LLV with resistance

Mutations: M184V, K103N, Y181C, D67N, N155H
Comorbidities: None
Comedications: None
Treatment history: 3TC (Lamivudine/Epivir) , AZT (Zidovudine/Generic) , EFV (Efavirenz/Sustiva) , ETR (Etravirine/Intelence) , NVP (Nevirapine/Viramune) , RAL (Raltegravir/Isentress) , TDF/FTC (Truvada)
Current regimen: ETR (Etravirine/Intelence) , RAL (Raltegravir/Isentress) , TDF/FTC (Truvada)
Adherence: Patients who prefer once daily dosing, Penalize regimens with IV/IM dosing
CD4: Unknown
Viral load: Low (200 - 100,000)
HLA-B5701: Negative
Tropism: Unknown
View results
Submitted by maunank on Fri, 06/05/2020 - 22:15

52 y/o diagnose dx 30 years ago:

ZDV/3TC, then ZDV/3TC/NVP, later TDF/FTC/EFV-->K103N, M184V, Y181C, D67N

Later RAL, ETR, TDF/FTC (didn't want DRV)-->generaly suppressed, but occasional LLV.  Develops N155H.  He wants a once/daily regimen

CCO audience:  

BIC/TAF/FTC 32%, DRV/c/TAF/FTC 11%, DRV/c+TAF/FTC+DOR 26%, DTG/RPV+DTG 5%, DRV/c/TAF/FTC+DTG BID 5%, 11% IBA regimens

Regimen Weighted Score Active Drugs Total Pills Frequency (x/day)
DRV/c/TAF/FTC 1.35 2 1 1
DRV/c+TDF/FTC 1.35 2 2 1
DRV/r+TAF/FTC 1.55 2 3 1
DRV/r+TDF/FTC 1.55 2 3 1
DRV/c+BIC/TAF/FTC 1.95 2.67 2 1
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Submitted by maunank on Fri, 06/05/2020 - 23:16

BIC: very little data on 2nd line usage, particularly in setting of an INSTI mutation. By guidelines and package insert, if using an INSTI in this situation, it likely would be DTG BID. Patient has some underlying NRTI resistance. A boosted PI with continuation of NRTI (EARNEST, SECOND-LINE, SELECT) should be able to suppress, and may improve adherence with one tablet once/day. DRV/c/TAF/FTC was the consensus of CCO panel as well.