 2 |
| 5 | IBA+DRV/r+AZT+FTC | 16.81 | 3 | 5 | 2 |
| 5 | LEN+DRV/r+3TC+AZT | 16.81 | 3 | 5 | 2 |
| 5 | LEN+DRV/r+AZT+FTC | 16.81 | 3 | 5 | 2 |
| 5 | RAL+FTR+DRV/c+3TC+AZT | 16.81 | 4 | 8 | 2 |
| 5 | RAL+FTR+DRV/c+AZT+FTC | 16.81 | 4 | 8 | 2 |
| 5 | LEN+DRV/c+3TC+AZT | 16.86 | 3 | 4 | 2 |
| 5 | LEN+DRV/c+AZT+FTC | 16.86 | 3 | 4 | 2 |
| 5 | RAL+FTR+DRV/r+3TC+AZT | 16.96 | 4 | 9 | 2 |
| 5 | RAL+FTR+DRV/r+AZT+FTC | 16.96 | 4 | 9 | 2 |
| 5 | LEN+RAL+FTR+RPV | 17.05 | 4 | 5 | 2 |
| 5 | RAL+IBA+DRV/c+3TC+AZT | 17.16 | 4 | 6 | 2 |
| 5 | RAL+IBA+DRV/c+AZT+FTC | 17.16 | 4 | 6 | 2 |
| 5 | RAL+FTR+3TC+AZT | 17.25 | 3 | 7 | 2 |
| 5 | RAL+FTR+AZT+FTC | 17.25 | 3 | 7 | 2 |
| 5 | RAL+FTR+IBA+ETR | 17.35 | 4 | 6 | 2 |
| 5 | RAL+IBA+DRV/r+3TC+AZT | 17.46 | 4 | 7 | 2 |
| 5 | RAL+IBA+DRV/r+AZT+FTC | 17.46 | 4 | 7 | 2 |
| 5 | LEN+RAL+ETR | 17.55 | 3 | 4 | 2 |
| 5 | LEN+RAL+DRV/c+3TC+AZT | 17.66 | 4 | 6 | 2 |
| 5 | LEN+RAL+DRV/c+AZT+FTC | 17.66 | 4 | 6 | 2 |
| 5 | LEN+RAL+DRV/r+3TC+AZT | 17.71 | 4 | 7 | 2 |
| 5 | LEN+RAL+DRV/r+AZT+FTC | 17.71 | 4 | 7 | 2 |
| 5 | DOR+3TC+AZT | 17.8 | 2 | 4 | 2 |
| 5 | DOR+AZT+FTC | 17.8 | 2 | 4 | 2 |
| 5 | LEN+RAL+DRV/r+ETR | 17.81 | 4 | 6 | 2 |
| 5 | LEN+FTR+DRV/r+ETR | 17.81 | 4 | 6 | 2 |
| 5 | RAL+LEN+3TC+AZT | 17.85 | 3 | 5 | 2 |
| 5 | RAL+LEN+AZT+FTC | 17.85 | 3 | 5 | 2 |
| 5 | RAL+IBA+3TC+AZT | 18.1 | 3 | 5 | 2 |
| 5 | RAL+IBA+AZT+FTC | 18.1 | 3 | 5 | 2 |
| 5 | ETR+3TC+AZT | 18.45 | 2 | 5 | 2 |
| 5 | ETR+AZT+FTC | 18.45 | 2 | 5 | 2 |
| 5 | LEN+RAL+IBA+ETR | 18.5 | 4 | 4 | 2 |
| 5 | EFV+3TC+AZT | 18.8 | 2 | 4 | 2 |
| 5 | EFV+AZT+FTC | 18.8 | 2 | 4 | 2 |
| 5 | LEN+RAL+FTR+ETR | 19.5 | 4 | 6 | 2 |
| 5 | RPV+3TC+AZT | 19.55 | 2 | 4 | 2 |
| 5 | RPV+AZT+FTC | 19.55 | 2 | 4 | 2 |
Report
Preferred regimen based on the HIV-ASSIST algorithm: DTG+DRV/c/TAF/FTC
DTG+DRV/c/TAF/FTC had the lowest weighted score (1.01) 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.
| Score Code | Regimen | Weighted Score | Active Drugs | Total Pills | Frequency (x/day) |
|---|---|---|---|---|---|
| 1 | DTG+DRV/c/TAF/FTC | 1.01 | 3 | 2 | 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.
| Score Code | Regimen | Weighted Score | Active Drugs | Total Pills | Frequency (x/day) |
|---|---|---|---|---|---|
| 2 | DTG+DRV/r+TAF/FTC | 1.51 | 3 | 4 | 1 |
| 2 | DRV/c+BIC/TAF/FTC | 1.71 | 3 | 2 | 1 |
| 2 | DRV/c/TAF/FTC [Current regimen] [Your preferred regimen] | 1.76 | 2 | 1 | 1 |
| 2 | BIC/TAF/FTC | 1.85 | 2 | 1 | 1 |
What about your originally preferred regimen: DRV/c/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.
* 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 |
| Total | 60 | 60 | 15 | -10 | -10 | -10 | -10 | 10 |
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
| CI Mutation(s) | LEN |
|---|---|
| Total | 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.
- Penalty:
- 0.05
- HIV-ASSIST Notes:
- Coformulations are not recommended under CrCl<50, with preference for splitting into individual components. CrCl 30-49, 3TC is currently recommended to dosage adjust to 150mg Q24.
- Penalty:
- 0.05
- HIV-ASSIST Notes:
- At CrCl 30-49, it is currently recommended to dosage adjust FTC to 200mg Q48 when given individually. When coformulated with TDF/FTC, dosage is 1 tab q 48hours. TDF/FTC coformulated with EVG/c, EFV, DOR, RPV are currently not recommended at CrCl<50. TAF/FTC containing coformulations do not have any recommended dosage adjustments until CrCl<30.
- Penalty:
- 0
- Penalty:
- 0.05
- HIV-ASSIST Notes:
- TAF (used alone, e.g. Vemlidy) can be used down to CrCl of 15 ml/min, per FDA labeling for Hepatitis B. TAF/FTC(+/- EVG or RPV) have no dosage adjustment until CrCl<30.
