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Test Case PA

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
Submitted by ahaines8 on

<p>Our study recruits participants who qualify for CAP/RPV based on pre-screening evidence. The goal of the study is to optimize drug regimens for adolescents and young adults, and to gauge interest in and knowledge of LAIs among this population and providers who serve this population. I did a test run on this potential participant because I had a hunch that they would not qualify for CAB/RPV, even though none of the exclusion criteria we are using for pre-screening are met. I read the rationale and understand how the program arrived at that conclusion. Of note, this patient was perinatally infected and he is 29 y/o; he had been on DRV/r-ETR-RAL from 2009-2017, and has been on DRV/c since 2017, TAF/FTC since 2018, DTG since 2018. Previously he took:&nbsp;</p><p>2007-2009: ABC-TDF-FTC, LPV/r, SQV<br>2004-2007: ZDV-TDF-FTC, LPV/r &nbsp;<br>2003-2004: TDF, 3TC, LPV/r<br>2002-2003: DDL, 3TC, NVP, LPV/r &nbsp;<br>2001-2002: DDL. 3TC. LPV/r &nbsp;<br>2001 : DDL, D4T, NFV<br>He briefly took RPV for ~8 months in 2017, but there is a note explaining that he has high-level resistance to RPV, but I have not found the source of this note.</p><p>I wanted to share because I learned a lot about mutations and other exclusionary criteria.</p>

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
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Comments

Submitted by maunank on Tue, 02/11/2025 - 12:30

Dear Ahaines, Thank you for the note. One item I will point out for the purposes of getting the optimal results, is to enter the prior treatment history in the 'Treatment History/Failure' section. The reason to include this information is if you want a more conservative approach--the system will also consider the potential for archived mutations that are not entered (such as M184V, which wasn't listed in the genotype, but might be present given the amount of NRTI exposure).  In that instance, the results would be a bit different (ie the system would steer away from DTG/3TC alone). For the purposes of your study, it doesn't make as much of a difference and the system would approach CAB/RPV very cautiously (and with the treatment history, it would become almost contraindicated if one considers potential additional unrecognized NNRTI resistance). Happy to discuss further if helpful.