Endocarditis on rifampin and oxacillin

Mutations: M184V K103N
Comorbidities: None
Comedications: Other penicillins (oxacillin, nafcillin,etc), Rifampin
Treatment history: EFV/TDF/FTC (Atripla)
Current regimen: DTG (Dolutegravir/Tivicay) , TAF/FTC (Descovy)
Adherence: Penalize regimens with IV/IM dosing
CD4: > 200
Viral load: Suppressed (<50) for more than 6 months
HLA-B5701: Negative
Tropism: Unknown
View results
Submitted by maunank on Fri, 06/05/2020 - 20:45

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

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

‒Previously stable on opiate replacement therapy

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

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

‒Endocarditis secondary to IDU

‒Underwent bioprosthetic aortic valve replacement 5 yrs before current admission

Previously failed Atripla

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

Regimen Weighted Score Active Drugs Total Pills Frequency (x/day)
DTG+TDF/FTC 2.45 2 3 2
DTG+TAF/FTC [Current regimen] 2.95 2 3 2
RAL+TDF/FTC 7.4 2 5 2
RAL+TAF/FTC 7.9 2 5 2
DTG+IBA 8.5 2 2 2
Ask on the National Clinical Consultation Center