- Penalty:
- 1
- HIV-ASSIST Notes:
- Consider avoiding TDF if GFR< 60ml/min as it has been associated with renal tubulopathy. Most experts recommend switching to a TAF or TAF containing fixed dose combination, or avoiding tenofovir. When given individually, TDF is dosed 300mg q48hrs at Cr Cl 30-49. As part of TDF/FTC, dosed at 1 tablet q48hours. TDF/FTC coformulations are not recommended under CrCl<50. More information: https://www.hiv.uw.edu/go/basic-primary-care/primary-care-medical-management/core-concept/all#chronic-kidney-disease
- Penalty:
- 0
- Penalty:
- 0.1
- HIV-ASSIST Notes:
- At CrCl 26-50, it is currently recommended to dosage adjust to 20mg Q12hrs (15mg for <60kg). CrCl <25 or HD, 20mg Q24hrs.
- Penalty:
- 0.25
- HIV-ASSIST Notes:
- CrCl 10-29 125mg QD (100mg <60kg).
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0.01
- HIV-ASSIST Notes:
- If GFR<70 ml/min do NOT use ATVc with TDF.
- Penalty:
- 0.01
- HIV-ASSIST Notes:
- If GFR<70 ml/min do NOT use ATVc with TDF.
- Penalty:
- 0.01
- HIV-ASSIST Notes:
- If GFR<70 ml/min do NOT use ATVc with TDF.
- Penalty:
- 0.01
- HIV-ASSIST Notes:
- DRV can be used irrespective of renal disease. However, if GFR<70 ml/min do NOT use DRVc with TDF.
- Penalty:
- 0.01
- HIV-ASSIST Notes:
- DRV can be used irrespective of renal disease. However, if GFR<70 ml/min do NOT use DRVc with TDF.
- Penalty:
- 0.01
- HIV-ASSIST Notes:
- DRV can be used irrespective of renal disease. However, if GFR<70 ml/min do NOT use DRVc with TDF.
- Penalty:
- 0
- Penalty:
- 0
- HIV-ASSIST Notes:
- If GFR<70 ml/min do NOT use EVGc/FTC with TDF.
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
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.
- Penalty:
- 0.1
- HIV-ASSIST Notes:
- TMP increased 3TC exposure by 40%. No dose adjustment required with normal renal function.
- Liverpool Interaction Status:
- Yellow/Moderate-low: Potential Weak Interaction (Low Quality of Evidence)
- Liverpool Notes:
- Administration of trimethoprim/sulfamethoxazole 160/800 mg results in a 40% increase in lamivudine exposure, because of the trimethoprim component; the sulfamethoxazole component did not interact. However, unless the patient has renal impairment, no dosage adjustment of lamivudine is necessary. Lamivudine has no effect on the pharmacokinetics of trimethoprim or sulfamethoxazole. When concomitant administration is warranted, patients should be monitored clinically. Co-administration of lamivudine with high doses of co-trimoxazole for the treatment of Pneumocystis carinii pneumonia (PCP) and toxoplasmosis should be avoided. Coadministration of sorbitol solution (3.2 g, 10.2 g, 13.4 g) with a single 300 mg dose of lamivudine oral solution resulted in dose-dependent decreases of 14%, 32%, and 36% in lamivudine exposure (AUC) and 28%, 52%, and 55% in the Cmax of lamivudine in adults. When possible, avoid chronic coadministration of Epivir with medicinal products containing sorbitol. Consider more frequent monitoring of HIV-1 viral load when chronic coadministration cannot be avoided.Epivir Summary of Product Characteristics, ViiV Healthcare UK Ltd, February 2019. Lamivudine and trimethoprim/sulfamethoxazole (TMP/SMX) were coadministered to 14 HIV-positive patients in a single-centre, open-label, randomized, crossover study. Each patient received treatment with a single 300 mg dose of lamivudine and TMP/SMX 160/800 mg once a day for 5 days with concomitant administration of lamivudine 300 mg with the fifth dose in a crossover design. Coadministration of TMP/SMX with lamivudine resulted in an increase of 43±23% (mean ± SD) in lamivudine AUC, a decrease of 29±13% in lamivudine oral clearance, and a decrease of 30±36% in lamivudine renal clearance. The pharmacokinetic properties of TMP and SMX were not altered by coadministration with lamivudine. No change in dose of either drug is recommended. There is no information regarding the effect on lamivudine pharmacokinetics of higher doses of TMP/SMX such as those used to treat PCP. Coadministration of single doses of lamivudine and sorbitol resulted in a sorbitol dose-dependent reduction in lamivudine exposures. When possible, avoid use of sorbitol-containing medicines with lamivudine. Lamivudine and sorbitol solutions were coadministered to 16 healthy adult subjects in an open-label, randomized-sequence, 4-period, crossover trial. Each subject received a single 300-mg dose of lamivudine oral solution alone or coadministered with a single dose of 3.2 grams, 10.2 grams, or 13.4 grams of sorbitol in solution. Coadministration of lamivudine with sorbitol resulted in dose-dependent decreases of 20%, 39%, and 44% in the AUC(0-24), 14%, 32%, and 36% in the AUC(infinity), and 28%, 52%, and 55% in the Cmax; of lamivudine, respectively.Epivir Prescribing Information, ViiV Healthcare, May 2019. The effect of sorbitol on the single dose pharmacokinetics of 3TC oral solution was evaluated in 16 HIV-negative subjects. Sorbitol had a dose-dependent effect on 3TC PK with decreases of 28%, 52%, and 55% in Cmax and decreases of 20%, 39%, and 44% in AUC when co-administered with 3.2 g, 10.2 g, and 13.4 g sorbitol, respectively.Effect of sorbitol on 3TC PK after administration of lamivudine solution in adults. Adkinson KK, McCoig C, Wolstenholm A, et al. CROI 2017, Seattle USA, February 2017, abstract 428. Non-linear mixed effects modelling analysis on samples from 77 HIV-infected subjects receiving lamivudine alone (150 twice daily) or with nevirapine (200 mg twice daily) with concurrent trimethoprim/sulfamethoxazole (160/800 mg every other day [n=51], three times weekly [n=23], or twice daily [n=3]) revealed an effect of trimethoprim/sulfamethoxazole on lamivudine pharmacokinetics. There was a significant reduction of 31% in apparent oral clearance of lamivudine which would be expected to result in a 43% increase in the average steady-state concentration. Pharmacokinetics of nevirapine and lamivudine in patients with HIV-1 infection. Sabo JP et al. AAPS Pharm Sci, 2002, 2: E1. The effect of trimethoprim/sulfamethoxazole (160/800 mg once daily) on a single dose of lamivudine (300 mg) was studied in 14 HIV-infected subjects. Coadministration increased lamivudine AUV by 43% and decreased renal clearance by 35%. There was no effect of lamivudine on the