Results

Mutations: V101I,D67N,K70R,RT_L74I,M184V,K219Q,L33F,I50V,I54L,D67N,K70R,M184I,T97A,N155H, K101E,V106L,V108I
Comorbidities: None
Comedications: None
Treatment history: None
Current regimen: None
Adherence: Patients who prefer once daily dosing, Patients with intermittent adherence, Penalize regimens with IV/IM dosing
CD4: ≤ 200
Viral load: Low (200 - 100,000)
HLA-B5701: Negative
Tropism: Unknown
View results
Because there are salvage regimens in consideration, please consider sharing your case or seeking ID consultation.
Regimen Weighted Score Active Drugs Total Pills Frequency (x/day)
ATV/c+BIC/TAF/FTC 5 2 2 1
ATV/r+BIC/TAF/FTC 5.2 2 3 1
DTG+ATV/c+TAF/FTC 6.15 2 4 2
DTG+ATV/r+TAF/FTC 6.35 2 5 2
DTG+FOS+ATV/c+TAF/FTC 7.65 3 6 2
DTG+FOS+ATV/r+TAF/FTC 7.85 3 7 2
DTG+ATV/r+ETR 7.85 2 6 2
ATV/c+EFV+TAF/FTC 7.9 2 3 1
ATV/r+EFV+TAF/FTC 8.1 2 4 1
DTG+FOS+ATV/c 8.25 2.33 5 2
DTG+DRV/r+TAF/FTC 8.35 1.67 7 2
DTG+FOS+ATV/r 8.45 2.33 6 2
IBA+ATV/c+BIC/TAF/FTC 8.6 3 2 1
IBA+ATV/r+BIC/TAF/FTC 8.8 3 3 1
ATV/c+DOR+BIC/TAF/FTC 8.8 2.33 3 1

Report [beta]

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

ATV/c+BIC/TAF/FTC had the lowest weighted score (5) 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)
ATV/c+BIC/TAF/FTC 5 2 2 1

The rationale behind why this regimen was chosen by our algorithm as the most appropriate is shown below:

Score (Change) Explanation
3.5 (Base score) Base score for ATV/c+BIC/TAF/FTC
3.5 (+0) Pill burden: All regimens with more than one pill once per day incur a pill burden penalty. This regimen received a penalty of 0 using the formula 0.5 * (1 time(s) daily - 1) + 0.2 * (2 total pill(s) - 2)
3.9 (+0.4) Mutations: This regimen was penalized 0.4 for drug mutations using the formula 2<sup>-1</sup> * 0.02 * 80/ 2. According to the Stanford Database, individual drug mutation scores were : ATVc: 20, BIC: 10, FTC: 130, TAF: 20 M184V penalties were ignored for this regimen.
4.9 (+1) Mutations: We penalized regimens containing NRTIs with TAMs and fewer active drugs
5.65 (+0.75) Mutations: We penalized BIC/TAF/FTC if there were any INSTI mutations
6.65 (+1) Non-suppressed viral load: In general, we penalized regimens with fewer than three active drugs. (Active drugs in this regimen: 2).
6.75 (+0.1) ARV Preference: We gave preference to DRV over older PIs
6.5 (-0.25) Non-suppressed viral load: We prioritized switching to 2 NRTI + PI +/- another ARV after treatment failure on an NNRTI regimen
6 (-0.5) Non-suppressed viral load: We prioritized switching to 2 NRTI + (DTG or BIC) +/- another ARV after treatment failure on an NNRTI regimen
5.75 (-0.25) Non-suppressed viral load: We prioritized switching to PI + INSTI +/- another ARV after treatment failure on an NNRTI regimen
5.5 (-0.25) Non-suppressed viral load: We prioritized remaining on a 2 NRTI + PI +/- another ARV regimen after treatment failure on an PI regimen
5.25 (-0.25) Non-suppressed viral load: We prioritized switching to a 2 NRTI + INSTI +/- another ARV regimen after treatment failure on an PI regimen
4 (-1.25) Non-suppressed viral load: We prioritized switching to PI + DTG +/- another ARV after treatment failure on an INSTI regimen with INSTI mutations
5 (+1) Non-suppressed viral load: We penalized switching to BIC + 2 NRTI +/- another ARV after treatment failure on an INSTI regimen with INSTI mutations
5 (Final) Final weighted score

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)
ATV/r+BIC/TAF/FTC 5.2 2 3 1
DTG+ATV/c+TAF/FTC 6.15 2 4 2
DTG+ATV/r+TAF/FTC 6.35 2 5 2
DTG+FOS+ATV/c+TAF/FTC 7.65 3 6 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.

NRTI Mutation(s) 3TC FTC ABC TAF TDF AZT D4T DDI
D67N 0 0 5 5 5 15 15 5
K70R 0 0 5 5 5 30 15 10
L74I 0 0 30 5 5 0 0 60
M184V 60 60 15 -10 -10 -10 -10 10
K219Q 0 0 5 5 5 10 10 5
M184I 60 60 15 -10 -10 -10 -10 10
D67EGN + K70R + M184IV + K219ENQR 0 0 20 0 0 0 0 0
D67EGN + K70R + K219ENQR 10 10 10 10 10 10 10 10
K70EGNQST + M184IV 0 0 0 10 10 0 10 0
L74IV + M184IV 0 0 15 0 0 0 0 0
Total 130 130 120 20 20 45 40 110
NNRTI Mutation(s) EFV ETR RPV NVP DOR
K101E 15 15 45 30 15
V108I 10 0 0 15 15
K101E + M184I 0 0 15 0 0
Total 25 15 60 45 30
PI Mutation(s) LPVr FPVr TPVr SQVr IDVr NFV ATVr ATVc ATV DRV DRVr DRVc
L33F 5 10 10 5 5 10 5 5 5 5 5 5
I50V 30 60 -5 15 0 15 0 0 0 20 20 20
I54L 20 60 -10 15 10 20 15 15 15 20 20 20
Total 55 130 -5 35 15 45 20 20 20 45 45 45
INSTI Mutation(s) RAL EVGc DTG BIC
T97A 10 10 0 0
N155H 60 60 10 10
Total 70 70 10 10
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 based on your listed co-morbidities or side-effects. 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. 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.