Table 4.
Cases Involving Drug Resistance and Viral Suppression
| Most Common Responses | ||||
|---|---|---|---|---|
| Casea | Case Summary | Cumulative Resistance | Classesb,c | No. (%) |
| S1 | 43 y, M VL <20 CD4 >200 Taking TAF/FTC/DRV/c + DTG Prior treatment failure (unknown regimen) Requests simplification |
NRTI: M184V NNRTI: K103N |
1 INSTI, 2 NRTI 1 INSTI, 1 NNRTI 1 PI, 1 INSTI, 2 NRTI Other |
42 (54.5) 20 (26.0) 9 (11.7) 6 (7.8) |
| S2 | 37 y, M VL <20 CD4, 375 Taking EVG/c/TDF/FTC Prior failure of EFV/TDF/FTC |
NRTI: M184V | 1 INSTI, 2 NRTI 1 INSTI, 1 NNRTI Other |
56 (78.9) 13 (18.3) 2 (2.8) |
| S3 | 24 y, F VL <20 CD4 >200 Taking BIC/TAF/FTC Perinatal HIV, desires few pills Prior AZT, AZT/ABC/3TC, LPV/r + AZT/3TC, EFV/TDF/FTC, ATV/r + TDF/FTC, suppressed >1 y |
NRTI: M184V | 1 INSTI, 2 NRTI 1 INSTI, 1 NNRTI 1 INSTI, 1 NRTI |
42 (73.7) 14 (24.6) 1 (1.7) |
| S4 | 64 y, F VL <20 CD4, 380 Taking DTG + TDF/FTC Prior EFV/TDF/FTC |
Archived genotype NRTI: K65R, M184V NNRTI: K103N |
1 INSTI, 2 NRTI 1 INSTI, 1 NNRTI 1 PI, 1 INSTI Other |
28 (51.8) 17 (31.5) 3 (5.6) 6 (11.1) |
| S5 | 36 y, F VL <20 CD4, 440 Taking DRV/r + TDF/FTC for 12 mo Prior EFV/TDF/FTC Preferences for decreased pill burden |
NRTI: M184V, M41L, T215Y, L210W | 1 INSTI, 1 NNRTI 1 INSTI, 2 NRTI 1 PI, 2 NRTI Other |
37 (64.9) 8 (14.0) 7 (12.3) 5 (8.8) |
Abbreviations: INSTI, integrase strand transfer inhibitor; K, thousand; NNRTI, nonnucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; PI, protease inhibitor; VL, viral load.
aFor a list of antiretroviral abbreviations, full clinical vignette details, as well as specific antiretroviral regimen responses, see Supplementary Tables 1–3.
bSecond-generation INSTIs were selected by providers (ie, dolutegravir, bictegravir, cabotegravir); no first-generation INSTIs were selected (ie, elvitegravir and raltegravir), with the exception of case S2, where the patient was already taking an elvitegravir-containing regimen; boosted darunavir was selected in all cases as the PI.
cCabotegravir/rilpivirine use as follows: S1, n = 11 (14.3%); S2, n = 12 (16.9%); S3, n = 14 (24.6%); S4, n = 1 (1.7%); S5, n = 30 (52.6%).