pharmacokinetics of trimethoprim of sulfamethoxazole. Given the favourable safety profile of lamivudine, it is unlikely that this interaction will result in a significant increase in concentration-related toxicity at the doses studied. Pharmacokinetics of lamivudine administered alone and with trimethoprim-sulfamethoxazole. Moore KHP, et al. Clin Pharmacol Ther, 1996, 59: 550-558. , Summary:Trimethoprim is primarily eliminated by the kidneys through glomerular filtration and tubular secretion. In vitro data indicate that trimethoprim inhibits the renal transporters OCT2 and MATE1. Coadministration with trimethoprim increased lamivudine exposure by 43%, but lamivudine had no effect on trimethoprim or sulfamethoxazole. No dose adjustment is required in patients with normal renal function. Note, the bioavailability of lamivudine solution has been shown to be significantly reduced in a dose dependent manner by sorbitol which is present in liquid formulations such trimethoprim/sulfamethoxazole paediatric suspension. When possible, avoid use of sorbitol-containing medicines with lamivudine-containing medicines.
- Penalty:
- 0.1
- HIV-ASSIST Notes:
- No dose adjustment required with normal renal function.
- Liverpool Interaction Status:
- Yellow/Moderate-low: Potential Weak Interaction (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied. Trimethoprim is primarily eliminated by the kidney and in vitro data suggest that it inhibits the renal transporters OCT2 and MATE1, and could therefore potentially decrease emtricitabine renal elimination (via inhibition of MATE1). No a priori dosage adjustment is recommended in patients with normal renal function.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trimethoprim and sulfamethoxazole are eliminated by the kidneys through glomerular filtration and tubular secretion.
- Penalty:
- 0
- Liverpool Interaction Status:
- Yellow/Moderate-low: Potential Weak Interaction (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied. Trimethoprim is primarily eliminated by the kidneys through glomerular filtration and tubular secretion. In vitro data suggest that trimethoprim inhibits the renal transporters OCT2 and MATE1 and therefore could potentially decrease emtricitabine renal elimination (via inhibition of MATE1). No pharmacokinetic interaction is expected with tenofovir derived from tenofovir alafenamide. Dose Descovy according to the concomitant antiretroviral.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trimethoprim is primarily eliminated by the kidney and in vitro data suggest that it inhibits the renal transporters OCT2 and MATE1. A clinically relevant drug interaction is unlikely as tenofovir is excreted by different renal transporters.
- Penalty:
- 1
- HIV-ASSIST Notes:
- No significant effect. However, TMP results in increased AZT blood levels. Renal function and hematological parameters should be monitored, and AZT dose reduction can be considered if required
- Liverpool Interaction Status:
- Amber/Moderate: Interaction Expected (Low Quality of Evidence)
- Liverpool Notes:
- Concomitant treatment, especially acute therapy, with potentially nephrotoxic or myelosuppressive drugs (e.g. systemic pentamidine, dapsone, pyrimethamine, co-trimoxazole, amphotericin, flucytosine, ganciclovir, interferon, vincristine, vinblastine and doxorubicin) may also increase the risk of adverse reactions to zidovudine. If concomitant therapy with any of these drugs is necessary then extra care should be taken in monitoring renal function and haematological parameters and, if required, the dosage of one or more agents should be reduced. Limited data from clinical trials do not indicate a significantly increased risk of adverse reactions to zidovudine with cotrimoxazole, aerosolised pentamidine, pyrimethamine and aciclovir at doses used in prophylaxis. Retrovir Summary of Product Characteristics, ViiV Healthcare UK, Ltd, December 2018. The effect of trimethoprim/sulfamethoxazole (160/800 mg, twice daily, three times weekly) on the pharmacokinetics of zidovudine (250 mg twice daily) was studied in 16 HIV-infected subjects. There were no significant differences in the pharmacokinetics of zidovudine or zidovudine glucuronide when administered alone or with trimethoprim/sulfamethoxazole. Absence of effect of trimethoprim/sulfamethoxazole on pharmacokinetics of zidovudine in patients infected with human immunodeficiency virus. Canas E, et al. Antimicrob Agents Chemother, 1996, 40: 230-233. The effects of dapsone (100 mg once daily) and/or trimethoprim (200 mg twice daily) on single doses of zidovudine (200 mg ) were investigated in 8 HIV-infected subjects. Zidovudine did not influence the pharmacokinetics of dapsone or trimethoprim. Dapsone had no effect on the pharmacokinetics of zidovudine. Trimethoprim significantly decreased renal clearance of zidovudine by 58%, with a concurrent 54% decrease in the mean urinary recovery of zidovudine. The combination effect of trimethoprim plus dapsone on the pharmacokinetics of zidovudine was similar to effect of trimethoprim alone. Zidovudine, trimethoprim and dapsone pharmacokinetic interactions in patients with human immunodeficiency virus infection. Lee BL, et al. Antimicrob Agents Chemother, 1996, 40: 1231-1236. The pharmacokinetics of zidovudine (3 mg/kg iv infusion over 1 h) were evaluated in 9 HIV-infected subjects alone, with trimethoprim (150 mg) or with trimethoprim/sulfamethoxazole (160/800 mg). Metabolic clearance of zidovudine was not affected by TMP or TMP/SMX. However, zidovudine renal clearance decreased in the presence of TMP (48%) and TMP/SMX (58%) and that of zidovudine glucuronide by 20% and 27% respectively. Trimethoprim, alone or in combination with sulphamethoxazole, decreases the renal excretion of zidovudine and its glucuronide. Chatton JY, et al. Br J Clin Pharmacol, 1992, 34: 551-554. , Summary:Multidose studies showed no significant effect of trimethoprim/sulfamethoxazole on zidovudine pharmacokinetics. However, concomitant treatment, especially acute therapy, with potentially nephrotoxic or myelosuppressive drugs (e.g. trimethoprim/sulfamethoxazole) may also increase the risk of adverse reactions to zidovudine. Monitor renal function and haematological parameters and consider dose reduction if required.
