Results
| Mutations: M41L, D67N, V75T, A98G, K219Q, L10I, L24I, K43T, M46L, I54V, A71V, V82S, K20R, K64H, E122K, S162A, D218E, L228H, V245E, R277K, K281R, E297K, V3I, K20R, E35D, M36I, S37N, K55R, R57K, L63P, I72V, Q92K Comorbidities: Schizophrenia Comedications: Paliperidone Treatment history: None Current regimen: DRV/c (Darunavir-cobicistat/Prezcobix) , DTG (Dolutegravir/Tivicay) , TAF/FTC (Descovy) |
Adherence: Pill burden: Prioritize fewer and smaller pills, Pill frequency: Prioritize once daily dosing, Administration preference: Prioritize IV/IM/SC dosing CD4: > 200 Viral load: Suppressed (<50) for more than 6 months HLA-B5701: Positive (or unknown) Tropism: Unknown |
View results |
to help us improve HIV-ASSIST.
HIV-ASSIST calculates a regimen's weighted score on a scale of 1 to 10, in which lower values represent preferred regimens based upon current IAS and DHHS guidelines, while factoring in treatment history, comorbidities, co-medications, and other factors entered on the input page. The weighting system utilizes standardized utility weights based on current literature evidence and expert opinion. HIV-ASSIST is an educational tool and not a substitute for clinical judgement. Click on a regimen and 'Rationale' to see all steps leading to the presented weighted score. Please note that rankings would differ if if some factors were weighed more or less than those applied within HIV-ASSIST algorithms.
The Score Code is a value from 1-5 that corresponds with the chart below.
| Score Code | HIV-ASSIST Score | Efficacy (likelihood of viral suppression) | Tolerability (side-effects and pill burden) | Notes |
|---|---|---|---|---|
| 1 | ≤ 1.5 | Strong evidence | Strong evidence | Reserved for fully- or near fully- active regimens. |
| 2 | 1.5 - 2.5 | Strong or moderate evidence | Strong or moderate evidence | Includes regimens that started at better rank but were impacted by mutations, comorbidities, and drug interactions. |
| 3 | 2.5 - 4.0 | Moderate evidence | Moderate evidence | As above. Additionally, most treatment-experienced patients will see regimens in this category. |
| 4 | 4.0 - 6.0 | Moderate to poor evidence | Moderate or poor evidence | As above. Additionally, most treatment-experienced patients will see regimens in this category. |
| 5 | ≥ 6.0 | Poor evidence | Poor evidence | As above. Additionally, these represent salvage regimens in patients with limited options. |
Signifies that there may be additional regimen warnings.
Note: We do not show regimens for which there is evidence against usage.
| Score Code | Regimen | Weighted Score | Active Drugs | Total Pills | Frequency (x/day) |
|---|---|---|---|---|---|
| 1 | DTG/3TC | 1.35 | 2 | 1 | 1 |
| 2 | DTG+TAF/FTC | 1.6 | 2.67 | 2 | 1 |
| 2 | BIC/TAF/FTC | 1.75 | 2.67 | 1 | 1 |
| 2 | DRV/c+3TC | 1.95 | 2 | 2 | 1 |
| 2 | DRV/c+DTG/3TC | 2.1 | 3 | 2 | 1 |
| 3 | DTG+DRV/c | 2.6 | 2 | 2 | 1 |
| 3 | DOR+DTG/3TC | 2.61 | 3 | 2 | 1 |
| 3 | DRV/c/TAF/FTC | 2.65 | 2.67 | 1 | 1 |
| 3 | DRV/r+3TC | 3.05 | 2 | 3 | 1 |
| 3 | DTG+DRV/c/TAF/FTC [Current regimen] | 3.1 | 3.67 | 2 | 1 |
