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  • 1.  Biktarvy with LLV

    Posted 07-26-2022 22:05

    There are a few patients that we have in clinic and there is a number of other sites that I'm aware of that have patients on Biktarvy with LLV who overall are doing quite well. No ADRs,  swear by excellent compliance, usually few prior regimens, no historical genotypes suggesting resistance in the past. Overall these bounce around 50-400 with avg of ~200 copies/mL. Has anyone done anything different other than comprehensive re-evaluation of the basics and monitor a bit closer (compliance, DDIs, etc)? Especially as well tolerated and likely limited STR alternative options. (DDIs/age. etc)

    Thanks in advance!

    Tomasz Jodlowski, PharmD
    Boise ID

  • 2.  RE: Biktarvy with LLV

    Posted 08-11-2022 12:34
    Hi Tomasz.

    I generally follow the DHHS guidelines on low level viremia. As our assays have gotten more and more sensitive, I'm seeing a lot more detectable and quantifiable viral loads, on all regimens. Under 50 c/mL I generally don't do much and don't really change the monitoring schedule. 50-200 c/mL I ask about missed doses, look for drug drug interactions and try to get them back for a recheck within 3 months. Over 200 c/mL I worry much more about adherence and the risk of developing resistance if it persists, so I will bring those patients back sooner for an evaluation and recheck (and genotype if possible), but I don't presumptively change the regimen without a frank conversation with the patient and a careful review of all factors that might be impacting their ability to take their medications. Definitely curious to hear about the practices of others!


    Lealah Pollock, MD MS
    UCSF, National Clinician Consultation Center, Perinatal HIV Hotline
    San Francisco CA