- Penalty:
- 0.1
- HIV-ASSIST Notes:
- Potential interaction due to competition for active renal secretion could lead to increased concentrations of both drugs
- Liverpool Interaction Status:
- Amber/Moderate: Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Since stavudine is actively secreted by the renal tubules, interactions with other actively secreted medicinal products are possible, e.g. with trimethoprim. Zerit Summary of Product Characteristics, Bristol-Myers Squibb Pharmaceuticals Ltd, February 2019., Summary:Coadministration has not been studied but there is potential for an interaction due to competition for active renal secretion.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration of trimethoprim (200 mg single dose) and didanosine buffered tablets (200 mg single dose) had no effect on didanosine AUC but increased Cmax by 17%; trimethoprim AUC increased by 10% and Cmax decreased by 22%. Coadministration of sulfamethoxazole (1000 mg single dose) and didanosine buffered tablets (200 mg single dose) had no effect on didanosine AUC or Cmax; sulfamethoxazole AUC and Cmax decreased by 11% and 12%. No dose adjustment is necessary for either medicinal product. Videx Summary of Product Characteristics, Bristol-Myers Squibb Pharmaceuticals Ltd, April 2016. When the buffered formulation of ddI (200 mg single dose) was coadministered with trimethoprim (200 mg single dose) to 8 HIV-infected subjects, there was no change in ddI AUC and a 17% increase in Cmax. Trimethoprim AUC increased 10% and Cmax decreased by 22%. When the buffered formulation of ddI (200 mg single dose) was coadministered with sulfamethoxazole (1000 mg single dose) to 8 HIV-infected subjects, there was no change in ddI AUC or Cmax. Sulfamethoxazole AUC and Cmax decreased by 11% and 12% respectively. Videx Prescribing Information, Bristol-Myers Squibb Company, December 2018. The pharmacokinetics of didanosine (200 mg, buffered tablets), trimethoprim (200 mg) and sulfamethoxazole (1000 mg) were evaluated in 10 HIV-infected subjects as single agents and upon coadministration of single doses. The addition of didanosine to trimethoprim/sulfamethoxazole resulted in a statistically significant decrease of 32% in renal clearance of trimethoprim and a statistically significant decrease of 8% in sulfamethoxazole AUC. There were no statistically significant effects of trimethoprim and/or sulfamethoxazole on the AUC or Cmax of didanosine. However, didanosine renal clearance decreased by 35% and percentage urinary recovery decreased by 16% when the three drugs were coadministered. These changes are no considered to be clinically relevant and dose modification is not required. A pharmacokinetic interaction study of didanosine coadministered with trimethoprim and/or sulphamethoxazole in HIV seropositive asymptomatic male patients. Srinivas NR, et al. Br J Clin Pharmacol, 1996, 41: 207-215. , Summary:Coadministration with didanosine gastro-resistant capsules has not been studied. Coadministration of trimethoprim and didanosine buffered tablets had no effect on didanosine AUC but increased Cmax by 17%; trimethoprim AUC increased by 10% and Cmax decreased by 22%. Coadministration of sulfamethoxazole and didanosine buffered tablets had no effect on didanosine AUC or Cmax; sulfamethoxazole AUC and Cmax decreased by 11% and 12%. No dose adjustment is necessary.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trimethoprim and sulfamethoxazole are eliminated by the kidneys through glomerular filtration and tubular secretion.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trimethoprim and sulfamethoxazole are eliminated by the kidneys through glomerular filtration and tubular secretion.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trimethoprim and sulfamethoxazole are eliminated by the kidneys through glomerular filtration and tubular secretion.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Studies using human liver microsomes indicated that trimethoprim/sulfamethoxazole did not affect the formation of nevirapine hydroxylated metabolites. Viramune Summary of Product Characteristics, Boehringer Ingelheim Ltd, November 2019., Summary:In vitro studies showed that trimethoprim/sulfamethoxazole did not affect the formation of nevirapine hydroxylated metabolites.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trimethoprim is primarily eliminated by the kidneys through glomerular filtration and tubular secretion.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Based on known metabolic profiles, a clinically significant interaction is not expected between lopinavir and trimethoprim/sulfamethoxazole. Kaletra Summary of Product Characteristics, AbbVie Ltd, January 2021. Based on known metabolic profiles, a clinically significant interaction is not expected between lopinavir and trimethoprim/sulfamethoxazole. Kaletra Prescribing Information, AbbVie Inc, October 2020., Summary:Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trimethoprim is primarily eliminated by the kidneys through glomerular filtration and tubular secretion. Sulfamethoxazole is metabolized by CYP2C9.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trimethoprim and sulfamethoxazole are eliminated by the kidneys through glomerular filtration and tubular secretion.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely.