| 3 | DRV/c+BIC/TAF/FTC | 3.2 | 3.67 | 2 | 1 |
| 3 | 3TC+DTG/RPV | 3.26 | 2.67 | 2 | 1 |
| 3 | DRV/r+DTG/3TC | 3.3 | 3 | 3 | 1 |
| 3 | DTG+DOR | 3.41 | 2 | 2 | 1 |
| 3 | IBA+DTG/3TC | 3.6 | 3 | 1 | 1 |
| 3 | LEN+DTG/3TC | 3.6 | 3 | 1 | 1 |
| 3 | DRV/c+DTG/RPV | 3.61 | 2.67 | 2 | 1 |
| 3 | EVG/c/TAF/FTC | 3.65 | 2.67 | 1 | 1 |
| 3 | DRV+EVG/c/TAF/FTC | 3.65 | 3.67 | 2 | 1 |
| 3 | DRV/r+TAF/FTC | 3.75 | 2.67 | 3 | 1 |
| 3 | DTG+DRV/r | 3.8 | 2 | 3 | 1 |
| 3 | DTG+IBA+DRV/c | 3.85 | 3 | 2 | 1 |
| 3 | DOR+BIC/TAF/FTC | 3.85 | 3.67 | 2 | 1 |
| 3 | DTG+DRV/c+DOR | 3.91 | 3 | 3 | 1 |
| 4 | DOR+DRV/c/TAF/FTC | 4.1 | 3.67 | 2 | 1 |
| 4 | DTG+DRV/r+DOR | 4.21 | 3 | 4 | 1 |
| 4 | DTG+RPV/TAF/FTC | 4.26 | 3.33 | 2 | 1 |
| 4 | DRV/r+BIC/TAF/FTC | 4.3 | 3.67 | 3 | 1 |
| 4 | DTG+IBA | 4.35 | 2 | 1 | 1 |
| 4 | DTG+LEN | 4.35 | 2 | 1 | 1 |
| 4 | DTG+LEN+DRV/c | 4.35 | 3 | 2 | 1 |
| 4 | RPV+BIC/TAF/FTC | 4.35 | 3.33 | 2 | 1 |
| 4 | DTG+IBA+DOR | 4.36 | 3 | 2 | 1 |
| 4 | RAL+DRV/c+3TC | 4.5 | 3 | 4 | 1 |
| 4 | DOR+EVG/c/TAF/FTC | 4.5 | 3.67 | 2 | 1 |
| 4 | DTG+DRV/r+TAF/FTC | 4.5 | 3.67 | 4 | 1 |
| 4 | DTG+LEN+DOR | 4.61 | 3 | 2 | 1 |
| 4 | RAL+DRV/r+3TC | 4.7 | 3 | 5 | 1 |
| 4 | DRV/r+DTG/RPV | 4.96 | 2.67 | 3 | 1 |
| 4 | RAL+TAF/FTC | 5 | 2.67 | 3 | 1 |
| 4 | IBA+DTG/RPV | 5.01 | 2.67 | 1 | 1 |
| 4 | DTG+IBA+DRV/r | 5.05 | 3 | 3 | 1 |
| 4 | DTG+DOR+TAF/FTC | 5.06 | 3.67 | 3 | 1 |
| 4 | RAL+DRV/c+DOR | 5.1 | 3 | 4 | 1 |
| 4 | DTG+IBA+TAF/FTC | 5.2 | 3.67 | 2 | 1 |
| 4 | LEN+DTG/RPV | 5.26 | 2.67 | 1 | 1 |
| 4 | DOR+TAF/FTC | 5.3 | 2.67 | 2 | 1 |
| 4 | DTG+LEN+DRV/r | 5.3 | 3 | 3 | 1 |
| 4 | IBA+BIC/TAF/FTC | 5.35 | 3.67 | 1 | 1 |
| 4 | RAL+DRV/r+DOR | 5.4 | 3 | 5 | 1 |
| 4 | DTG+DOR+DRV/c/TAF/FTC | 5.41 | 4.67 | 3 | 1 |
| 4 | DTG+LEN+TAF/FTC | 5.45 | 3.67 | 2 | 1 |
| 4 | DRV/r+DOR+TAF/FTC | 5.5 | 3.67 | 4 | 1 |
| 4 | DRV/c+DOR+BIC/TAF/FTC | 5.5 | 4.67 | 3 | 1 |
| 4 | LEN+BIC/TAF/FTC | 5.6 | 3.67 | 1 | 1 |
| 4 | RAL+DRV/r+TAF/FTC | 5.7 | 3.67 | 5 | 1 |
| 4 | DRV/r+DOR+BIC/TAF/FTC | 5.7 | 4.67 | 4 | 1 |
| 4 | RPV/TAF/FTC | 5.75 | 2.33 | 1 | 1 |
| 4 | RAL+DRV/c/TAF/FTC | 5.8 | 3.67 | 3 | 1 |
| 4 | IBA+DRV/c+DTG/RPV | 5.91 | 3.67 | 2 | 1 |
| 4 | DTG+DRV/r+DOR+TAF/FTC | 5.91 | 4.67 | 5 | 1 |
| 5 | DRV/c+DOR | 6 | 2 | 2 | 1 |
| 5 | RAL+DRV/c | 6.05 | 2 | 3 | 1 |
| 5 | RAL+IBA+DRV/c | 6.05 | 3 | 3 | 1 |
| 5 | DTG+RPV+DRV/c/TAF/FTC | 6.16 | 4.33 | 3 | 1 |
| 5 | CAB/RPV | 6.25 | 1.67 | 0 | 0.03 |
| 5 | RAL+DRV/r | 6.25 | 2 | 4 | 1 |
| 5 | RAL+IBA+DRV/r | 6.25 | 3 | 4 | 1 |
| 5 | LEN+EVG/c/TAF/FTC | 6.25 | 3.67 | 1 | 1 |
| 5 | DRV/c+RPV+BIC/TAF/FTC | 6.25 | 4.33 | 3 | 1 |
| 5 | DRV/c+DOR+3TC | 6.3 | 3 | 3 | 1 |
| 5 | LEN+DRV/r+DTG/3TC | 6.3 | 4 | 3 | 1 |
| 5 | RAL+DRV/c+RPV | 6.35 | 2.67 | 4 | 1 |
| 5 | IBA+DRV/c+DTG/3TC | 6.35 | 4 | 2 | 1 |
| 5 | LEN+DRV/c+DTG/3TC | 6.35 | 4 | 2 | 1 |
| 5 | DRV/r+DOR+3TC | 6.5 | 3 | 4 | 1 |
| 5 | RAL+LEN+DRV/r | 6.5 | 3 | 4 | 1 |
| 5 | LEN+DRV/c/TAF/FTC | 6.5 | 3.67 | 1 | 1 |
| 5 | DRV/r+RPV+BIC/TAF/FTC | 6.5 | 4.33 | 4 | 1 |
| 5 | DTG+DRV/r+RPV/TAF/FTC | 6.51 | 4.33 | 4 | 1 |
| 5 | RAL+LEN+DRV/c | 6.55 | 3 | 3 | 1 |
