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Antiretroviral Therapy.

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Evaluation and Management of Virologic FailureQuestion 7/10

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A 55-year-old cisgender woman is seen in a clinic for a follow-up evaluation. Her HIV RNA level has been suppressed for several years while taking bictegravir-tenofovir alafenamide-emtricitabine. During the last 2 years, she has gained about 15 to 20 pounds. In the past, she took efavirenz-tenofovir DF-emtricitabine and on this regimen had virologic failure; drug-resistant genotype results showed the following reverse transcriptase mutations: Y188L, K103N, M184V, and G190A. Because of the weight gain, there is a consideration for switching the current antiretroviral regimen to doravirine-tenofovir DF-emtricitabine.

Based on the drug-resistance genotype result, do these mutations indicate drug resistance to doravirine?

Figure 1. Impact of Reverse Transcriptase Mutations on Doravirine
Source: Stanford University HIV Drug Resistance Database
Illustration: David H. Spach, MD
Figure 2. Doravirine Resistance Pathways
Source: Feng M, Wang D, Grobler JA, Hazuda DJ, Miller MD, Lai MT. In vitro resistance selection with doravirine (MK-1439), a novel nonnucleoside reverse transcriptase inhibitor with distinct mutation development pathways. Antimicrob Agents Chemother. 2015;59:590-8.
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Question Last Updated
September 22nd, 2023

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