- Penalty:
- 0
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Low Quality of Evidence)
- Liverpool Notes:
- Indinavir and sulphamethoxazole/trimethoprim can be co-administered without dose adjustment. Coadministration of indinavir (400 mg four times daily) and sulphamethoxazole/trimethoprim (800/160 mg twice daily) had no effect on the AUC or Cmin of indinavir or sulphamethoxazole. Crixivan Summary of Product Characteristics, Merck Sharp & Dohme Ltd, October 2018. Coadministration of trimethoprim (800 mg twice daily for 7 days), sulfamethoxazole (160 mg twice daily for 7 days) and indinavir (400 mg four times daily for 7 days) to 12 subjects resulted in a 12% increase in indinavir Cmax and decreases in AUC and Cmin of 2% and 17% respectively. Trimethoprim Cmax, AUC and Cmin all increased by 18%; sulfamethoxazole Cmax increased by 1%, AUC by 5% and Cmin by 5%. Crixivan Prescribing Information, Merck & Co Inc, May 2018. The pharmacokinetic interaction between indinavir (400 mg every 6 h) and trimethoprim/sulfamethoxazole (160/800 mg twice daily) was evaluated in 12 healthy volunteers. There was a 17% decrease in the Cmin of indinavir. The Cmax and AUC of trimethoprim increased by 18% and the AUC of sulfamethoxazole increased by 5%. None of these effects were considered clinically significant and no dose modification is required.Trimethoprim/sulphamethoxazole does not affect the steady-state disposition of indinavir. Sturgill MG, Seibold JR, Boruchoff SE, et al. J Clin Pharmacol, 1999, 39:1-8., Summary:No data with indinavir/ritonavir. Coadministration with indinavir alone did not result in any clinically significant interactions.
- Penalty:
- 0
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Based on known metabolic profiles, clinically significant drug interactions are not expected between Reyataz and trimethoprim/sulfamethoxazole. Reyataz US Prescribing Information, Bristol-Myers Squibb Company, March 2018. , Summary:Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trimethoprim is primarily eliminated by the kidneys through glomerular filtration and tubular secretion. Atazanavir/ritonavir is unlikely to inhibit OAT and OCT renal transporters at clinically relevant concentrations.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Based on known metabolic profiles, clinically significant drug interactions are not expected between Evotaz and trimethoprim/sulfamethoxazole. Evotaz US Prescribing Information Bristol-Myers Squibb Company, March 2018. , Summary:Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trimethoprim is primarily eliminated by the kidneys through glomerular filtration and tubular secretion. Atazanavir/cobicistat is unlikely to inhibit OAT and OCT renal transporters at clinically relevant concentrations.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Based on known metabolic profiles, clinically significant drug interactions are not expected between Reyataz and trimethoprim/sulfamethoxazole. Reyataz US Prescribing Information, Bristol-Myers Squibb Company, March 2018. , Summary:Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trimethoprim is primarily eliminated by the kidneys through glomerular filtration and tubular secretion. Atazanavir is unlikely to inhibit OAT and OCT renal transporters at clinically relevant concentrations.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trimethoprim and sulfamethoxazole are eliminated by the kidneys through glomerular filtration and tubular secretion. Darunavir/ritonavir is unlikely to inhibit the renal transporters OATs and OCTs at clinically relevant concentrations.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trimethoprim and sulfamethoxazole are eliminated by the kidneys through glomerular filtration and tubular secretion. Darunavir/ritonavir is unlikely to inhibit the renal transporters OATs and OCTs at clinically relevant concentrations.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trimethoprim and sulfamethoxazole are eliminated by the kidneys through glomerular filtration and tubular secretion. Darunavir/cobicistat is unlikely to inhibit the renal transporters OATs and OCTs at clinically relevant concentrations.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trimethoprim and sulfamethoxazole are eliminated by the kidneys through glomerular filtration and tubular secretion.
- Penalty:
- 0.1
- Liverpool Interaction Status:
- Yellow/Moderate-low: Potential Weak Interaction (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied. Trimethoprim is primarily eliminated by the kidneys through glomerular filtration and tubular secretion. In vitro data suggest that trimethoprim inhibits the renal transporters OCT2 and MATE1 and therefore could potentially decrease emtricitabine renal elimination (via inhibition of MATE1). No pharmacokinetic interactions are expected with elvitegravir/cobicistat and tenofovir derived from tenofovir alafenamide.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trimethoprim is primarily eliminated by the kidneys through glomerular filtration and tubular secretion. In vitro data indicate that dolutegravir inhibits OCT2 but is unlikely to cause a clinically relevant drug interaction with trimethoprim/sulfamethoxazole.
- Penalty:
- 0.1
- HIV-ASSIST Notes:
- In vitro data suggest that trimethoprim inhibits the renal transporters OCT2 and MATE1 and therefore could potentially decrease emtricitabine renal elimination (via inhibition of MATE1). Coadministration with higher doses of trimethoprim/sulfamethoxazole for PCP should be avoided. Bictegravir inhibits OCT2 and MATE1 but is unlikely to cause a clinically relevant drug interaction with trimethoprim/sulfamethoxazole
- Liverpool Interaction Status:
- Yellow/Moderate-low: Potential Weak Interaction (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied. Trimethoprim is primarily eliminated by the kidneys through glomerular filtration and tubular secretion. In vitro data suggest that trimethoprim inhibits the renal transporters OCT2 and MATE1 and therefore could potentially decrease emtricitabine renal elimination (via inhibition of MATE1). Bictegravir inhibits OCT2 and MATE1 but is unlikely to cause a clinically relevant drug interaction with trimethoprim/sulfamethoxazole. No pharmacokinetic interaction is expected with tenofovir derived from tenofovir alafenamide.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trimethoprim is primarily eliminated by the kidneys through glomerular filtration and tubular secretion. Cabotegravir does not cause clinically relevant inhibition of renal transporters.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Low Quality of Evidence)
- Liverpool Notes:
