Academy Exchange

Hello! 

We have a PLWHIV diagnosed in 2014, started on ABC/3TC + DTG. They were shortly switched to ABC/3TC/DTG STR once it became available later in 2014. Patient has displayed intermittent compliance Triumeq. Genosure Archive demonstrated M184MV, and K70PQT, K103KT, and E138EK. Patient was switched to BIC/FTC/TAF and has demonstrated low-level viremia (20s - low 100s) since starting. Patient has never been undetectable on Biktarvy. Based on my review of primary literature and Stanford, it appears the K70X combined M184V alters tenofovir susceptibility to a low-level without impacting XTC.

We are thinking of switching the patient to a DTG + DOR + FTR regimen to avoid a boosted PI regimen (possibly DTG/3TC + DOR). However, we are hesitant about adding a BID medication with the fostemsavir. Does anyone have experience or clinical data they might be able to share about once daily dosing of FTR?

Thanks in advance, 

Colter

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Colter G. Sheveland, PharmD
ID Clinical Pharmacy Specialist
SMC-Center for ID | Spartanburg SC
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Do you think the patient's adherence to B/F/TAF is significantly better than when they were on DTG/ABC/3TC?  My personal opinion is that VL 20-200 is probably due to the pt missing a dose or two here and there, especially if they have struggled with compliance in the past. 

I would hesitate to take someone with adherence issues and move them from a STR to a 4 tablet regimen where one of the meds is BID.  I would either leave well enough alone with the low level viremia (unlikely to develop further resistance at those VLs) and continue to hammer adherence OR consider adding LEN Q6mo.  

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Alexandra Danforth, PharmD, AAHIVP, BCACP
Director, Infectious Disease and Clinical Pharmacy
Trillium Health
Rochester, NY
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Original Message:
Sent: 10-14-2025 13:40
From: Colter Sheveland
Subject: Once Daily Fostemsavir Dosing

Hello! 

We have a PLWHIV diagnosed in 2014, started on ABC/3TC + DTG. They were shortly switched to ABC/3TC/DTG STR once it became available later in 2014. Patient has displayed intermittent compliance Triumeq. Genosure Archive demonstrated M184MV, and K70PQT, K103KT, and E138EK. Patient was switched to BIC/FTC/TAF and has demonstrated low-level viremia (20s - low 100s) since starting. Patient has never been undetectable on Biktarvy. Based on my review of primary literature and Stanford, it appears the K70X combined M184V alters tenofovir susceptibility to a low-level without impacting XTC.

We are thinking of switching the patient to a DTG + DOR + FTR regimen to avoid a boosted PI regimen (possibly DTG/3TC + DOR). However, we are hesitant about adding a BID medication with the fostemsavir. Does anyone have experience or clinical data they might be able to share about once daily dosing of FTR?

Thanks in advance, 

Colter

------------------------------
Colter G. Sheveland, PharmD
ID Clinical Pharmacy Specialist
SMC-Center for ID | Spartanburg SC
------------------------------

Your patient is already having difficulty adhering to a simple, one pill per day regimen, so I'm not sure that switching him to a more complex, twice-daily regimen is the answer. Biktarvy should work fine if he takes it.  In addition, he doesn't meet the criteria for virologic failure (repeated VL >200) on Biktarvy. The focus here should be on adherence, and keeping his regimen simple is an important part of supporting his adherence.

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Joel Gallant, MD, MPH
Johns Hopkins University
Baltimore, MD

AXCES Research Group
Santa Fe, NM
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Original Message:
Sent: 10-14-2025 13:40
From: Colter Sheveland
Subject: Once Daily Fostemsavir Dosing

Hello! 

We have a PLWHIV diagnosed in 2014, started on ABC/3TC + DTG. They were shortly switched to ABC/3TC/DTG STR once it became available later in 2014. Patient has displayed intermittent compliance Triumeq. Genosure Archive demonstrated M184MV, and K70PQT, K103KT, and E138EK. Patient was switched to BIC/FTC/TAF and has demonstrated low-level viremia (20s - low 100s) since starting. Patient has never been undetectable on Biktarvy. Based on my review of primary literature and Stanford, it appears the K70X combined M184V alters tenofovir susceptibility to a low-level without impacting XTC.

We are thinking of switching the patient to a DTG + DOR + FTR regimen to avoid a boosted PI regimen (possibly DTG/3TC + DOR). However, we are hesitant about adding a BID medication with the fostemsavir. Does anyone have experience or clinical data they might be able to share about once daily dosing of FTR?

Thanks in advance, 

Colter

------------------------------
Colter G. Sheveland, PharmD
ID Clinical Pharmacy Specialist
SMC-Center for ID | Spartanburg SC
------------------------------