Results

Mutations: M41L ,D67N , K103N ,Y181C, M184V, G190V, L210W ,T215Y ,P225H
L10I, I13V, K20R, M46L, I54V ,T74P, L76V , V82A, I84V, L90M
N155H
V38A
Comorbidities: None
Comedications: None
Treatment history: None
Current regimen: DRV/r (Darunavir-ritonavir/Prezista and Norvir) , TDF/FTC (Truvada)
Adherence: No options selected
CD4: ≤ 200
Viral load: Low (200 - 100,000)
HLA-B5701: Negative
Tropism: X4 virus
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Regimen Weighted Score Active Drugs Total Pills Frequency (x/day)
DTG+FOS+IBA+TAF/FTC 7.65 3 5 2
DTG+FOS+IBA+TDF/FTC 7.75 3 5 2
DTG+FOS+IBA 7.75 2.67 4 2
DTG+FOS+IBA+DRV/r 8.4 3 8 2
DTG+FOS+IBA+DRV/r+TAF/FTC 8.65 3.33 9 2
DTG+FOS+IBA+DRV/r+TDF/FTC 8.85 3.33 9 2
IBA+FOS+BIC/TAF/FTC 9 3 3 2
FOS+IBA+DRV/r+BIC/TAF/FTC 10 3.33 7 2
DTG+IBA+DRV/r+TAF/FTC 10 2.33 7 2
IBA+FOS+DRV/r 10.2 2.33 6 2
IBA+FOS+DRV/r 10.2 2.33 6 2
DTG+IBA+DRV/r+TDF/FTC 10.2 2.33 7 2
DTG+IBA+DRV/r 10.25 2 6 2
DTG+FOS+DRV/r 10.25 2 8 2
IBA+FOS+ETR 10.4 2.33 4 2

Report

Preferred regimen based on the HIV-ASSIST algorithm: DTG+FOS+IBA+TAF/FTC

DTG+FOS+IBA+TAF/FTC had the lowest weighted score (7.65) 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)
DTG+FOS+IBA+TAF/FTC 7.65 3 5 2

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+FOS+IBA+TDF/FTC 7.75 3 5 2
DTG+FOS+IBA 7.75 2.67 4 2
DTG+FOS+IBA+DRV/r 8.4 3 8 2
DTG+FOS+IBA+DRV/r+TAF/FTC 8.65 3.33 9 2

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
M41L 0 0 5 5 5 15 15 10
D67N 0 0 5 5 5 15 15 5
M184V 60 60 15 -10 -10 -10 -10 10
L210W 0 0 5 5 5 15 15 10
T215Y 0 0 10 10 10 40 40 15
L210W + T215FY 5 5 10 10 10 10 10 10
M41L + L210W 0 0 10 10 10 10 10 10
M41L + L210W + T215FY 5 5 5 5 5 0 0 0
M41L + T215FY 5 5 15 10 10 10 10 10
M41L + D67EGN + T215FY 5 5 5 5 5 5 5 5
Total 80 80 85 55 55 110 110 85
NNRTI Mutation(s) EFV ETR RPV NVP DOR
K103N 60 0 0 60 0
Y181C 30 30 45 60 10
G190V 60 10 10 60 10
P225H 45 0 0 45 30
K103N + Y181C 0 0 0 0 10
Y181C + G190ACSTV 0 10 10 0 20
Total 195 50 65 225 80
PI Mutation(s) LPVr FPVr TPVr SQVr IDVr NFV ATVr ATVc ATV DRV DRVr DRVc
M46L 10 10 10 10 10 20 10 10 10 0 0 0
I54V 15 10 20 15 15 20 15 15 15 0 0 0
T74P 5 10 25 10 10 20 10 10 10 5 5 5
L76V 30 60 -5 0 30 10 0 0 0 20 20 20
V82A 30 15 0 15 30 30 15 15 15 0 0 0
I84V 30 60 30 60 60 60 60 60 60 15 15 15
L90M 15 20 0 45 30 60 25 25 25 0 0 0
M46IL + I84V + L90M 5 5 5 5 5 5 5 5 5 0 0 0
M46ILV + L76V 10 10 0 0 10 10 0 0 0 0 0 0
M46ILV + V82ACFLMST 10 10 0 10 10 10 10 10 10 0 0 0
M46ILV + L90M 0 10 0 5 10 10 10 10 10 0 0 0
I54ALMSTV + V82ACFLMST 10 10 0 10 10 10 10 10 10 0 0 0
I54ALMSTV + L90M 5 10 0 10 10 10 10 10 10 0 0 0
I54LM + I84V 5 5 0 0 5 5 0 0 0 5 5 5
V82ACFLMST + L90M 5 10 0 10 10 10 10 10 10 0 0 0
Total 185 255 85 205 255 290 190 190 190 45 45 45
INSTI Mutation(s) RAL EVGc DTG BIC CAB
N155H 60 60 10 10 25
Total 60 60 10 10 25
EI Mutation(s) MVC IBA FOS
Total 0 0 0

Comorbidities, Side Effects, and Pregnancy Interactions

HIV-ASSIST incorporates a mathematical penalty into our algorithms for ARVs that are less preferred due to comorbidities or side-effects, based on recommendations from DHHS guidelines and HIV-ASSIST clinician and pharmacist expertise. In general, higher penalties suggest that the listed ARV is less favored in the presence of the stated comorbidity or side effect.

Co-medication Interactions

We have identified the following possible drug interactions which HIV-ASSIST factors into ARV regimen selection, based on recommendations from DHHS guidelines, University of Liverpool HIV Drug Interaction Checker, and HIV-ASSIST clinician and pharmacist expertise. Penalties less than 1.0 are typically those representing minor interactions that can be mediated by dosage adjustments, whereas a penalty of 2.0 represents medically contraindicated ARVs.