- Coadministration of sulphamethoxazole/trimethoprim (800 mg/160 mg twice daily) and maraviroc (300 mg twice daily) increased maraviroc AUC by 11% and Cmax by 19%. Sulphamethoxazole/trimethoprim concentrations were not measured, but no effect expected. Maraviroc 300 mg twice daily and sulphamethoxazole/trimethoprim can be co-administered without dose adjustment. Celsentri Summary of Product Characteristics, ViiV Healthcare, September 2018. Co-trimoxazole (sulphamethoxazole/trimethoprim) did not affect the pharmacokinetics of maraviroc. Selzentry Prescribing Information, ViiV Healthcare, July 2018., Summary:No dose adjustment required. Coadministration of sulphamethoxazole/trimethoprim and maraviroc increased maraviroc AUC by 11% and Cmax by 19%. Sulphamethoxazole/trimethoprim concentrations were not measured, but no effect expected.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. No drug interaction studies have been conducted with ibalizumab: based on ibalizumab’s mechanism of action and target-mediated drug disposition, drug-drug interactions are not expected. Trimethoprim is primarily eliminated renally whereas sulfamethoxazole undergoes hepatic metabolism. Ibalizumab, a monoclonal antibody binding to the CD4 receptor, is likely to be eliminated via intracellular catabolism similarly to other monoclonal antibodies.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied. Trimethoprim is primarily eliminated by the kidneys through glomerular filtration and tubular secretion. Fostemsavir is a prodrug and is hydrolysed to the active compound temsavir in the small intestine. Temsavir is mainly metabolized by esterase-mediated hydrolysis with a small contribution of CYP3A4. Temsavir is unlikely to affect trimethoprim/sulfamethoxazole elimination.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trimethoprim is primarily eliminated by the kidneys through glomerular filtration and tubular secretion. Lenacapavir is mainly cleared as unchanged drug and does not inhibit the renal transporters MATE, OCTs, OATs, BCRP in the range of clinically relevant concentrations.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as azithromycin is mainly eliminated via biliary excretion.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as azithromycin is mainly eliminated via biliary excretion.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as azithromycin is mainly eliminated via biliary excretion.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Azithromycin is mainly eliminated via biliary excretion and animal data suggest this may occur via P-glycoprotein and MRP2. Emtricitabine and tenofovir alafenamide are not expected to interfere with this metabolic pathway. Dose Descovy according to the concomitant antiretroviral.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as azithromycin is mainly eliminated via biliary excretion.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Moderate Quality of Evidence)
- Liverpool Notes:
- The interaction between azithromycin (1200 mg/day [n=7] or 600 mg/day [n=5]) and zidovudine (100 mg five times daily) was studied in 12 HIV-infected subjects. Azithromycin had no significant effect on zidovudine Cmax or AUC, although it significantly decreased Tmax by 44% and increased intracellular total phosphorylated zidovudine by 110%. These changes are unlikely to be clinically significant. Lack of an effect of azithromycin on the disposition of zidovudine and dideoxyinosine in HIV-infected patients. Amsden G, et al. J Clin Pharmacol, 2001, 41: 210-216. The effect of azithromycin on the pharmacokinetics of zidovudine (10 mg/kg/day) was evaluated in 9 HIV-infected subjects. Azithromycin (1000 mg) was administered once weekly for 5 weeks 2 h prior to the morning dose of zidovudine and zidovudine parameters determined prior to the 1st dose, and after the 1st and 5th doses of azithromycin. The pharmacokinetics of zidovudine and zidovudine glucuronide did not differ over the study period and were in close agreement with historical values. The kinetics of azithromycin were similar after the 1st and 5th doses. Once-a-week azithromycin in AIDS patients: tolerability, kinetics, and effects on zidovudine disposition. Chave JP, et al. Antimicrob Agents Chemother, 1992, 36:1013-1018. , Summary:No significant interaction observed.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as azithromycin is mainly eliminated via biliary excretion.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Moderate Quality of Evidence)
- Liverpool Notes:
- LHPG Comment: Note dose separation in the study. The interaction between azithromycin (1200 mg/day) and didanosine (200 mg twice daily, buffered tablets) was studied in 12 HIV-infected subjects. Azithromycin was administered 4 h prior to the didanosine dose and had no significant effect on any didanosine pharmacokinetic parameter. Lack of an effect of azithromycin on the disposition of zidovudine and dideoxyinosine in HIV-infected patients. Amsden G, et al. J Clin Pharmacol, 2001, 41: 210-216. , Summary:No interaction expected with didanosine gastro-resistant capsules (Videx EC). No significant effect with azithromycin and didanosine buffered tablets when administered 4 h apart.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Co-administration of azithromycin (600 mg single dose) and efavirenz (400 mg once daily) did not result in any clinically significant pharmacokinetic interaction. No dosage adjustment is necessary for either medicinal product. Sustiva Summary of Product Characteristics, Bristol-Myers Squibb Pharmaceuticals Ltd, April 2015. Coadministration of a single dose of azithromycin (600 mg single dose) with efavirenz (400 mg once daily for 7 days) in 14 subjects led to a 22% increase in azithromycin Cmax but caused no change in AUC. No alteration in efavirenz Cmax, AUC or Cmin was observed. Based on these drug interaction studies, no dosage adjustment is recommended when efavirenz is given with azithromycin. Sustiva Prescribing Information, Bristol-Myers Squibb Company, March 2015. Coadministration of a single dose of azithromycin (600 mg) with efavirenz (400 mg once daily) to 14 healthy volunteers did not result in any clinically significant pharmacokinetic interaction for either drug (no change in AUC or Cmax for efavirenz, 22% increase in azithromycin Cmax, no change in azithromycin AUC). Pharmacokinetic interaction studies in healthy volunteers with efavirenz and the macrolide antibiotics, azithromycin and clarithromycin. Benedek IH, Joshi A, Fiske WD, et al. 5th Conference on Retroviruses and Opportunistic Infections, 1998, abstract 347., Summary:Coadministration of azithromycin (600 mg single dose) with efavirenz (400 mg once daily) increased azithromycin Cmax by 22%, but had no effect on azithromycin AUC or efavirenz Cmax, AUC or Cmin. No dosage adjustment is necessary.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied. Based on the biliary elimination pathway of azithromycin, no drug interactions are expected between azithromycin and etravirine. Etravirine and azithromycin can be used without dose adjustments.Intelence Summary of Product Characteristics, Janssen-Cilag Ltd, March 2019., Summary:Coadministration has not been studied, but no drug interactions are expected based on the biliary elimination pathway of azithromycin. No dose adjustments required.
- Penalty:
- 0.25
- HIV-ASSIST Notes:
- While there is no data studying coadministration, given that azithromycin can prolong the QT interval, caution should be taken when prescribing RPV with strong CYP3A4 inhibitor , along with regular monitoring.
