How is it possible that there is so much NNRTI resistance with no NRTI resistance? Seems very strange to me.
Original Message:
Sent: 09-11-2025 15:49
From: Cameron Wolfe
Subject: ART regimen change with upcoming Kidney Transplant
agree with the trial of a trophile, as some maraviroc is good in transplant as there's data it also reduces potential rejection risk.
otherwise atypical as it sounds, TAF/FTC/BIC+LEN ? Would really need a good conversation with the transplant team, as there's some limited drug interactions with tacrolimus, but not prohibitive. They'd just need to realize levels might be a bit unusual, and they'd need to think through waning levels and interactions as you approach the tail. But regular tacro monitoring should be ok there.
Finally there's just some people who you shouldn't move off their current meds, if that's whats FINALLY brought them into control. Yet they still can get life-affirming transplant. The transplant issue will also be the tacro-PI interaction - leaves the kidney at greater risk of rejection over time as immunosuppressant levels are variable. But if teams are struggling with that, we have moved some patients off tacrolimus and onto belatacept as an alternative immunosuppressant, which has worked well. Not "routine", but certainly an option that works. But i'd really strongly recommend a good chat with their TxID doc and their transplant pharmacist.
good luck, and happy to help further if you need!!
cameron
(919) 599-7252
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Cameron Wolfe
Durham NC
Original Message:
Sent: 09-11-2025 15:27
From: Adam Zweig
Subject: ART regimen change with upcoming Kidney Transplant
This might be one of the rare cases where doing a Trofile assay may be helpful. This will likely need to be a Trofie DNA assay if the patient is suppressed. Then, consider using maraviroc if R5 trophic.
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Adam Zweig
San Diego CA
Original Message:
Sent: 09-11-2025 14:28
From: Kristen Lindauer
Subject: ART regimen change with upcoming Kidney Transplant
Hi all,
One of my ID providers has an HIV patient that he just picked up from another provider. The patient is non-urgently being planned for kidney transplant in the future. He is currently on Symtuza due to history of resistances. His transplant ID provider reached out hoping to maybe get this patient off a boosting agent which would interact with future immunosuppressing medications post-transplant (tacrolimus, prednisone). Attached is most, if not all, of the patient's genotype history in Stanford. I have also copied the mutations below.
The patient is currently undetectable on Symtuza. I would love to gather the community's thoughts on the patient and potential options for him moving forward. Thank you.
Patient information:
When Diagnosed/Mode of transmission: 2007
Past ARV: Atripla, Epzicom, Sustiva, Prezista, Norvir, Tivicay, Lamivudine, Abacavir, Juluca, Pifeltro
Current: Symtuza
Risk: MSM
Resistances:
Rt: V60I, A98S, K101E, Q102K, D121Y, K122E, E138A, I142V, C162S, D177E, T200A, V245I/M, D250E, I257L, R277K, T286A, V293I, V60I, K64R, A98S, K101R, Q102K, V106I/L, D121Y, K122E, E138E/A, I142V, C162S, D177D/E, I178I/L, Y181C, T200A, H221Y, E248D/N, D250D/G, R277K, T286A, V293I
INSTI: D6E, S17N, S39N, M50I, L101I, T124A, V234L, R263K
PI: L10V, L19E, K20R, D60E, I62I/V, L63P, H69Y, I72V
Hep A Immune 2015
Hep B No evidence of chronic Hep B (borderline immunity)
Hep C neg
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Kristen Lindauer, PharmD, BCPS, AAHIVP
Fallon, NV
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