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Sequencing ARV Regimens in Treatment-Experienced Patients with HIV Disease
Slide 1.
Sequencing ARV Regimens in Treatment-Experienced Patients with HIV Disease
Slide 1.
Case 1
Slide 2.
What 1st regimen would you choose?
Slide 3.
Transmitted Drug Resistance
Slide 4.
Integrase Resistance in Commercial Lab Database (Labcorp)
Slide 5.
Newer ARV Agents with Improved Activity Against Drug-Resistant HIV Strains
Slide 6.
When starting RPV based regimens, remember...
Slide 7.
When considering using EVG/COBI/FTC/TDF remember...
Slide 8.
Case 1 patient genotype
Slide 9.
Which additional tests would you get prior to initiating ART in this patient?
Slide 10.
Weighted etravirine mutation score
Slide 11.
Response to ETV based upon mutation score
Slide 12.
Case 1: Patient starts TDF/FTC, DRV/r
Slide 13.
SPIRAL: PI/r to RAL in Suppressed Patients
Slide 14.
Switchmrk vs. Spiral: switch studies in suppressed pts
Slide 15.
Switching to RPV/FTC/TDF in Virologically Suppressed Subjects
Slide 16.
Switching to RPV/FTC/TDF Maintains High Levels of Virologic Suppression
Slide 17.
GS-123: RAL + FTC/TDF Switch to EVG/COBI/FTC/TDF
Slide 18.
GS 123: HIV-1 RNA <50 copies/mL at Week 12
Slide 19.
Case 2
Slide 20.
Now on ZDV / 3TC / LPV/r :
Slide 21.
Principles for using ARVs in Treatment-Experienced Patients
Slide 22.
Patient's Drug Resistance Chart
Slide 	23.
Question
Slide 24.
Darunavir Mutation Score:
Slide 25.
What regimen would you start patient on?
Slide 26.
Case 2: Patient f/u
Slide 27.
Your advice to the patient is:
Slide 28.
What tropism assays are commercially available?
Slide 29.
You start pt on TDF/FTC, etravirine, and raltegravir
Slide 30.
Integrase Resistance Pathways
Slide 31.
BENCHMRK 1 & 2: Evolution From N155 to Q148 Mutations Over Time
Slide 32.
Comparison of EVG and RAL primary resistance mutations
Slide 33.
Important recent trials in treatment experienced patients
Slide 34.
Can we omit nRTIs in second-line ART after PI failure?
Slide 36.
SAILING Study
Slide 36.
SAILING Study: % with HIV RNA < 50 c/ml
Slide 37.
SAILING Study
Slide 38.
DTG resistance: reduced fitness
Slide 39.
VIKING-3
Slide 40.
VIKING 3: Baseline Characteristics
Slide 41.
VIKING 3: % < 50 @ 24 wks and 48 wks
Slide 42.
VIKING 3: Baseline Characteristics
Slide 43.
Summary
Slide 44.