Second line Treatment Options in Resource Limited

Mutations: M184V
K103N
Y181C
K65R
Comorbidities: Mycobacterium avium complex (MAC)
Comedications: Ethambutol, Rifabutin, Azithromycin
Treatment history: 3TC (Lamivudine/Epivir) , TDF (Tenofovir/Viread) , AZT (Zidovudine/Generic) , EFV (Efavirenz/Sustiva) , LPV/r (Lopinavir-ritonavir/Kaletra)
Current regimen: 3TC (Lamivudine/Epivir) , AZT (Zidovudine/Generic) , ATV/r (Atazanavir-ritonavir/Reyataz and Norvir)
Adherence: Patients who prefer once daily dosing, Patients with intermittent adherence
CD4: ≤ 50
Viral load: Low (200 - 100,000)
HLA-B5701: Negative
Tropism: Unknown
View results
Submitted by PreethiMol on Wed, 11/17/2021 - 23:54

RVD - diagnosed in 2017

- failed first line

- - multiple defaults while on TenvirEM, EFV
- VL not suppressed after restarting same regime since April 2019
- HIV drug resistance test 23/9/2019:
PI - all susceptible
NRTI - susceptible top AZT / high level resistance to 3TC, FTC / intermediate resistance to ABC / low level resistance to TDF, DDI, D4T
NNRTI - high level resistance to EFV, NVP
- Changed to Combivir/Kaletra on 25/11/2019

not compliant to combivir/kaletra since April 2020.

Compliance issues: Pill burden & stigma of taking meds at work.

-  VL (September 2021): 97481 (log 4.98)

- CD4 (September 2021): <35

switched to combivir / atazanavir/ ritonavir since 30/9/2021 till now

 

Current issue

1. Advanced RVD - on second line and concerned of possible PI resistance

2. Persistent MAC bacteremia

 

Culture history:
MycoF culture (19/9/19): AFB 3+, culture mycobacterium avium
Repeat mycoF culture (4/10/19): NGD42
Repeated mycoF lytic culture (April 2021):positive
MycoF lytic culture (June 2021): positive
MycoF lytic culture (6/9/2021): positive
MycoF lytic culture (20/9/2021): positive, AFB seen

 

Repeated blood mycoF culture on 17/10/2021 - no growth after 30 days

 

Treatment history:
Started Akurit-4 + B6 + Azithromycin on 30/9/2019
Changed to rRfabutin + ETH + Azithromycin on 25/11/2019 (because of potential interaction between Kaletra + Rifampicin)
Current regime: Azithromycin, Ethambutol, Rifabutin (1/10/2021)

plan to switch to Tab DTG 50mg OD + T.Atazanavir 300mg + Ritonavir 100mg ( ATZ due to reduce pill burden)

long-acting ARVs & many STRs are not available

Regimen Weighted Score Active Drugs Total Pills Frequency (x/day)
DTG+TDF/FTC 2.35 1.33 2 1
DTG+DRV/r 2.6 2 3 1
DTG+DRV/r+TDF/FTC 3 2.33 4 1
DTG+DRV/r+TAF/FTC 3.05 2.33 4 1
DTG+TAF/FTC 3.05 1.33 2 1
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