Academy Exchange

Good morning,

I'm hoping for guidance on changing ART for a 79 y/o M with long history of HIV, but new to our practice. Briefly, he is virally suppressed on FTC/TAF + ATV 400mg daily. He's been on the current regimen since 2018, and notes from previous provider state that only known prior regimen was FTC/TDF + ATV 400mg daily. Patient is unaware of any prior resistance or virologic failure, but no genotype is available. He was diagnosed in the mid-90s. PMH is significant for stage 3b CKD, CAD, HTN, COPD, dyslipidemia. 

Good morning,

I'm hoping for guidance on changing ART for a 79 y/o M with long history of HIV, but new to our practice. Briefly, he is virally suppressed on FTC/TAF + ATV 400mg daily. He's been on the current regimen since 2018, and notes from previous provider state that only known prior regimen was FTC/TDF + ATV 400mg daily. Patient is unaware of any prior resistance or virologic failure, but no genotype is available. He was diagnosed in the mid-90s. PMH is significant for stage 3b CKD, CAD, HTN, COPD, dyslipidemia. 

Do a search to all his labs to see if genotype done at any time, and this maybe time consuming and it may yield

significant results, and as to change, there are other options, and as usual if it ain't broke, don't fix it

Good morning,

I'm hoping for guidance on changing ART for a 79 y/o M with long history of HIV, but new to our practice. Briefly, he is virally suppressed on FTC/TAF + ATV 400mg daily. He's been on the current regimen since 2018, and notes from previous provider state that only known prior regimen was FTC/TDF + ATV 400mg daily. Patient is unaware of any prior resistance or virologic failure, but no genotype is available. He was diagnosed in the mid-90s. PMH is significant for stage 3b CKD, CAD, HTN, COPD, dyslipidemia. 

Original Message:
Sent: 4/23/2025 9:48:00 AM
From: Emily Delmotte
Subject: Changing ART without genotype available in setting of cardiac and renal comorbidities

Good morning,

I'm hoping for guidance on changing ART for a 79 y/o M with long history of HIV, but new to our practice. Briefly, he is virally suppressed on FTC/TAF + ATV 400mg daily. He's been on the current regimen since 2018, and notes from previous provider state that only known prior regimen was FTC/TDF + ATV 400mg daily. Patient is unaware of any prior resistance or virologic failure, but no genotype is available. He was diagnosed in the mid-90s. PMH is significant for stage 3b CKD, CAD, HTN, COPD, dyslipidemia. 

------------------------------
Emily Delmotte
Berrien Springs MI
------------------------------

Thank you all for the guidance and resources.

My understanding of proviral DNA in the setting of viral suppression is that it may provide some insights but should be interpreted with caution given that it might not capture all resistance associated mutations. Is that accurate?

------------------------------
Emily Delmotte
Berrien Springs MI

Original Message:
Sent: 04-23-2025 15:15
From: Joshua Khalili
Subject: Changing ART without genotype available in setting of cardiac and renal comorbidities

Original Message:
Sent: 4/23/2025 9:48:00 AM
From: Emily Delmotte
Subject: Changing ART without genotype available in setting of cardiac and renal comorbidities

Good morning,

I'm hoping for guidance on changing ART for a 79 y/o M with long history of HIV, but new to our practice. Briefly, he is virally suppressed on FTC/TAF + ATV 400mg daily. He's been on the current regimen since 2018, and notes from previous provider state that only known prior regimen was FTC/TDF + ATV 400mg daily. Patient is unaware of any prior resistance or virologic failure, but no genotype is available. He was diagnosed in the mid-90s. PMH is significant for stage 3b CKD, CAD, HTN, COPD, dyslipidemia. 

------------------------------
Emily Delmotte
Berrien Springs MI
------------------------------

Thank you all for the guidance and resources.

My understanding of proviral DNA in the setting of viral suppression is that it may provide some insights but should be interpreted with caution given that it might not capture all resistance associated mutations. Is that accurate?

------------------------------
Emily Delmotte
Berrien Springs MI

Original Message:
Sent: 04-23-2025 15:15
From: Joshua Khalili
Subject: Changing ART without genotype available in setting of cardiac and renal comorbidities

Original Message:
Sent: 4/23/2025 9:48:00 AM
From: Emily Delmotte
Subject: Changing ART without genotype available in setting of cardiac and renal comorbidities

Good morning,

I'm hoping for guidance on changing ART for a 79 y/o M with long history of HIV, but new to our practice. Briefly, he is virally suppressed on FTC/TAF + ATV 400mg daily. He's been on the current regimen since 2018, and notes from previous provider state that only known prior regimen was FTC/TDF + ATV 400mg daily. Patient is unaware of any prior resistance or virologic failure, but no genotype is available. He was diagnosed in the mid-90s. PMH is significant for stage 3b CKD, CAD, HTN, COPD, dyslipidemia. 