| 5 | IBA+DRV/r+DTG/3TC | 6.55 | 4 | 3 | 1 |
| 5 | DRV+DOR+EVG/c/TAF/FTC | 6.55 | 4.67 | 3 | 1 |
| 5 | LEN+DRV/c+DTG/RPV | 6.66 | 3.67 | 2 | 1 |
| 5 | RAL+DRV/r+RPV | 6.7 | 2.67 | 5 | 1 |
| 5 | DTG+LEN+IBA+DRV/r | 6.8 | 4 | 3 | 1 |
| 5 | LEN+IBA+DTG/RPV | 6.81 | 3.67 | 1 | 1 |
| 5 | DTG+LEN+IBA+DRV/c | 6.85 | 4 | 2 | 1 |
| 5 | DTG+IBA+DRV/c/TAF/FTC | 6.85 | 4.67 | 2 | 1 |
| 5 | IBA+DRV/c+BIC/TAF/FTC | 6.95 | 4.67 | 2 | 1 |
| 5 | RAL+DOR+3TC | 7 | 3 | 4 | 1 |
| 5 | IBA+DRV/r+BIC/TAF/FTC | 7.05 | 4.67 | 3 | 1 |
| 5 | RAL+DOR+DRV/c/TAF/FTC | 7.1 | 4.67 | 4 | 1 |
| 5 | DRV/r+DOR | 7.2 | 2 | 3 | 1 |
| 5 | RAL+3TC | 7.2 | 2 | 3 | 1 |
| 5 | DTG+IBA+DRV/r+TAF/FTC | 7.25 | 4.67 | 4 | 1 |
| 5 | IBA+DRV/r+DTG/RPV | 7.26 | 3.67 | 3 | 1 |
| 5 | RPV+DRV/c/TAF/FTC | 7.35 | 3.33 | 2 | 1 |
| 5 | LEN+DRV/r+TAF/FTC | 7.35 | 3.67 | 3 | 1 |
| 5 | DRV/c+RPV+3TC | 7.45 | 2.67 | 3 | 1 |
| 5 | DTG+IBA+DRV/c+DOR | 7.46 | 4 | 3 | 1 |
| 5 | LEN+DRV/r+BIC/TAF/FTC | 7.55 | 4.67 | 3 | 1 |
| 5 | DTG+LEN+DRV/c/TAF/FTC | 7.6 | 4.67 | 2 | 1 |
| 5 | RAL+DRV/r+DOR+TAF/FTC | 7.6 | 4.67 | 6 | 1 |
| 5 | DRV/r+RPV+3TC | 7.7 | 2.67 | 4 | 1 |
| 5 | LEN+RAL+DRV/r+3TC | 7.7 | 4 | 5 | 1 |
| 5 | DRV+RPV+EVG/c/TAF/FTC | 7.7 | 4.33 | 3 | 1 |
| 5 | LEN+DRV/c+BIC/TAF/FTC | 7.7 | 4.67 | 2 | 1 |
| 5 | RPV+EVG/c/TAF/FTC | 7.75 | 3.33 | 2 | 1 |
| 5 | RAL+IBA+DRV/c+3TC | 7.75 | 4 | 4 | 1 |
| 5 | DTG+LEN+DRV/r+TAF/FTC | 7.75 | 4.67 | 4 | 1 |
| 5 | LEN+DRV/r+DTG/RPV | 7.76 | 3.67 | 3 | 1 |
| 5 | DTG+IBA+DRV/r+DOR | 7.76 | 4 | 4 | 1 |
| 5 | EFV+TAF/FTC | 7.9 | 2.67 | 2 | 1 |
| 5 | IBA+DRV+EVG/c/TAF/FTC | 7.9 | 4.67 | 2 | 1 |
| 5 | RAL+DRV/r+EFV | 7.95 | 3 | 5 | 1 |
| 5 | RAL+IBA+DRV/r+3TC | 7.95 | 4 | 5 | 1 |
| 5 | RAL+RPV+DRV/c/TAF/FTC | 7.95 | 4.33 | 4 | 1 |
| 5 | LEN+RAL+IBA+DRV/r | 8 | 4 | 4 | 1 |
| 5 | DRV/r+EFV+TAF/FTC | 8.05 | 3.67 | 4 | 1 |
| 5 | LEN+RAL+IBA+DRV/c | 8.05 | 4 | 3 | 1 |
| 5 | IBA+DRV/c+3TC | 8.2 | 3 | 2 | 1 |
| 5 | DTG+LEN+DRV/c+DOR | 8.21 | 4 | 3 | 1 |
| 5 | LEN+RAL+DRV/c+3TC | 8.25 | 4 | 4 | 1 |
| 5 | DTG+LEN+DRV/r+DOR | 8.26 | 4 | 4 | 1 |
| 5 | IBA+DRV/r | 8.3 | 2 | 2 | 1 |
| 5 | RAL+DRV/r+RPV/TAF/FTC | 8.3 | 4.33 | 5 | 1 |
| 5 | IBA+DRV/c | 8.4 | 2 | 1 | 1 |
| 5 | LEN+DRV+EVG/c/TAF/FTC | 8.4 | 4.67 | 2 | 1 |
| 5 | DTG+LEN+IBA+DOR | 8.41 | 4 | 2 | 1 |
| 5 | RAL+IBA+DRV/c/TAF/FTC | 8.55 | 4.67 | 3 | 1 |
| 5 | DRV/r+RPV/TAF/FTC | 8.6 | 3.33 | 3 | 1 |
| 5 | LEN+DRV/r | 8.64 | 2 | 2 | 1 |
| 5 | RAL+RPV+3TC | 8.65 | 2.67 | 4 | 1 |
| 5 | RAL+IBA+DRV/c+RPV | 8.65 | 3.67 | 4 | 1 |
| 5 | RAL+IBA+DRV/c+DOR | 8.65 | 4 | 4 | 1 |
| 5 | LEN+DRV/c+3TC | 8.7 | 3 | 2 | 1 |
| 5 | DTG+DRV/r+ETR | 8.7 | 3 | 6 | 2 |
| 5 | IBA+DRV/c+DOR | 8.8 | 3 | 2 | 1 |
| 5 | FTR+DTG/3TC | 8.8 | 3 | 3 | 2 |
| 5 | DRV/r+ETR+TAF/FTC | 8.8 | 3.67 | 5 | 2 |
| 5 | RAL+DOR+TAF/FTC | 8.85 | 3.67 | 4 | 1 |
| 5 | RAL+IBA+DRV/r+DOR | 8.95 | 4 | 5 | 1 |
| 5 | RAL+IBA+DRV/r+TAF/FTC | 8.95 | 4.67 | 5 | 1 |
| 5 | LEN+DRV/c | 8.99 | 2 | 1 | 1 |
| 5 | RAL+RPV/TAF/FTC | 9 | 3.33 | 3 | 1 |
| 5 | RAL+IBA+DRV/r+RPV | 9 | 3.67 | 5 | 1 |
| 5 | DRV/r+EFV+3TC | 9.05 | 3 | 4 | 1 |
| 5 | IBA+DRV/r+3TC | 9.3 | 3 | 3 | 1 |
| 5 | LEN+RAL+DRV/c/TAF/FTC | 9.3 | 4.67 | 3 | 1 |
| 5 | RAL+EFV+3TC | 9.4 | 3 | 4 | 1 |
| 5 | LEN+RAL+DRV/c+RPV | 9.4 | 3.67 | 4 | 1 |
| 5 | LEN+RAL+DRV/c+DOR | 9.4 | 4 | 4 | 1 |
| 5 | LEN+RAL+DRV/r+DOR | 9.45 | 4 | 5 | 1 |
| 5 | LEN+RAL+DRV/r+TAF/FTC | 9.45 | 4.67 | 5 | 1 |
| 5 | DTG+FTR+DRV/c | 9.5 | 3 | 4 | 2 |
| 5 | LEN+RAL+DRV/r+RPV | 9.5 | 3.67 | 5 | 1 |
| 5 | LEN+DRV/c+DOR | 9.55 | 3 | 2 | 1 |
| 5 | LEN+DRV/r+3TC | 9.55 | 3 | 3 | 1 |
| 5 | DTG+FTR+DRV/r | 9.55 | 3 | 5 | 2 |
| 5 | EFV+DTG/3TC | 9.7 | 3 | 3 | 2 |
| 5 | RAL+DRV/r+ETR | 9.7 | 3 | 6 | 2 |
| 5 | DTG+FTR+IBA+DRV/c | 9.75 | 4 | 4 | 2 |
| 5 | DTG+FTR+DOR | 9.76 | 3 | 4 | 2 |
| 5 | DTG+FTR | 9.8 | 2 | 3 | 2 |
| 5 | DRV/r+ETR+3TC | 9.8 | 3 | 5 | 2 |
| 5 | DTG+FTR+IBA+DRV/r | 9.8 | 4 | 5 | 2 |
| 5 | DRV/r+EFV | 9.85 | 2 | 3 | 1 |
| 5 | RAL+DOR | 9.85 | 2 | 3 | 1 |
| 5 | DTG/RPV | 9.91 | 1.67 | 1 | 1 |
| 5 | IBA+DRV/c+RPV | 9.95 | 2.67 | 2 | 1 |
| 5 | IBA+DRV/r+DOR | 10 | 3 | 3 | 1 |
| 5 | LEN+RAL+3TC | 10 | 3 | 3 | 1 |
| 5 | RAL+IBA+3TC | 10 | 3 | 3 | 1 |
| 5 | RAL+IBA | 10.15 | 2 | 2 | 1 |
| 5 | RAL+DRV/r+EFV+TAF/FTC | 10.15 | 4.67 | 6 | 1 |
| 5 | RAL+LEN | 10.24 | 2 | 2 | 1 |
| 5 | DTG+LEN+FTR+DRV/r | 10.3 | 4 | 5 | 2 |
| 5 | FTR+DTG/RPV | 10.31 | 2.67 | 3 | 2 |
| 5 | DTG+DRV/r+ETR+TAF/FTC | 10.4 | 4.67 | 7 | 2 |
| 5 | DTG+DRV/r+EFV | 10.45 | 3 | 5 | 2 |
| 5 | LEN+DRV/r+DOR | 10.5 | 3 | 3 | 1 |
| 5 | IBA+DRV/c/TAF/FTC | 10.5 | 3.67 | 1 | 1 |
| 5 | IBA+EVG/c/TAF/FTC | 10.5 | 3.67 | 1 | 1 |
| 5 | DTG+LEN+FTR+DRV/c | 10.5 | 4 | 4 | 2 |
| 5 | DTG+EFV | 10.6 | 2 | 3 | 2 |
| 5 | FTR+BIC/TAF/FTC | 10.6 | 3.67 | 3 | 2 |
| 5 | FTR+IBA+DTG/RPV | 10.61 | 3.67 | 3 | 2 |
| 5 | DRV/c+RPV | 10.7 | 1.67 | 2 | 1 |
| 5 | LEN+DRV/c+RPV | 10.7 | 2.67 | 2 | 1 |
| 5 | RAL+FTR+DRV/c | 10.7 | 3 | 5 | 2 |
| 5 | RAL+IBA+DOR | 10.75 | 3 | 3 | 1 |
| 5 | RAL+FTR+DRV/r | 10.75 | 3 | 6 | 2 |
| 5 | DTG+FTR+TAF/FTC | 10.8 | 3.67 | 4 | 2 |
| 5 | ETR+TAF/FTC | 10.85 | 2.67 | 3 | 2 |
| 5 | RAL+FTR+IBA+DRV/c | 10.95 | 4 | 5 | 2 |
| 5 | LEN+RAL+DOR | 11 | 3 | 3 | 1 |
| 5 | FTR+DRV/c+DTG/3TC | 11 | 4 | 4 | 2 |
| 5 | RAL+FTR+IBA+DRV/r | 11 | 4 | 6 | 2 |
| 5 | FTR+DRV/r+DTG/3TC | 11.05 | 4 | 5 | 2 |
| 5 | LEN+FTR+DTG/RPV | 11.11 | 3.67 | 3 | 2 |
| 5 | RAL+ETR+3TC | 11.15 | 3 | 5 | 2 |
| 5 | DTG+EFV+TAF/FTC | 11.15 | 3.67 | 4 | 2 |
| 5 | IBA+DRV/r+RPV | 11.2 | 2.67 | 3 | 1 |
| 5 | RAL+EFV+TAF/FTC | 11.25 | 3.67 | 4 | 1 |
| 5 | DTG+FTR+IBA+DOR | 11.31 | 4 | 4 | 2 |
| 5 | DTG+IBA+EFV | 11.45 | 3 | 3 | 2 |
| 5 | DRV/r+ETR | 11.5 | 2 | 4 | 2 |
| 5 | RAL+IBA+DRV/r+EFV | 11.5 | 4 | 5 | 1 |
| 5 | LEN+RAL+FTR+DRV/r | 11.5 | 4 | 6 | 2 |
| 5 | DTG+FTR+DRV/c/TAF/FTC | 11.55 | 4.67 | 4 | 2 |
| 5 | IBA+DRV/r+TAF/FTC | 11.6 | 3.67 | 3 | 1 |
| 5 | FTR+DRV/r+BIC/TAF/FTC | 11.6 | 4.67 | 5 | 2 |
| 5 | FTR+DRV/c+BIC/TAF/FTC | 11.65 | 4.67 | 4 | 2 |
| 5 | FTR+DRV/c+DTG/RPV | 11.66 | 3.67 | 4 | 2 |
| 5 | LEN+DRV/r+RPV | 11.7 | 2.67 | 3 | 1 |
| 5 | LEN+RAL+FTR+DRV/c | 11.7 | 4 | 5 | 2 |
| 5 | DTG+FTR+DRV/r+TAF/FTC | 11.8 | 4.67 | 6 | 2 |
| 5 | DTG+LEN+FTR+DOR | 11.81 | 4 | 4 | 2 |
