Academy Exchange

Hello all, 

First time posting here and could use some guidance. I had switched a gentleman from Biktarvy to CAB/RPV due to his strong preference to stop oral ART. He is a 34 year old latine MSM dx 2008. Past hx of ART incluces DTG/TDF/FTC since 2016, prior to that abacavir dx Kaletra, ATZ and some other regimens he can't recall. He was living in out of country at dx and was switched many times d/t lack of availability of ART. He would often take every other day trying to stretch and make his medication last, sometimes had gaps of no more than 10 days. Proviral wasn't able to amplify prior to switch, no past genotypes on file. 

I decided to start him on monthly and keep a close eye on VL given unclear med hx and possible masked resistance then switch him after a few months to Q 2 months if he remained virally suppressed but there was administration timing error while I was out of office on parental leave. When switched to every two months was planned he was given the 1 month dose then came back two months later instead of 1 month later to receive 2 month dose.

Here's the timeline of events

9/27/24 loading dose

10/25/24 monthly dose VL UD

11/27/24 monthly dose VL UD

12/27/24 monthly dose VL UD

Plan was to switch to every two months but this didn't happen and he came two months later after the monthly dose

2/26/25 VL 92

2/28/25 600/900 dose given as monthly wasn't available at time of injection.

3/28/2024 VL 170

4/1/25 monthly dose VL UD

4/29/25 monthly dose VL 26

On 4/1/2025 genotype showed M184VI, K103N and H221H/Y so some low level RPV resistance.

Insti genotype was ordered but unable to amplify, No proviral ordered at that time

Given this mutation BUT that he's now virally suppressed I'm not sure at this point if I should switch.  He does strongly prefer LAI but I'm worried about the partial activity RPV given noted mutation on genotype. I plan on trying for a proviral to see if any insti resistance and if there is any noted definitely switch but perhaps should switch anyway re RPV mutation. Might add lencap but that could be overkill. 

Any advice would be appreciated!!

Hello all, 

First time posting here and could use some guidance. I had switched a gentleman from Biktarvy to CAB/RPV due to his strong preference to stop oral ART. He is a 34 year old latine MSM dx 2008. Past hx of ART incluces DTG/TDF/FTC since 2016, prior to that abacavir dx Kaletra, ATZ and some other regimens he can't recall. He was living in out of country at dx and was switched many times d/t lack of availability of ART. He would often take every other day trying to stretch and make his medication last, sometimes had gaps of no more than 10 days. Proviral wasn't able to amplify prior to switch, no past genotypes on file. 

I decided to start him on monthly and keep a close eye on VL given unclear med hx and possible masked resistance then switch him after a few months to Q 2 months if he remained virally suppressed but there was administration timing error while I was out of office on parental leave. When switched to every two months was planned he was given the 1 month dose then came back two months later instead of 1 month later to receive 2 month dose.

Here's the timeline of events

9/27/24 loading dose

10/25/24 monthly dose VL UD

11/27/24 monthly dose VL UD

12/27/24 monthly dose VL UD

Plan was to switch to every two months but this didn't happen and he came two months later after the monthly dose

2/26/25 VL 92

2/28/25 600/900 dose given as monthly wasn't available at time of injection.

3/28/2024 VL 170

4/1/25 monthly dose VL UD

4/29/25 monthly dose VL 26

On 4/1/2025 genotype showed M184VI, K103N and H221H/Y so some low level RPV resistance.

Insti genotype was ordered but unable to amplify, No proviral ordered at that time

Given this mutation BUT that he's now virally suppressed I'm not sure at this point if I should switch.  He does strongly prefer LAI but I'm worried about the partial activity RPV given noted mutation on genotype. I plan on trying for a proviral to see if any insti resistance and if there is any noted definitely switch but perhaps should switch anyway re RPV mutation. Might add lencap but that could be overkill. 

Any advice would be appreciated!!

Hello all, 

First time posting here and could use some guidance. I had switched a gentleman from Biktarvy to CAB/RPV due to his strong preference to stop oral ART. He is a 34 year old latine MSM dx 2008. Past hx of ART incluces DTG/TDF/FTC since 2016, prior to that abacavir dx Kaletra, ATZ and some other regimens he can't recall. He was living in out of country at dx and was switched many times d/t lack of availability of ART. He would often take every other day trying to stretch and make his medication last, sometimes had gaps of no more than 10 days. Proviral wasn't able to amplify prior to switch, no past genotypes on file. 

I decided to start him on monthly and keep a close eye on VL given unclear med hx and possible masked resistance then switch him after a few months to Q 2 months if he remained virally suppressed but there was administration timing error while I was out of office on parental leave. When switched to every two months was planned he was given the 1 month dose then came back two months later instead of 1 month later to receive 2 month dose.

Here's the timeline of events

9/27/24 loading dose

10/25/24 monthly dose VL UD

11/27/24 monthly dose VL UD

12/27/24 monthly dose VL UD

Plan was to switch to every two months but this didn't happen and he came two months later after the monthly dose

2/26/25 VL 92

2/28/25 600/900 dose given as monthly wasn't available at time of injection.

3/28/2024 VL 170

4/1/25 monthly dose VL UD

4/29/25 monthly dose VL 26

On 4/1/2025 genotype showed M184VI, K103N and H221H/Y so some low level RPV resistance.

Insti genotype was ordered but unable to amplify, No proviral ordered at that time

Given this mutation BUT that he's now virally suppressed I'm not sure at this point if I should switch.  He does strongly prefer LAI but I'm worried about the partial activity RPV given noted mutation on genotype. I plan on trying for a proviral to see if any insti resistance and if there is any noted definitely switch but perhaps should switch anyway re RPV mutation. Might add lencap but that could be overkill. 

Any advice would be appreciated!!