Would you consider transition to a cabotegravir/rilpivirine injectable regimen in a patient living with HIV who is well-suppressed on BIC/FTC/TAF since initial diagnosis in Colombia in 2022 at which time her viral load was in the 400s precluding genotypic resistance testing?

The clinical scenario as presented is somewhat ambiguous. If the patient is described as “well suppressed” on bictegravir/emtricitabine/tenofovir alafenamide, this typically implies consistent HIV RNA <200 copies/mL. A persistent viral load in the 400s, however, would suggest low-level virologic fai...

Given that she is undetectable on BIC/TAF/FTC, she should do well on CAB/RPV. Treatment failure overall is very low on CAB/RPV, but possibly higher than BIC/TAF/FTC. Having RPV HIV drug resistance mutations on proviral DNA testing appears to correlate with a slightly higher risk of treatment failure...

Yes if (1) if "well-suppressed" means undetectable (<20 viral copies/mL) because that is what the package insert says, and the conditions on which the FDA approved the drug, (2) the patient wants to. Some patients prefer to take a pill every day. That particular injectable requires them to come to t...

Easy. I have done it many times. The injectable regimen is becoming the preferred regimen for health care providers and patients. Fine to switch.

Yes, I would make the switch. Her viral suppression on BIC/TAF/FTC shows her virus is sensitive to INSTIs. Those with virologic suppression prior to switch to CAB/RPV tend to stay suppressed even if there was efavirenz exposure in the past.

Why are you considering the switch?