| 5 | FTR+DRV/r+DTG/RPV | 11.86 | 3.67 | 5 | 2 |
| 5 | RAL+DRV/r+ETR+TAF/FTC | 11.9 | 4.67 | 7 | 2 |
| 5 | DRV/r+RPV | 11.95 | 1.67 | 3 | 1 |
| 5 | DTG+FTR+DRV/c+DOR | 12.11 | 4 | 5 | 2 |
| 5 | RAL+LEN+TAF/FTC | 12.15 | 3.67 | 3 | 1 |
| 5 | RAL+IBA+TAF/FTC | 12.15 | 3.67 | 3 | 1 |
| 5 | DTG+DRV/r+EFV+TAF/FTC | 12.15 | 4.67 | 6 | 2 |
| 5 | LEN+IBA+DRV/c+RPV | 12.2 | 3.67 | 2 | 1 |
| 5 | DTG+IBA+DRV/r+ETR | 12.25 | 4 | 6 | 2 |
| 5 | DTG+FTR+DRV/r+DOR | 12.26 | 4 | 6 | 2 |
| 5 | RAL+EFV | 12.35 | 2 | 3 | 1 |
| 5 | FTR+DRV+EVG/c/TAF/FTC | 12.35 | 4.67 | 4 | 2 |
| 5 | RAL+IBA+RPV | 12.4 | 2.67 | 3 | 1 |
| 5 | RAL+FTR+DRV/c+3TC | 12.4 | 4 | 6 | 2 |
| 5 | RAL+FTR+DRV/r+3TC | 12.45 | 4 | 7 | 2 |
| 5 | IBA+DRV/r+EFV | 12.55 | 3 | 3 | 1 |
| 5 | LEN+RAL+RPV | 12.65 | 2.67 | 3 | 1 |
| 5 | RAL+ETR+TAF/FTC | 13 | 3.67 | 5 | 2 |
| 5 | RAL+IBA+EFV | 13.15 | 3 | 3 | 1 |
| 5 | LEN+IBA+DRV/r+RPV | 13.2 | 3.67 | 3 | 1 |
| 5 | LEN+IBA+DRV/r+DOR | 13.25 | 4 | 3 | 1 |
| 5 | RAL+IBA+DRV/r+ETR | 13.25 | 4 | 6 | 2 |
| 5 | RAL+FTR+DRV/c/TAF/FTC | 13.25 | 4.67 | 5 | 2 |
| 5 | IBA+DRV/r+ETR | 13.3 | 3 | 4 | 2 |
| 5 | LEN+IBA+DRV/c+DOR | 13.3 | 4 | 2 | 1 |
| 5 | RAL+FTR+DRV/c+DOR | 13.3 | 4 | 6 | 2 |
| 5 | DTG+FTR+EFV | 13.35 | 3 | 5 | 2 |
| 5 | RAL+FTR+DRV/c+RPV | 13.4 | 3.67 | 6 | 2 |
| 5 | RAL+RPV | 13.45 | 1.67 | 3 | 1 |
| 5 | RAL+FTR+DRV/r+DOR | 13.45 | 4 | 7 | 2 |
| 5 | RAL+FTR+DRV/r+TAF/FTC | 13.5 | 4.67 | 7 | 2 |
| 5 | RAL+FTR+DRV/r+RPV | 13.6 | 3.67 | 7 | 2 |
| 5 | LEN+RAL+IBA+RPV | 13.65 | 3.67 | 3 | 1 |
| 5 | LEN+RAL+IBA+DOR | 13.75 | 4 | 3 | 1 |
| 5 | FTR+DRV/r+3TC | 13.8 | 3 | 5 | 2 |
| 5 | FTR+DRV/c+3TC | 13.85 | 3 | 4 | 2 |
| 5 | FTR+DRV/r | 13.89 | 2 | 4 | 2 |
| 5 | FTR+DRV/c | 13.94 | 2 | 3 | 2 |
| 5 | DTG+IBA+DRV/r+EFV | 14 | 4 | 5 | 2 |
| 5 | RAL+ETR | 14.1 | 2 | 4 | 2 |
| 5 | DTG+FTR+DRV/r+ETR | 14.35 | 4 | 8 | 2 |
| 5 | RAL+FTR+3TC | 14.4 | 3 | 5 | 2 |
| 5 | DTG+LEN+DRV/r+ETR | 14.4 | 4 | 6 | 2 |
| 5 | FTR+DRV/c+DOR | 14.45 | 3 | 4 | 2 |
| 5 | FTR+DRV/r+DOR | 14.5 | 3 | 5 | 2 |
| 5 | RAL+IBA+ETR | 14.9 | 3 | 4 | 2 |
| 5 | DTG+FTR+IBA+EFV | 14.9 | 4 | 5 | 2 |
| 5 | RAL+FTR+DOR | 15.15 | 3 | 5 | 2 |
| 5 | RAL+FTR+DRV/r+ETR | 15.35 | 4 | 8 | 2 |
| 5 | FTR+DRV/r+ETR | 15.4 | 3 | 6 | 2 |
| 5 | LEN+RAL+DRV/r+ETR | 15.4 | 4 | 6 | 2 |
| 5 | LEN+DRV/r+ETR | 15.45 | 3 | 4 | 2 |
| 5 | FTR+EVG/c/TAF/FTC | 15.5 | 3.67 | 3 | 2 |
| 5 | RAL+FTR | 15.64 | 2 | 4 | 2 |
| 5 | FTR+DRV/c+RPV | 15.7 | 2.67 | 4 | 2 |
| 5 | FTR+DRV/c/TAF/FTC | 15.75 | 3.67 | 3 | 2 |
| 5 | FTR+DRV/r+RPV | 15.8 | 2.67 | 5 | 2 |
| 5 | FTR+DRV/r+TAF/FTC | 15.9 | 3.67 | 5 | 2 |
| 5 | FTR+IBA+DRV/c+RPV | 15.95 | 3.67 | 4 | 2 |
| 5 | FTR+IBA+DRV/c+DOR | 15.95 | 4 | 4 | 2 |
| 5 | FTR+IBA+DRV/r+DOR | 16 | 4 | 5 | 2 |
| 5 | DTG+FTR+DRV/r+EFV | 16 | 4 | 7 | 2 |
| 5 | RAL+FTR+DRV/r+EFV | 16 | 4 | 7 | 2 |
| 5 | FTR+IBA+DRV/r+RPV | 16.05 | 3.67 | 5 | 2 |
| 5 | RAL+FTR+TAF/FTC | 16.35 | 3.67 | 5 | 2 |
| 5 | RAL+FTR+IBA+RPV | 16.65 | 3.67 | 5 | 2 |
| 5 | RAL+FTR+IBA+DOR | 16.65 | 4 | 5 | 2 |
| 5 | LEN+FTR+DRV/r+DOR | 16.75 | 4 | 5 | 2 |
| 5 | LEN+RAL+ETR | 16.8 | 3 | 4 | 2 |