- Liverpool Interaction Status:
- Amber/Moderate: Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- There is limited information available on the potential for a pharmacodynamic interaction between rilpivirine and medicinal products that prolong the QTc interval of the ECG. In a study of healthy subjects, supratherapeutic doses of rilpivirine (75 mg once daily and 300 mg once daily) have been shown to prolong the QTc interval of the electrocardiogram (ECG). Rilpivirine at the recommended dose of 25 mg once daily is not associated with a clinically relevant effect on QTc. Rilpivirine should be used with caution when co-administered with medicinal products with a known risk of Torsade de Pointes. Edurant Summary of Product Characteristics, Janssen-Cilag Ltd, January 2019. There is limited information available on the potential for a pharmacodynamic interaction between rilpivirine and drugs that prolong the QTc interval of the electrocardiogram. In healthy subjects, 75 mg once daily and 300 mg once daily (3 times and 12 times the dose in Edurant) have been shown to prolong the QTc interval of the electrocardiogram. Consider alternatives to rilpivirine when coadministered with a drug that is known to have a risk of torsade de pointes. Edurant US Prescribing Information, Janssen Therapeutics, May 2019., Summary:Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Azithromycin is mainly eliminated via biliary excretion and animal data suggest this may occur via P-glycoprotein and MRP2. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with azithromycin. However, given the known QT prolongation risk associated with azithromycin, caution is recommended.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as azithromycin is mainly eliminated via biliary excretion.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Azithromycin is mainly eliminated via biliary excretion and animal data suggest this may occur via P-glycoprotein and MRP2. Doravirine does not interfere with azithromycin elimination.
- Penalty:
- 0.25
- HIV-ASSIST Notes:
- Given that azithromycin can prolong the QT interval, caution should be taken when prescribing with other agents that can prolong QTc , along with regular monitoring.
- Liverpool Interaction Status:
- Amber/Moderate: Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Based on known metabolic profiles, a clinically significant interaction is not expected between lopinavir and azithromycin. Kaletra Summary of Product Characteristics, AbbVie Ltd, January 2021. Based on known metabolic profiles, a clinically significant interaction is not expected between lopinavir and azithromycin. Kaletra Prescribing Information, AbbVie Inc, October 2020., Summary:Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Lopinavir/ritonavir is metabolized by CYP3A. Azithromycin is not expected to have a clinically relevant effect on drugs metabolised by CYP enzymes. Azithromycin is mainly eliminated via biliary excretion and animal data suggest this may occur via P-glycoprotein and MRP2. Lopinavir/ritonavir could potentially increase azithromycin exposure (inhibition of P-gp and MRP2), however no a priori dosage adjustment is recommended for azithromycin. However, caution should be exercised as both drugs have risks of QT prolongation and/or TdP on the CredibleMeds.org website (possible risk for lopinavir; known risk for azithromycin). If coadministration is necessary, clinical monitoring including ECG assessment is recommended.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Azithromycin is mainly eliminated via biliary excretion and animal data suggest this may occur via P-gp and MRP2. Fosamprenavir/ritonavir could potentially increase azithromycin exposure due to inhibition of P-gp and MRP2, however no a priori dosage adjustment is recommended for azithromycin.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Azithromycin is mainly eliminated via biliary excretion and animal data suggest this may occur via P-gp and MRP2. Tipranavir/ritonavir could potentially increase azithromycin exposure due to inhibition of P-gp and MRP2, however no a priori dosage adjustment is recommended for azithromycin.
- Penalty:
- 2
- HIV-ASSIST Notes:
- Contraindicated. Do not administer. SQV is contraindicated when used in combination with drugs that cause QT interval prolongation.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Moderate Quality of Evidence)
- Liverpool Notes:
- Coadministration of indinavir (800 mg every 8 h) and a single dose of azithromycin (1200 mg) were studied in 13 healthy volunteers. A single dose of azithromycin did not significantly alter the pharmacokinetics of indinavir.The effect of azithromycin on the pharmacokinetics of indinavir. Foulds G, LaBoy–Goral L, Wei GCG, et al. J Clin Pharmcol, 1999, 39:842–6., Summary:No data with indinavir/ritonavir. Coadministration with indinavir alone had no effect on indinavir pharmacokinetics.
- Penalty:
- 0
- Penalty:
- 0.25
- Liverpool Interaction Status:
- Amber/Moderate: Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Based on known metabolic profiles, clinically significant drug interactions are not expected between Reyataz and azithromycin. Reyataz US Prescribing Information, Bristol-Myers Squibb Company, March 2018., Summary:Coadministration has not been studied. Azithromycin is mainly eliminated via biliary excretion and animal data suggest this may occur via P-glycoprotein and MRP2. Atazanavir/ritonavir could potentially increase azithromycin exposure (inhibition of P-gp and MRP2), but no a priori dosage adjustment is recommended for azithromycin. Azithromycin is not expected to have a clinically relevant effect on drugs metabolised by CYP enzymes. However, both azithromycin and atazanavir have risks of QT prolongation and/or TdP on the CredibleMeds.org website (known risk for azithromycin; conditional risk for atazanavir). Caution is advised. The product label for atazanavir advises caution when prescribing atazanavir with medicinal products which have the potential to increase the QT interval. If coadministration is necessary, clinical monitoring including ECG assessment is recommended.
- Penalty:
- 0.25
- Liverpool Interaction Status:
- Amber/Moderate: Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Based on known metabolic profiles, clinically significant drug interactions are not expected between Evotaz and azithromycin. Evotaz US Prescribing Information Bristol-Myers Squibb Company, March 2018., Summary:Coadministration has not been studied. Azithromycin is mainly eliminated via biliary excretion and animal data suggest this may occur via P-glycoprotein and MRP2. Atazanavir/cobicistat could potentially increase azithromycin exposure (inhibition of P-gp and MRP2), however, no a priori dosage adjustment is recommended for azithromycin. Azithromycin is not expected to have a clinically relevant effect on drugs metabolised by CYP enzymes. However, both azithromycin and atazanavir have risks of QT prolongation and/or TdP on the CredibleMeds.org website (known risk for azithromycin; conditional risk for atazanavir). Caution is advised. The product label for atazanavir advises caution when prescribing atazanavir with medicinal products which have the potential to increase the QT interval. If coadministration is necessary, clinical monitoring including ECG assessment is recommended.
