Keep in mind ibalizumab. We have one patient with XDR HIV (four-class resistance) due to inability to adhere to oral medication who has done well for over a year now with ibalizumab + lenacapavir. He is able to report q2weeks to Option Care for his infusion ...

To give a good answer to this question, I'd want to know his actual mutations - to see whether he needs once- or twice-daily DRV, for example, and whether there's any point in continuing an INSTI. But even the most carefully chosen regimen won't work ...

Gary, You don't mention anything about PI resistance, so I am going to assume he has none. With the information you provided, lenacapavir and boosted darunavir should work fine as long as he adheres to this regimen. I don't think I would keep ...