| 5 | LEN+FTR+DRV/r+RPV | 16.8 | 3.67 | 5 | 2 |
| 5 | RAL+FTR+RPV | 16.9 | 2.67 | 5 | 2 |
| 5 | RAL+FTR+ETR | 16.9 | 3 | 6 | 2 |
| 5 | FTR+IBA+DRV/r+ETR | 16.9 | 4 | 6 | 2 |
| 5 | LEN+FTR+DRV/c+RPV | 16.95 | 3.67 | 4 | 2 |
| 5 | LEN+FTR+DRV/c+DOR | 16.95 | 4 | 4 | 2 |
| 5 | FTR+DRV/r+EFV | 17.05 | 3 | 5 | 2 |
| 5 | LEN+RAL+FTR+RPV | 17.15 | 3.67 | 5 | 2 |
| 5 | LEN+RAL+FTR+DOR | 17.15 | 4 | 5 | 2 |
| 5 | RAL+FTR+EFV | 17.55 | 3 | 5 | 2 |
| 5 | LEN+IBA+DRV/r+ETR | 18.2 | 4 | 4 | 2 |
| 5 | RAL+FTR+IBA+ETR | 18.4 | 4 | 6 | 2 |
| 5 | FTR+IBA+DRV/r+EFV | 18.55 | 4 | 5 | 2 |
| 5 | RAL+FTR+IBA+EFV | 19.05 | 4 | 5 | 2 |
| 5 | LEN+FTR+DRV/r+ETR | 19.3 | 4 | 6 | 2 |
| 5 | LEN+RAL+IBA+ETR | 19.55 | 4 | 4 | 2 |
| 5 | LEN+RAL+FTR+ETR | 20.55 | 4 | 6 | 2 |
Report
Preferred regimen based on the HIV-ASSIST algorithm: DTG/3TC
DTG/3TC had the lowest weighted score (1.35) 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.
| Score Code | Regimen | Weighted Score | Active Drugs | Total Pills | Frequency (x/day) |
|---|---|---|---|---|---|
| 1 | DTG/3TC | 1.35 | 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.
| Score Code | Regimen | Weighted Score | Active Drugs | Total Pills | Frequency (x/day) |
|---|---|---|---|---|---|
| 2 | DTG+TAF/FTC | 1.6 | 2.67 | 2 | 1 |
| 2 | BIC/TAF/FTC | 1.75 | 2.67 | 1 | 1 |
| 2 | DRV/c+3TC | 1.95 | 2 | 2 | 1 |
| 2 | DRV/c+DTG/3TC | 2.1 | 3 | 2 | 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.
* 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 |
| V75T | 0 | 0 | 0 | 0 | 0 | 10 | 60 | 30 |
| K219Q | 0 | 0 | 5 | 5 | 5 | 10 | 10 | 5 |
| Total | 0 | 0 | 15 | 15 | 15 | 50 | 100 | 50 |
| NNRTI Mutation(s) | EFV | ETR | RPV | NVP | DOR |
|---|---|---|---|---|---|
| A98G | 10 | 10 | 15 | 30 | 10 |
| Total | 10 | 10 | 15 | 30 | 10 |
| PI Mutation(s) | LPVr | FPVr | TPVr | SQVr | IDVr | NFV | ATVr | ATVc | ATV | DRV | DRVr | DRVc |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| L24I | 10 | 10 | -5 | 10 | 15 | 10 | 10 | 10 | 10 | 0 | 0 | 0 |
| K43T | 0 | 0 | 10 | 0 | 0 | 10 | 0 | 0 | 0 | 0 | 0 | 0 |
| 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 |
| V82S | 30 | 15 | 30 | 15 | 30 | 30 | 30 | 30 | 30 | 0 | 0 | 0 |
| M46ILV + V82ACFLMST | 10 | 10 | 0 | 10 | 10 | 10 | 10 | 10 | 10 | 0 | 0 | 0 |
| I54ALMSTV + V82ACFLMST | 10 | 10 | 0 | 10 | 10 | 10 | 10 | 10 | 10 | 0 | 0 | 0 |
| Total | 85 | 65 | 65 | 70 | 90 | 110 | 85 | 85 | 85 | 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 |
| CI Mutation(s) | LEN |
|---|---|
| Total | 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.
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 1.5
- HIV-ASSIST Notes:
- EFV is associated with neuropsychiatric effects and can exacerbate psychiatric symptoms. It may be associated with suicidality. Consider avoiding EFV-based regimens if possible. Symptoms usually subside or diminish after 2 to 4 weeks. Bedtime dosing may reduce symptoms. Risks include psychiatric illness, concomitant use of agents with neuropsychiatric effects, and increased EFV concentrations because of genetic factors or increased absorption with food.