------------------------------
Emily Delmotte
Berrien Springs MI
------------------------------

Good morning,

I'm hoping for guidance on changing ART for a 79 y/o M with long history of HIV, but new to our practice. Briefly, he is virally suppressed on FTC/TAF + ATV 400mg daily. He's been on the current regimen since 2018, and notes from previous provider state that only known prior regimen was FTC/TDF + ATV 400mg daily. Patient is unaware of any prior resistance or virologic failure, but no genotype is available. He was diagnosed in the mid-90s. PMH is significant for stage 3b CKD, CAD, HTN, COPD, dyslipidemia. 

Good morning,

I'm hoping for guidance on changing ART for a 79 y/o M with long history of HIV, but new to our practice. Briefly, he is virally suppressed on FTC/TAF + ATV 400mg daily. He's been on the current regimen since 2018, and notes from previous provider state that only known prior regimen was FTC/TDF + ATV 400mg daily. Patient is unaware of any prior resistance or virologic failure, but no genotype is available. He was diagnosed in the mid-90s. PMH is significant for stage 3b CKD, CAD, HTN, COPD, dyslipidemia. 

Can you not get a genotype Archive?  if you cannot, would favor switching to an INSTI regimen as per Dr. Gallant.

For a patient that has been on treatment since the 90s, would be concerned that he may have seen an NNRTI or a regimen with 3TC in the past that would make the use of DTG/3TC or DTG/RPV risky now

Good morning,

I'm hoping for guidance on changing ART for a 79 y/o M with long history of HIV, but new to our practice. Briefly, he is virally suppressed on FTC/TAF + ATV 400mg daily. He's been on the current regimen since 2018, and notes from previous provider state that only known prior regimen was FTC/TDF + ATV 400mg daily. Patient is unaware of any prior resistance or virologic failure, but no genotype is available. He was diagnosed in the mid-90s. PMH is significant for stage 3b CKD, CAD, HTN, COPD, dyslipidemia. 

I think we have pretty good data that suggests an M184V mutation that developed many years ago would likely have no clinical effect on a suppressed switch patient.  Therefore, I would not be too worried about using DTG/3TC in this patient.  

Can you not get a genotype Archive?  if you cannot, would favor switching to an INSTI regimen as per Dr. Gallant.

For a patient that has been on treatment since the 90s, would be concerned that he may have seen an NNRTI or a regimen with 3TC in the past that would make the use of DTG/3TC or DTG/RPV risky now

Good morning,

I'm hoping for guidance on changing ART for a 79 y/o M with long history of HIV, but new to our practice. Briefly, he is virally suppressed on FTC/TAF + ATV 400mg daily. He's been on the current regimen since 2018, and notes from previous provider state that only known prior regimen was FTC/TDF + ATV 400mg daily. Patient is unaware of any prior resistance or virologic failure, but no genotype is available. He was diagnosed in the mid-90s. PMH is significant for stage 3b CKD, CAD, HTN, COPD, dyslipidemia. 

I'm not sure we have enough data to make this switch.  It's true that there are studies showing good results with DTG/3TC if the M184V is "old" (selected many years ago).  But what's the threshold?  3 years?  5 years? 7?  I think we need larger, better studies before I'd be willing to completely ignore a mutation I knew was there, especially when there's rarely a compelling reason to do so.

I think we have pretty good data that suggests an M184V mutation that developed many years ago would likely have no clinical effect on a suppressed switch patient.  Therefore, I would not be too worried about using DTG/3TC in this patient.  

Can you not get a genotype Archive?  if you cannot, would favor switching to an INSTI regimen as per Dr. Gallant.

For a patient that has been on treatment since the 90s, would be concerned that he may have seen an NNRTI or a regimen with 3TC in the past that would make the use of DTG/3TC or DTG/RPV risky now

Good morning,

I'm hoping for guidance on changing ART for a 79 y/o M with long history of HIV, but new to our practice. Briefly, he is virally suppressed on FTC/TAF + ATV 400mg daily. He's been on the current regimen since 2018, and notes from previous provider state that only known prior regimen was FTC/TDF + ATV 400mg daily. Patient is unaware of any prior resistance or virologic failure, but no genotype is available. He was diagnosed in the mid-90s. PMH is significant for stage 3b CKD, CAD, HTN, COPD, dyslipidemia. 

