Case 1. Returning to Care – Is Biktarvy Always the Answer?

48-yr-old man with HIV for 12 years presented 1 year after his last visit with a history of methamphetamine use, inconsistent engagement in care, and a new diabetes diagnosis. He reported no recent ART and no meth use for about 8 months. On returning to care, his viral load was 250,000 copies/mL, the CD4 count was 230 cells/mm3, creatinine levels were elevated, and genotype testing found a K103N mutation. He was motivated to resume ART. Drs. Scully and Hoffmann evaluate the patient’s new ART options in light of his clinical viremia and comorbidities.  References CitedAndreatta K, D’Antoni ML, Chang S, et al. High efficacy of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in Black adults in the United States, including those with pre-existing HIV resistance and suboptimal adherence. J Med Virol. 2024;96(10):e29899. PMID: 39370775.Denyer R, Zemskova J, Benator DA. HIV treatment with dolutegravir and doravirine: rationale for selection and clinical outcomes in a highly treatment experienced population. Int J STD AIDS. 2022;33(12):1073-1077. PMID: 36113042Figueroa MI, Sued O, Cecchini D, et al. Dual therapy based on co-formulated darunavir/ritonavir plus lamivudine for initial therapy of HIV infection: The ANDES randomized controlled trial. Int J Antimicrob Agents. 2024;64(4):107301. PMID: 39151647Kabra M, Barber TJ, Allavena C, et al. Virologic Response to Dolutegravir Plus Lamivudine in People With Suppressed Human Immunodeficiency Virus Type 1 and Historical M184V/I: A Systematic Literature Review and Meta-analysis. Open Forum Infect Dis. 2023;10(11):ofad526. Published 2023 Oct 27. PMID: 38033982Paton NI, Musaazi J, Kityo C, et al. Dolutegravir or Darunavir in Combination with Zidovudine or Tenofovir to Treat HIV. N Engl J Med. 2021 Jul 22;385(4):330-341. PMID: 34289276.Rolle CP, Berhe M, Singh T, et al. Dolutegravir/lamivudine as a first-line regimen in a test-and-treat setting for newly diagnosed people living with HIV. AIDS. 2021;35(12):1957-1965. PMID: 34115650Rossotti R, D'Amico F, Bana NB, et al. Durability of doravirine with dolutegravir dual regimen compared with other dolutegravir-based dual combinations. HIV Med. 2024;25(6):675-683. PMID: 38263787Sax PE, Rockstroh JK, Luetkemeyer AF, et al. Switching to Bictegravir, Emtricitabine, and Tenofovir Alafenamide in Virologically Suppressed Adults With Human Immunodeficiency Virus. Clin Infect Dis. 2021;73(2):e485-e493. PMID: 32668455Related Guidance and GuidelinesNYSDOH AI Clinical Guidelines Program:ChemSex: Questions and AnswersHIV Resistance AssaysResource: ART Drug-Drug InteractionsStimulant Use Clinical GuidanceSubstance Use Harm Reduction in Medical CareUse of Injectable CAB/RPV LA as Replacement ART in Virally Suppressed AdultsClinical Info HIV.gov:Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIVGuidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV