Fellow experts & HIV enthusiasts!
Within one week, I've come across the use and/or suggestion of a
4-drug regimen for patients exposed to PrEP who seroconvert HIV+
Last week: New pt est care at my office, hx of PrEP exposure (inconsistent use) now HIV+ and was started on 4-drug regimen of Tivicay + Symtuza prior to seeing me.
Today: I read on National HIV Curriculum; "
Some experts, however, would consider utilizing a more aggressive four-drug initial regimen, such as darunavir (boosted with cobicistat or ritonavir) plus dolutegravir plus either tenofovir alafenamide-emtricitabine or tenofovir DF-emtricitabine, until results from the genotypic drug resistance test became available." BUT NO REFERENCE.
Quick literature search found no reference to this practice. Is this experimental? Accepted practice? Standard of Practice?
I've read how Biktarvy (biktegravir-FTC-TAF) works well despite M184V resistance (which would be the presumptive mutation in someone exposed to PrEP who then tests positive for HIV), and could potentially still be used (as opposed to 4-drug regimen).
What do you folks do?
Thoughts? (and thanks!)
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Kurtis Mohr, MD, AAHIVS (he/him/his)
HIV Medicine Fellow, Kaiser Permanente
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