How would you manage a patient with viremia up to 400 copies/mL on CAB/RIL injections who was previously undetectable on BIC/FTC/TAF and with prior genotypic testing without drug resistance mutations?

CAB/RPV seems to have a higher failure rate (around 1%) than BIC or DTG plus NRTIs. This may be a result of the lower potency of CAB. In addition, CAB has a lower barrier to resistance than BIC and DTG. That said, CAB/RPV is an excellent option for a wide range of patients. I review all injection appointment data to double-check that injections occurred on schedule, assess any reasons for challenges in effective injection, such as a high BMI without the use of a longer injection needle or buttoc...

We have definitely seen treatment failure with CAB/RPV, which unfortunately made using both classes of medications impossible.

Assuming usual issues of adherence and attending appointments are not issues, I would review the administration technique, particularly if the patient has an elevated BMI or may have extra tissue overlying the gluteal injection areas. Consider using a 2-inch needle for injection to ensure injection into the muscle (I believe only 1.5-inch needles are included in the kit)...