- Penalty:
- 0.25
- Liverpool Interaction Status:
- Amber/Moderate: Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Based on known metabolic profiles, clinically significant drug interactions are not expected between Reyataz and azithromycin. Reyataz US Prescribing Information, Bristol-Myers Squibb Company, March 2018., Summary:Coadministration has not been studied. Azithromycin is mainly eliminated via biliary excretion and animal data suggest this may occur via P-glycoprotein and MRP2. Atazanavir could potentially increase azithromycin exposure (inhibition of P-gp and MRP2), but no a priori dosage adjustment is recommended for azithromycin. Azithromycin is not expected to have a clinically relevant effect on drugs metabolised by CYP enzymes. However, both azithromycin and atazanavir have risks of QT prolongation and/or TdP on the CredibleMeds.org website (known risk for azithromycin; conditional risk for atazanavir). Caution is advised. The product label for atazanavir advises caution when prescribing atazanavir with medicinal products which have the potential to increase the QT interval. If coadministration is necessary, clinical monitoring including ECG assessment is recommended.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Azithromycin is mainly eliminated via biliary excretion and animal data suggest this may occur via P-glycoprotein and MRP2. Darunavir/ritonavir could potentially increase azithromycin exposure (inhibition of P-glycoprotein and MRP2), however, no a priori dosage adjustment is recommended for azithromycin.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Azithromycin is mainly eliminated via biliary excretion and animal data suggest this may occur via P-glycoprotein and MRP2. Darunavir/ritonavir could potentially increase azithromycin exposure (inhibition of P-glycoprotein and MRP2), however, no a priori dosage adjustment is recommended for azithromycin.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Azithromycin is mainly eliminated via biliary excretion and animal data suggest this may occur via P-glycoprotein and MRP2. Darunavir/cobicistat could potentially increase azithromycin exposure (inhibition of P-gp and MRP2), however no a priori dosage adjustment is recommended for azithromycin.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as azithromycin is mainly eliminated via biliary excretion.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Azithromycin is mainly eliminated via biliary excretion and animal data suggest this may occur via P-glycoprotein and MRP2. Elvitegravir/cobicistat could potentially increase azithromycin exposure (inhibition of P-gp and MRP2), however no a priori dosage adjustment is recommended for azithromycin. Emtricitabine and tenofovir alafenamide are not expected to interfere with this metabolic pathway.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Azithromycin is mainly eliminated via biliary excretion and animal data suggest this may occur via P-glycoprotein and MRP2. In vitro data indicate that dolutegravir does not inhibit P-glycoprotein and MRP2 at clinically relevant concentrations.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but may increase bictegravir plasma concentrations due to inhibition of P-gp. Caution is recommended due to the potential effect of these agents on the bictegravir component of Biktarvy. Biktarvy Summary of Product Characteristics, Gilead Sciences Ltd, June 2019., Summary:Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Azithromycin is mainly eliminated via biliary excretion and animal data suggest this may occur via P-gp and MRP2. Bictegravir, emtricitabine and tenofovir alafenamide are not expected to interfere with azithromycin elimination. Azithromycin is not a significant inhibitor of CYP3A4 or P-gp and therefore is not expected to increase bictegravir (CYP3A4 and P-gp substrate) to a significant extent. Note: the European product label for Biktarvy indicates that coadministration of azithromycin may increase bictegravir plasma concentrations and recommends caution.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Azithromycin is mainly eliminated via biliary excretion and animal data suggest this may occur via P-glycoprotein and MRP2. Cabotegravir does not inhibit these transporters.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as azithromycin is mainly eliminated via biliary excretion.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. No drug interaction studies have been conducted with ibalizumab: based on ibalizumab’s mechanism of action and target-mediated drug disposition, drug-drug interactions are not expected. Azithromycin is mainly eliminated via biliary excretion whereas ibalizumab, a monoclonal antibody binding to the CD4 receptor, is likely to be eliminated via intracellular catabolism similarly to other monoclonal antibodies.
- Penalty:
- 0.25
- HIV-ASSIST Notes:
- A pharmacokinetic interaction is unlikely. Fostemsavir has been associated with prolongation of the QTc interval at supra-therapeutic doses. Potential for additive QT prolongation with azithromycin co-administration, ECG monitoring is recommended in patients at risk for QTc.
- Liverpool Interaction Status:
- Amber/Moderate: Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- A supratherapeutic dose (at a Cmax approximately 4.2-fold the therapeutic dose) of fostemsavir has been shown to significantly prolong the QTc interval of the electrocardiogram. Fostemsavir should be used with caution in patients with a history of QT interval prolongation, when co-administered with a medicine with a known risk of Torsade de Pointes or in patients with relevant pre-existing cardiac disease. Elderly patients may be more susceptible to drug-induced QT interval prolongation. Rukobia Summary of Product Information, ViiV Healthcare, June 2021. Fostemsavir at 2,400 mg twice daily, 4 times the recommended daily dose, has been shown to significantly prolong the QTc interval of the electrocardiogram. Fostemsavir should be used with caution when coadministered with a drug with a known risk of Torsade de Pointes. Elderly patients may be more susceptible to drug-induced QT interval prolongation. Rukobia US Prescribing Information, ViiV Healthcare, July 2020., Summary:Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Azithromycin is mainly eliminated via biliary excretion and animal data suggest this may occur via P-gp and MRP2. Fostemsavir is a prodrug and is hydrolysed to the active compound temsavir in the small intestine. Temsavir is mainly metabolized by esterase-mediated hydrolysis with a small contribution of CYP3A4. Temsavir does not inhibit MRP2 and P-gp. Azithromycin is not a significant inhibitor of CYP3A4 or P-gp and is not expected to impact temsavir. Fostemsavir has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with azithromycin. However, given the known QT prolongation risk associated with azithromycin, ECG monitoring is recommended when coadministering both drugs.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Azithromycin is mainly eliminated via biliary excretion and animal data suggest this may occur via P-gp and MRP2. Lenacapavir is mainly cleared as unchanged drug and is a weak inhibitor of P-gp and therefore is unlikely to cause a clinically significant interaction.