Academy Exchange

Good Evening Friends and Colleagues,

What are your thought on starting Cabenuva (CAB/RPV) in a patient with a genotyped K103N mutation? I know this mutation can generally confer resistance to NNRTI's especially NVP; however, the patient does not have the L100I mutation, so literature I have reviewed seems to lean towards CAB/RPV should be okay. The patient has no resistance to RPV or CAB. Doing a chart review, it looks like this was an acquired mutation, he had no documented treatment failures, and was diagnosed with a low viral load and started on Dovato as an initial regimen (not by me). 

Thank you for your time.

Good Evening Friends and Colleagues,

What are your thought on starting Cabenuva (CAB/RPV) in a patient with a genotyped K103N mutation? I know this mutation can generally confer resistance to NNRTI's especially NVP; however, the patient does not have the L100I mutation, so literature I have reviewed seems to lean towards CAB/RPV should be okay. The patient has no resistance to RPV or CAB. Doing a chart review, it looks like this was an acquired mutation, he had no documented treatment failures, and was diagnosed with a low viral load and started on Dovato as an initial regimen (not by me). 

Thank you for your time.

Completely agree with Adam; K103N was allowed in Cabenuva trials. Just check there is no reason to think he has other non nucleoside mutations other than 103N and if he has been adherent to dolutegravir there is no medical reason not to switch your patient to LA- CAB + RPV. 

Good Evening Friends and Colleagues,

What are your thought on starting Cabenuva (CAB/RPV) in a patient with a genotyped K103N mutation? I know this mutation can generally confer resistance to NNRTI's especially NVP; however, the patient does not have the L100I mutation, so literature I have reviewed seems to lean towards CAB/RPV should be okay. The patient has no resistance to RPV or CAB. Doing a chart review, it looks like this was an acquired mutation, he had no documented treatment failures, and was diagnosed with a low viral load and started on Dovato as an initial regimen (not by me). 

Thank you for your time.