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  • 1.  Cabenuva switch

    Posted 08-18-2023 08:20
    I have a newly diagnosed 28yo male with initial CD4 of 418 and viral load of 780 who I started on Biktarvy, but he's strongly pushing for eventual Cabenuva switch based on all those adds he's seeing.  His genotype showed no integrase resistance, a single NRTI mutation (Q151L), no PI resistance, but multiple NNRTI mutations (I178L, V189I, P225H, V245E, L283I, P225H) with the interpretation "Doravirine, Efavirenz: resistance possible, Etravirine, Rilpivirine sensitive."

    Cabenuva with the rilpivirine SHOULD be fine, but given the (admittedly) small percentage of patients failing Cabenuva with INI and/or NNRTI resistance would everybody feel more confident than I'm feeling about this switch?  Biktarvy seems to be a perfect choice in this patient.

    Ben Stearn

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