Tough ART

Multiple Choice

You are seeing a patient who is on TAF/FTC + raltegravir. They had fallen out of care and were spacing out their medication 2-3 days to make it last. Now their viral load is 25,000 and genotype shows resistance to raltegravir with a mutation Y143C. Prior mutations showed K103N. She does not tolerate boosting agents. What is the best option for treatment?

• Dolutegravir + lamivudine

• TAF/FTC/ bictegravir

• TAF/FTC + BID dolutegravir

• TAF/FTC + darunavir/ cobicistat

• Maintains effectiveness against most raltegravir/elvitegravir mutations, dose BID

  • Q148 reduces susceptibility, especially with other mutations

Efficacy of dolutegravir

raltegravir = elvitegravir << dolutegravir = bictegravir

Barrier to resistance

Integrase inhibitor resistance