HomeQuestion
How would you manage a patient with good adherence on darunavir/cobicistat/emtricitabine/tenofovir alafenamide with persistent viremia 300-400 copies/mL with genotypic resistance testing demonstrating isolated T97A INSTI mutation, L10L/V, I13V, E35D, M36I, and L89M protease inhibitor mutations and no RT resistance?
1
1 Answers
Mednet Member
Infectious Disease · VA Connecticut Healthcare System
Complicated question and answer:
- Confirm and evaluate causes (do now)
- Repeat HIV RNA promptly (e.g., in ~2–4 weeks) to confirm persistence and trend.
- Medication reconciliation/interactions (common culprits even with “good adherence”): cation-containing supplements/antacids (relevant mainly to INST...