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  • 1.  Patient on Amiodarone due to AFib

    Posted 10-09-2025 12:03

    Good morning everyone, 

    I would like to hear your insights in reference to the scenario below. I really appreciate your time and feedback. 

    73-year-old female, under treatment with Amiodarone due to AFib. Patient is also taking iron supplements/multivitamins due to anemia. Chronic kidney disease.

    HIV regimen: Tivicay 50 mg 1-tab PO daily and Descovy. 

    Last lab works shows HIV VL 190 copies detected, Cr 1.93, eGFR 27 mL/min, Cr Cl 29 mL/min. 3 months before HIV VL was 213 copies detected. 

    No genotype is available. 

    Documentation shows that the client has been educated on the known interaction between Tivicay and iron supplements/vitamins.

    Due to current treatment with Amiodarone, DRV booted option has not been considered since the recommendations is to not co-administer. Significant interactions have been observed with protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), influencing serum concentrations (Amiodarone Therapy: Updated Practical Insights - PMC). Plus, the patient's Cr Cl is falling <30 mL/min, with insufficient evidence to recommend for or against the use of full-dose, daily FTC in people with CrCl <30 mL/min.

    I really appreciate you share any ideas to work towards viral suppression.

    Thank you very much for taking your time to read the scenario and share your thoughts. 

    Regards, 

    Randy Aguiar, DNP, AAHIVS



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    Randy Aguiar Ramos
    Miami FL
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  • 2.  RE: Patient on Amiodarone due to AFib

    Posted 10-12-2025 11:17
    I wouldn't assume she's failing therapy based on these two low viral loads. That being said, I am not at all reassured by your statement, "Documentation shows that the client has been educated on the known interaction between Tivicay and iron supplements/vitamins."  A statement like that may mean that at some point in the past-maybe years ago-someone told her about those interactions, but that doesn't mean she still remembers the discussion and follows the recommendations.  Someone on iron supplements needs to be reminded of this interaction regularly, esepcially when there is detectable viremia, like there is now. If her viremia persists, you might consider getting a genotype (or a GenoSure Archive if the viral load remains low).

    According to the labelled indication, Descovy shouldn't be given to people with creatinine clearances less than 30, and she's just below 30.  That being said, this is more due to lack of data than any real concerns about safety. I would just want to be sure that her impaired kidney function has been adequately evaluated.



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