- Penalty:
- 0
- Penalty:
- 0.5
- HIV-ASSIST Notes:
- RPV is associated with depression, suicidality, and sleep disturbances. DHHS guidelines suggest RPV can exacerbate psychiatric symptoms and state, "Consider avoiding RPV based regimens"
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0.1
- HIV-ASSIST Notes:
- Insomnia, depression, and suicidality have been infrequently reported with INSTI use, primarily in patients with preexisting psychiatric conditions. DHHS guidance suggests 'patients with pre-existing psychiatric conditions on INSTI based regimens should be closely monitored"
- Penalty:
- 0.1
- HIV-ASSIST Notes:
- Insomnia, depression, and suicidality have been infrequently reported with INSTI use, primarily in patients with preexisting psychiatric conditions. DHHS guidance suggests 'patients with pre-existing psychiatric conditions on INSTI based regimens should be closely monitored"
- Penalty:
- 0.1
- HIV-ASSIST Notes:
- Insomnia, depression, and suicidality have been infrequently reported with INSTI use, primarily in patients with preexisting psychiatric conditions. DHHS guidance suggests 'patients with pre-existing psychiatric conditions on INSTI based regimens should be closely monitored"
- Penalty:
- 0.1
- HIV-ASSIST Notes:
- Insomnia, depression, and suicidality have been infrequently reported with INSTI use, primarily in patients with preexisting psychiatric conditions. DHHS guidance suggests 'patients with pre-existing psychiatric conditions on INSTI based regimens should be closely monitored"
- Penalty:
- 0.1
- HIV-ASSIST Notes:
- Insomnia, depression, and suicidality have been infrequently reported with INSTI use, primarily in patients with preexisting psychiatric conditions. DHHS guidance suggests 'patients with pre-existing psychiatric conditions on INSTI based regimens should be closely monitored"
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
- Penalty:
- 0
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.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Paliperidone is primarily eliminated renally (possibly via OCT) with minimal metabolism occurring via CYP2D6 and CYP3A4. There is little potential for an interaction with lamivudine via competition for active renal transport mechanisms given the possible limited role of OCT in paliperidone’s elimination.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Paliperidone is primarily eliminated renally (possibly via OCT) with minimal metabolism occurring via CYP2D6 and CYP3A4.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Paliperidone is primarily eliminated renally (possibly via OCT) with minimal metabolism occurring via CYP2D6 and CYP3A4.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Paliperidone is primarily eliminated renally (possibly via OCT) with minimal metabolism occurring via CYP2D6 and 3A4. Emtricitabine and tenofovir derived from tenofovir alafenamide are unlikely to significantly impair paliperidone elimination. Dose Descovy according to the concomitant antiretroviral.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Paliperidone is primarily eliminated renally (possibly via OCT) with minimal metabolism occurring via CYP2D6 and CYP3A4.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Paliperidone is primarily eliminated renally (possibly via OCT) with minimal metabolism occurring via CYP2D6 and CYP3A4.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Paliperidone is primarily eliminated renally (possibly via OCT) with minimal metabolism occurring via CYP2D6 and CYP3A4.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Paliperidone is primarily eliminated renally (possibly via OCT) with minimal metabolism occurring via CYP2D6 and CYP3A4.
- Penalty:
- 0.25
- Liverpool Interaction Status:
- Yellow/Moderate-low: Potential Weak Interaction (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied. Paliperidone is primarily eliminated renally, with minimal metabolism occurring via CYP2D6 and CYP3A4. Efavirenz could potentially decrease paliperidone concentrations although to a limited extent and therefore no a priori dosage adjustment is needed. Paliperidone has a possible risk of QT prolongation and/or TdP on the CredibleMeds.org website. Efavirenz was shown to prolong the QT interval above the regulatory threshold of concern in homozygous carriers of the CYP2B6*6/*6 allele (i.e. 516T variant in the gene encoding CYP2B6). The European product label for efavirenz contraindicates coadministration with a drug with a known risk of Torsade de Pointes whereas the American product label for efavirenz recommends that alternatives should be considered. As the potential risk of a QT interval prolongation relates specifically to homozygous carriers of CYP2B6*6/*6 and given the accumulated years of safety data with efavirenz and such drugs, the contraindication is not reflected in the colour coding of this interaction summary.
- Penalty:
- 0.25
- Liverpool Interaction Status:
- Yellow/Moderate-low: Potential Weak Interaction (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied. Paliperidone is primarily eliminated renally, with minimal metabolism occurring via CYP2D6 and CYP3A4. Etravirine could potentially decrease paliperidone concentrations although to a limited extent and therefore no a priori dosage adjustment is needed.
- Penalty:
- 0.25
- Liverpool Interaction Status:
- Yellow/Moderate-low: Potential Weak Interaction (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Paliperidone is primarily eliminated renally, with minimal metabolism occurring via CYP2D6 and CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with paliperidone. However, the product labels for rilpivirine indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Paliperidone has a possible risk of QTc prolongation and/or TdP on the CredibleMeds.org website.
- Penalty:
- 0.25
- Liverpool Interaction Status:
- Yellow/Moderate-low: Potential Weak Interaction (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied. Paliperidone is primarily eliminated renally, with minimal metabolism occurring via CYP2D6 and CYP3A4. Nevirapine could potentially decrease paliperidone concentrations although to a limited extent and therefore no a priori dosage adjustment is needed.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Paliperidone is primarily eliminated renally (possibly via OCT) with minimal metabolism occurring via CYP2D6 and CYP3A4. Doravirine is unlikely to significantly impair paliperidone’s elimination or metabolism.
- Penalty:
- 1
- Liverpool Interaction Status:
- Amber/Moderate: Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied. Paliperidone is primarily eliminated renally, with minimal metabolism occurring via CYP2D6 and CYP3A4. Lopinavir/ritonavir could potentially increase paliperidone concentrations although to a limited extent and therefore no a priori dosage adjustment is needed. However, caution should be exercised as both drugs have possible risks of QT prolongation and/or TdP on the CredibleMeds.org website.
- Penalty:
- 0.25
- Liverpool Interaction Status:
- Yellow/Moderate-low: Potential Weak Interaction (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied. Paliperidone is primarily eliminated renally, with minimal metabolism occurring via CYP2D6 and CYP3A4. Fosamprenavir/ritonavir could potentially increase paliperidone concentrations although to a limited extent and therefore no a priori dosage adjustment is needed.
- Penalty:
- 0.25
- Liverpool Interaction Status:
- Yellow/Moderate-low: Potential Weak Interaction (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied. Paliperidone is primarily eliminated renally, with minimal metabolism occurring via CYP2D6 and CYP3A4. Tipranavir/ritonavir could potentially increase paliperidone concentrations although to a limited extent and therefore no a priori dosage adjustment is needed.
- Penalty:
- 0
- Penalty:
- 0.25
- Liverpool Interaction Status:
- Yellow/Moderate-low: Potential Weak Interaction (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied. Paliperidone is primarily eliminated renally, with minimal metabolism occurring via CYP2D6 and CYP3A4. Indinavir/ritonavir could potentially increase paliperidone concentrations although to a limited extent and therefore no a priori dosage adjustment is needed.
