Hi Ryan,
Good question. In a case like this, it is all about the "art" of medicine. There are no "right" answers.
For me, I would prefer to have this guy on an unboosted regimen. As he gets older and accumulates additional morbidities, he will likely need additional medications, and the risk of significant DDIs grows if he stays on Genvoya. Also, you would want to make sure his lipds are not elevated from this as well. That being said, if he is really attached to this med and is doing well, than I really don't see an overwhelming reason to push it. That could threaten his trust in you. If you do end up switching, I am not particularly concerned about the switch to Biktarvy. You would be switching from a low barrier to resistance regimen to a high one. Sure. It would be great to get one visit in a few months after he changes to assure tolerability. But once again, if he is opposed to this, I would not push it that hard. You could just ask him to call you if he experiences any issues. Thanks!
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Adam Zweig
AIDS Healthcare Foundation
San Diego CA
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Original Message:
Sent: 04-02-2024 05:54
From: Ryan Doyle
Subject: Therapy Switch
Hello,
I have a patient who recently transferred care to me who has been on Genvoya for many years and has been doing well with respect to control of HIV, always virally suppressed and great CD4 count (most recent CD4 >700). Patient does have CKD3a. We were recently discussing switching from Genvoya to Biktarvy as an option as patient may be interested, however patient is also very hesitant to come in for visits more frequently than annually for wellness visits. I am open to switching the patient to Biktarvy, however I am concerned about his willingness to attend closer follow up after the switch to assess for adherence and obtain follow up labs. Curious if others have thoughts? I have discussed with the patient given ongoing adequate control of HIV, there may not be indication/need to make a regimen change.
Thanks!
Ryan
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Ryan K. Doyle, DO (he/him/his)
rymed89@gmail.com
Grand Rapids, MI
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