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  • 1.  Multi-Drug Resistant Patient Conundrum: Next Regimen?

    Posted 2 days ago

    55-year-old otherwise healthy Hispanic male with 25+ year history of HIV infection and multi drug resistance, including near total NRTI, NNRTI, (new) INSTA, and a dual – mixed result on his Trofile has just broken through his most recent successful regimen of dolutegravir bid and Rukobia bid because of medication non-compliance

    He still maintains sensitivity to darunavir and has never taken lenacapavir. Would a salvage regimen of lenacapavir twice yearly, boosted Prezista, and keeping the dolutegravir on board (assuming partial resistance) be a reasonable next step? Or might you suggest another regimen, including enrolling him in an investigational trial of a novel agent?



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    Gary R Cohan, MD, FACP, AAHIVS

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  • 2.  RE: Multi-Drug Resistant Patient Conundrum: Next Regimen?

    Posted 2 days ago

    Gary,

    You don't mention anything about PI resistance, so I am going to assume he has none.

    With the information you provided, lenacapavir and boosted darunavir should work fine as long as he adheres to this regimen. I don't think I would keep bid dolutegravir on board.    This would add complexity and pill burden which may negatively affect his adherence.  But.   He really needs to realize that he has to take his meds because he is running out of options. 



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    Adam Zweig
    San Diego CA
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    Original Message


  • 3.  RE: Multi-Drug Resistant Patient Conundrum: Next Regimen?

    Posted 2 days ago
    To give a good answer to this question, I'd want to know his actual mutations-to see whether he needs once- or twice-daily DRV, for example, and whether there's any point in continuing an INSTI.  But even the most carefully chosen regimen won't work if he doesn't take it.



    Original Message


  • 4.  RE: Multi-Drug Resistant Patient Conundrum: Next Regimen?

    Posted 10 hours ago

    Keep in mind ibalizumab. We have one patient with XDR HIV (four-class resistance) due to inability to adhere to oral medication who has done well for over a year now with ibalizumab + lenacapavir. He is able to report q2weeks to Option Care for his infusion and to us q6 months for his Len injections, and has consistently had VL<20 on this regimen. It takes a certain kind of person to be able to adhere to q2 week infusions, and there needs to be an infusion center available, but for the right person ibalizumab is a valuable option.



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    Peter Shalit
    Seattle WA
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    Original Message


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