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Applying HIV ASSIST

CME

Applying an HIV Care Decision-making Tool in Asia: HIV-ASSIST 

Physicians: maximum of 1.00 AMA PRA Category 1 Credit

Released: June 26, 2025

Expiration: June 25, 2026

Manish Bamrotiya
Manish Bamrotiya, MBBS, FHM
Tanyaporn Wansom
Tanyaporn Wansom, MD, PhD
CME/CE Information

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Patient Case 4: ART for a Second-line ART in a Person With Virologic Failure

Our next case is a 37-year-old woman. She was diagnosed with HIV 6 years ago and started EFV/TDF/FTC as first-line therapy. At the time, this was the standard first-line ART in the region where she was residing.

She had previously achieved viral suppression with her current ART regimen, but her most recent HIV-1 RNA test shows that she has virologic failure, with HIV-1 RNA 6000 copies/mL. Her current CD4+ cell count is 370 cells/mm3.

Genotype testing reveals 2 key mutations: K103N, which confers resistance to EFV and other nonnucleoside reverse transcriptase inhibitors; and M184V, which confers resistance to 3TC and FTC.

Her other lab values are as follows:

  • CBC: normal.
  • BMI: 18 kg/m2
  • SCr: 0.7 mg/dL
  • No hepatitis B and hepatitis C confection
  • No comedications
  • HLA-B*5701 status: negative

She reports nausea and pill fatigue, which led to poor adherence over the past year. Staff has assessed her adherence to be approximately 60%.

So in this particular case, our goal is to switch this individual to a second-line regimen that addresses resistance and improves tolerability. 

To which ART regimen would you recommend switching this patient?

Video 4: Demonstration 

Patient Case 4: Discussion

The WHO guidelines recommend a DTG- or other INSTI-based combination with an optimized nucleoside reverse transcriptase inhibitor backbone as a preferred second-line regimen for people living with HIV whose non-DTG–based initial regimen is failing.

As demonstrated, HIV-ASSIST helps us readily identify suitable regimens based on guideline recommendations and patient preferences, including BIC/TAF/FTC or DTG with either TDF or TAF plus 3TC or FTC.

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