Can you not get a genotype Archive?  if you cannot, would favor switching to an INSTI regimen as per Dr. Gallant.

For a patient that has been on treatment since the 90s, would be concerned that he may have seen an NNRTI or a regimen with 3TC in the past that would make the use of DTG/3TC or DTG/RPV risky now

Good morning,

I'm hoping for guidance on changing ART for a 79 y/o M with long history of HIV, but new to our practice. Briefly, he is virally suppressed on FTC/TAF + ATV 400mg daily. He's been on the current regimen since 2018, and notes from previous provider state that only known prior regimen was FTC/TDF + ATV 400mg daily. Patient is unaware of any prior resistance or virologic failure, but no genotype is available. He was diagnosed in the mid-90s. PMH is significant for stage 3b CKD, CAD, HTN, COPD, dyslipidemia. 

Can you not get a genotype Archive?  if you cannot, would favor switching to an INSTI regimen as per Dr. Gallant.

For a patient that has been on treatment since the 90s, would be concerned that he may have seen an NNRTI or a regimen with 3TC in the past that would make the use of DTG/3TC or DTG/RPV risky now

Good morning,

I'm hoping for guidance on changing ART for a 79 y/o M with long history of HIV, but new to our practice. Briefly, he is virally suppressed on FTC/TAF + ATV 400mg daily. He's been on the current regimen since 2018, and notes from previous provider state that only known prior regimen was FTC/TDF + ATV 400mg daily. Patient is unaware of any prior resistance or virologic failure, but no genotype is available. He was diagnosed in the mid-90s. PMH is significant for stage 3b CKD, CAD, HTN, COPD, dyslipidemia. 

Agree discussion of all hiv meds once daily or injections 

and not to switch unless issue as described in case

What to do if all labs normal, no body changes, or any other issues with the "Atripla" and stable patient, who has been on for

years, and do you still change the hiv drug in this stable, long term patient?

Just asking

thanks

Can you not get a genotype Archive?  if you cannot, would favor switching to an INSTI regimen as per Dr. Gallant.

For a patient that has been on treatment since the 90s, would be concerned that he may have seen an NNRTI or a regimen with 3TC in the past that would make the use of DTG/3TC or DTG/RPV risky now

Good morning,

I'm hoping for guidance on changing ART for a 79 y/o M with long history of HIV, but new to our practice. Briefly, he is virally suppressed on FTC/TAF + ATV 400mg daily. He's been on the current regimen since 2018, and notes from previous provider state that only known prior regimen was FTC/TDF + ATV 400mg daily. Patient is unaware of any prior resistance or virologic failure, but no genotype is available. He was diagnosed in the mid-90s. PMH is significant for stage 3b CKD, CAD, HTN, COPD, dyslipidemia. 

Agree discussion of all hiv meds once daily or injections 

and not to switch unless issue as described in case

What to do if all labs normal, no body changes, or any other issues with the "Atripla" and stable patient, who has been on for

years, and do you still change the hiv drug in this stable, long term patient?

Just asking

thanks

Can you not get a genotype Archive?  if you cannot, would favor switching to an INSTI regimen as per Dr. Gallant.

For a patient that has been on treatment since the 90s, would be concerned that he may have seen an NNRTI or a regimen with 3TC in the past that would make the use of DTG/3TC or DTG/RPV risky now

Good morning,

I'm hoping for guidance on changing ART for a 79 y/o M with long history of HIV, but new to our practice. Briefly, he is virally suppressed on FTC/TAF + ATV 400mg daily. He's been on the current regimen since 2018, and notes from previous provider state that only known prior regimen was FTC/TDF + ATV 400mg daily. Patient is unaware of any prior resistance or virologic failure, but no genotype is available. He was diagnosed in the mid-90s. PMH is significant for stage 3b CKD, CAD, HTN, COPD, dyslipidemia. 

Can you not get a genotype Archive?  if you cannot, would favor switching to an INSTI regimen as per Dr. Gallant.

For a patient that has been on treatment since the 90s, would be concerned that he may have seen an NNRTI or a regimen with 3TC in the past that would make the use of DTG/3TC or DTG/RPV risky now

Good morning,

I'm hoping for guidance on changing ART for a 79 y/o M with long history of HIV, but new to our practice. Briefly, he is virally suppressed on FTC/TAF + ATV 400mg daily. He's been on the current regimen since 2018, and notes from previous provider state that only known prior regimen was FTC/TDF + ATV 400mg daily. Patient is unaware of any prior resistance or virologic failure, but no genotype is available. He was diagnosed in the mid-90s. PMH is significant for stage 3b CKD, CAD, HTN, COPD, dyslipidemia.