Very interesting case that brings up questions about if a patient has no initial risk factors for failure initially and does well on cabenuva for a year but than starts to fail assuming on time injections what other reasons for failure?? Depositis of drug at injection sites not absorbed ? Some type of drug interaction ? Or something else? Also I have used rukobia with 2 nucs in a patient like this where I am worried about DDI to symtuza even though it is BID and want to hold off or have resistance to integrase Lastly I know the DHSS guidelines states failure as well as transmissability are at risk with viral load levels > 200 but do some countries still use viral load levels of < 400 to indicate viral load suppression ?? Thanks peter gulick