Results

Mutations: 184V, 179D, 188L, 63P
Comorbidities: None
Comedications: Metoprolol, Buprenorphine
Treatment history: 3TC (Lamivudine/Epivir) , D4T (Stavudine/Zerit) , EFV (Efavirenz/Sustiva) , NVP (Nevirapine/Viramune) , NFV (Nelfinavir/Viracept)
Current regimen: EVG/c/TAF/FTC (Genvoya)
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
Regimen Weighted Score Active Drugs Total Pills Frequency (x/day)
BIC/TAF/FTC 1 2 1 1
DTG+TAF/FTC 1.25 2 2 1
DTG+DRV/c/TAF/FTC 3 3 2 1
DRV/c/TAF/FTC 3 2 1 1
DTG+DRV/r+TAF/FTC 3.5 3 4 1
DTG+DRV/c 3.5 2 2 1
DRV/c+BIC/TAF/FTC 3.6 3 2 1
DRV/r+BIC/TAF/FTC 3.8 3 3 1
DRV/r+TAF/FTC 4.2 2 3 1
DTG+DRV/r 4.55 2 3 1
RAL+DRV/c/TAF/FTC 5.25 3 3 1
EVG/c/TAF/FTC [Current regimen] 5.6 2 1 1
RAL+DRV/r+TAF/FTC 5.75 3 5 1
RAL+DRV/c 6 2 3 1
RAL+TAF/FTC 6 2 3 1

Report

Preferred regimen based on the HIV-ASSIST algorithm: BIC/TAF/FTC

BIC/TAF/FTC had the lowest weighted score (1) 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 1 2 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+TAF/FTC 1.25 2 2 1
DTG+DRV/c/TAF/FTC 3 3 2 1
DRV/c/TAF/FTC 3 2 1 1
DTG+DRV/r+TAF/FTC 3.5 3 4 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.

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
V179D 10 10 10 10 0
Y188L 60 10 60 60 60
K103N* 60 0 0 60 0
K103R + V179D 20 0 15 20 0
Total 150 20 85 150 60
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
* signifies an assumed archived mutation based on prior treatment experience.

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.