- Penalty:
- 0
- Penalty:
- 1
- Liverpool Interaction Status:
- Amber/Moderate: Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied. Paliperidone is primarily eliminated renally, with minimal metabolism occurring via CYP2D6 and CYP3A4. Atazanavir/ritonavir could potentially increase paliperidone concentrations although to a limited extent and therefore no a priori dosage adjustment is needed. However, the product label for atazanavir advises caution when prescribing atazanavir with medicinal products which have the potential to increase the QT interval; paliperidone has a possible risk of QT prolongation and/or TdP on the CredibleMeds.org website.
- Penalty:
- 1
- Liverpool Interaction Status:
- Amber/Moderate: Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied. Paliperidone is primarily eliminated renally, minimal metabolism occurs via CYP2D6 and CYP3A4. Atazanavir/cobicistat could potentially increase paliperidone although to a limited extent, therefore no a priori dosage adjustment is needed. However, the product label for atazanavir advises caution when prescribing atazanavir with medicinal products which have the potential to increase the QT interval; paliperidone has a possible risk of QT prolongation and/or TdP on the CredibleMeds.org website.
- Penalty:
- 1
- Liverpool Interaction Status:
- Amber/Moderate: Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied. Paliperidone is primarily eliminated renally, minimal metabolism occurs via CYP2D6 and CYP3A4. Atazanavir could potentially increase paliperidone although to a limited extent, therefore no a priori dosage adjustment is needed. However, the product label for atazanavir advises caution when prescribing atazanavir with medicinal products which have the potential to increase the QT interval; paliperidone has a possible risk of QT prolongation and/or TdP on the CredibleMeds.org website.
- Penalty:
- 0.25
- Liverpool Interaction Status:
- Yellow/Moderate-low: Potential Weak Interaction (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied. Paliperidone is primarily eliminated renally, with minimal metabolism occurring via CYP2D6 and CYP3A4. Darunavir/ritonavir could potentially increase paliperidone concentrations although to a limited extent and therefore no a priori dosage adjustment is needed.
- Penalty:
- 0.25
- Liverpool Interaction Status:
- Yellow/Moderate-low: Potential Weak Interaction (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied. Paliperidone is primarily eliminated renally, with minimal metabolism occurring via CYP2D6 and CYP3A4. Darunavir/ritonavir could potentially increase paliperidone concentrations although to a limited extent and therefore no a priori dosage adjustment is needed.
- Penalty:
- 0.25
- Liverpool Interaction Status:
- Yellow/Moderate-low: Potential Weak Interaction (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied. Paliperidone is primarily eliminated renally, with minimal metabolism occurring via CYP2D6 and CYP3A4. Darunavir/cobicistat could potentially increase paliperidone although to a limited extent therefore no a priori dosage adjustment is needed.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Paliperidone is primarily eliminated renally, with minimal metabolism occurring via CYP2D6 and CYP3A4.
- Penalty:
- 0.25
- Liverpool Interaction Status:
- Yellow/Moderate-low: Potential Weak Interaction (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied. Paliperidone is primarily eliminated renally (possibly via OCT) with minimal metabolism occurring via CYP2D6 and 3A4. Elvitegravir/cobicistat could potentially increase paliperidone although to a limited extent therefore no a priori dosage adjustment is recommended. Emtricitabine and tenofovir derived from tenofovir alafenamide are unlikely to significantly impair paliperidone elimination.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism/elimination and toxicity profiles of both drugs there is little potential for interaction. Paliperidone is primarily eliminated renally (possibly OCT), with minimal metabolism occurring via CYP2D6 and CYP3A4. Dolutegravir is not expected to inhibit or induce CYP450 enzymes at clinically relevant concentrations. In vitro data indicate that dolutegravir inhibits OCT2 but is unlikely to cause a clinically relevant drug interaction with paliperidone.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Paliperidone is primarily eliminated renally (possibly via OCT) with minimal metabolism occurring via CYP2D6 and CYP3A4. Bictegravir, emtricitabine and tenofovir derived from tenofovir alafenamide are unlikely to significantly impair paliperidone’s elimination or metabolism.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied, but based on metabolism and clearance a clinically significant interaction is unlikely. Paliperidone is primarily eliminated renally (possibly OCT), with minimal metabolism occurring via CYP2D6 and 3A4. Cabotegravir does not cause clinically relevant inhibition of renal transporters and was shown to have no inhibitory or inducing effects on CYP enzymes at clinically relevant concentrations.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Paliperidone is primarily eliminated renally, with minimal metabolism occurring via CYP2D6 and CYP3A4.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. No drug interaction studies have been conducted with ibalizumab: based on ibalizumab’s mechanism of action and target-mediated drug disposition, drug-drug interactions are not expected. Paliperidone undergoes hepatic metabolism whereas ibalizumab, a monoclonal antibody binding to the CD4 receptor, is likely to be eliminated via intracellular catabolism similarly to other monoclonal antibodies.
- Penalty:
- 0.25
- Liverpool Interaction Status:
- Yellow/Moderate-low: Potential Weak Interaction (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Paliperidone is primarily eliminated renally (possibly via OCT) with minimal metabolism occurring via CYP2D6 and CYP3A4. Fostemsavir is a prodrug and is hydrolysed to the active compound temsavir in the small intestine. Temsavir is mainly metabolized by esterase-mediated hydrolysis with a small contribution of CYP3A4. Temsavir does not inhibit or induce CYP enzymes. Fostemsavir has been associated with prolongation of the QTc interval at supra-therapeutic doses and the product label for fostemsavir indicates that fostemsavir should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Paliperidone has a possible risk of QTc prolongation and/or TdP on the CredibleMeds.org website. An interaction to increase QTc prolongation is unlikely to occur with paliperidone.
- Penalty:
- 0
- Liverpool Interaction Status:
- Green/Low: No Interaction Expected (Very Low Quality of Evidence)
- Liverpool Notes:
- Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Paliperidone is primarily eliminated renally (possibly via OCT) with minimal metabolism occurring via CYP2D6 and CYP3A4. Lenacapavir is mainly cleared as unchanged drug and does not inhibit or induce CYP2D6 in the range of clinically relevant concentrations. In addition, lenacapavir does not inhibit the renal transporters OCTs. Lenacapavir is a moderate inhibitor of CYP3A4 but a clinically relevant interaction is unlikely as CYP3A4 plays a minor role in paliperidone elimination.