Metoprolol Penalty Notes
LPV/r 0.75 Possible increase in level of beta blocker (particularly with metoprolol, timolol, carvedilol, propranolol). May need to decrease beta blocker dose. Adjust dose based on clinical response. Consider using beta blockers that are not metabolized by CYP450 enzymes (ex. Atenolol, labetalol, nadolol, sotalol). Use caution when using Sotalol as there is potential for QTc prolongation.
FPV/r 0.75 Possible increase in level of beta blocker (particularly with metoprolol, timolol, carvedilol, propranolol). May need to decrease beta blocker dose. Adjust dose based on clinical response. Consider using beta blockers that are not metabolized by CYP450 enzymes (ex. Atenolol, labetalol, nadolol, sotalol)
TPV/r 0.75 Possible increase in level of beta blocker (particularly with metoprolol, timolol, carvedilol, propranolol). May need to decrease beta blocker dose. Adjust dose based on clinical response. Consider using beta blockers that are not metabolized by CYP450 enzymes (ex. Atenolol, labetalol, nadolol, sotalol)
SQV/r 0.75 Possible increase in level of beta blocker (particularly with metoprolol, timolol, carvedilol, propranolol). May need to decrease beta blocker dose. Adjust dose based on clinical response. Consider using beta blockers that are not metabolized by CYP450 enzymes (ex. Atenolol, labetalol, nadolol, sotalol). Use caution when using Sotalol as there is potential for QTc prolongation.
IDV/r 0.75 Possible increase in level of beta blocker (particularly with metoprolol, timolol, carvedilol, propranolol). May need to decrease beta blocker dose. Adjust dose based on clinical response. Consider using beta blockers that are not metabolized by CYP450 enzymes (ex. Atenolol, labetalol, nadolol, sotalol)
NFV 0.75 Possible increase in level of beta blocker (particularly with metoprolol, timolol, carvedilol, propranolol). May need to decrease beta blocker dose. Adjust dose based on clinical response. Consider using beta blockers that are not metabolized by CYP450 enzymes (ex. Atenolol, labetalol, nadolol, sotalol)
ATV/r 0.75 Possible increase in level of beta blocker (particularly with metoprolol, timolol, carvedilol, propranolol). May need to decrease beta blocker dose. Adjust dose based on clinical response. Consider using beta blockers that are not metabolized by CYP450 enzymes (ex. Atenolol, labetalol, nadolol, sotalol). Use caution when using Sotalol as there is potential for QTc prolongation.
ATV/c 0.75 Possible increase in level of beta blocker (particularly with metoprolol, timolol, carvedilol, propranolol). May need to decrease beta blocker dose. Adjust dose based on clinical response. Consider using beta blockers that are not metabolized by CYP450 enzymes (ex. Atenolol, labetalol, nadolol, sotalol). Use caution when using Sotalol as there is potential for QTc prolongation.
ATV 0.75 Possible increase in level of beta blocker (particularly with metoprolol, timolol, carvedilol, propranolol). May need to decrease beta blocker dose. Adjust dose based on clinical response. Consider using beta blockers that are not metabolized by CYP450 enzymes (ex. Atenolol, labetalol, nadolol, sotalol). Use caution when using Sotalol as there is potential for QTc prolongation.
DRV 0.75 Possible increase in level of beta blocker (particularly with metoprolol, timolol, carvedilol, propranolol). May need to decrease beta blocker dose. Adjust dose based on clinical response. Consider using beta blockers that are not metabolized by CYP450 enzymes (ex. Atenolol, labetalol, nadolol, sotalol)
DRV/r 0.75 Possible increase in level of beta blocker (particularly with metoprolol, timolol, carvedilol, propranolol). May need to decrease beta blocker dose. Adjust dose based on clinical response. Consider using beta blockers that are not metabolized by CYP450 enzymes (ex. Atenolol, labetalol, nadolol, sotalol)
DRV/c 0.75 Possible increase in level of beta blocker (particularly with metoprolol, timolol, carvedilol, propranolol). May need to decrease beta blocker dose. Adjust dose based on clinical response. Consider using beta blockers that are not metabolized by CYP450 enzymes (ex. Atenolol, labetalol, nadolol, sotalol)
EVG/c 0.75 Possible increase in level of beta blocker (particularly with metoprolol, timolol, carvedilol, propranolol). May need to decrease beta blocker dose. Adjust dose based on clinical response. Consider using beta blockers that are not metabolized by CYP450 enzymes (ex. Atenolol, labetalol, nadolol, sotalol)
Buprenorphine Penalty Notes
EFV 0.75 Decrease in AUC of buprenorphine by 50%. No dosage adjustments recommended. Monitor for withdrawal symptoms.
ETR 0.75 Decrease in AUC of buprenorphine by 25%. No dosage adjustments recommended. Monitor for withdrawal symptoms.
NVP 0.1
FPV/r 0.75 Decrease in AUC of norbuprenorphine when used with FPVr. No dosage adjustment necessary. Clinical monitoring recommended.
TPV/r 0.75 Decrease in AUC of norbuprenorphine when used with TPVr. Consider monitoring TPV level. Clinical monitoring recommended.
ATV/r 0.75 When used with unboosted ATV, increase in AUC of buprenorphine by 93%. AUC of norbuprenorphine increases by 76%. Possible decrease in ATV. Do not coadminister with unboosted ATV. Similar effects with ATVr. Monitor for sedation. Buprenorphine dose reduction may be necessary. Effects unknown with ATVc. Titrate buprenorphine dose using the lowest initial dose. Dose adjustment of buprenorphine may be needed. Clinical monitoring is recommended.
ATV/c 0.75 When used with unboosted ATV, increase in AUC of buprenorphine by 93%. AUC of norbuprenorphine increases by 76%. Possible decrease in ATV. Do not coadminister with unboosted ATV. Similar effects with ATVr. Monitor for sedation. Buprenorphine dose reduction may be necessary. Effects unknown with ATVc. Titrate buprenorphine dose using the lowest initial dose. Dose adjustment of buprenorphine may be needed. Clinical monitoring is recommended.
ATV 0.75 When used with unboosted ATV, increase in AUC of buprenorphine by 93%. AUC of norbuprenorphine increases by 76%. Possible decrease in ATV. Do not coadminister with unboosted ATV. Similar effects with ATVr. Monitor for sedation. Buprenorphine dose reduction may be necessary. Effects unknown with ATVc. Titrate buprenorphine dose using the lowest initial dose. Dose adjustment of buprenorphine may be needed. Clinical monitoring is recommended.
DRV 0.75 When used with DRVr, increase in AUC of norbuprenorphine by 46% and Cmin by 71%. No dose adjustment necessary. Clinical monitoring is recommended. Effects unknown with DRVc. Titrate buprenorphine dose using the lowest initial dose. Dose adjustment of buprenorphine may be needed. Clinical monitoring is recommended.
DRV/r 0.75 When used with DRVr, increase in AUC of norbuprenorphine by 46% and Cmin by 71%. No dose adjustment necessary. Clinical monitoring is recommended. Effects unknown with DRVc. Titrate buprenorphine dose using the lowest initial dose. Dose adjustment of buprenorphine may be needed. Clinical monitoring is recommended.
DRV/c 0.75 When used with DRVr, increase in AUC of norbuprenorphine by 46% and Cmin by 71%. No dose adjustment necessary. Clinical monitoring is recommended. Effects unknown with DRVc. Titrate buprenorphine dose using the lowest initial dose. Dose adjustment of buprenorphine may be needed. Clinical monitoring is recommended.
EVG/c 0.75 Increase in AUC of buprenorphine by 35%. No dosage adjustment necessary. Clinical monitoring is recommended.
FOS 0.5 Buprenorphine and nor-buprenorphine AUC increased 30% and 39%, respectively. Use standard dose per manufacturer, but monitor for increased sedation.