1. Lydia, a clinically stable patient with HIV, is receiving tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) and raltegravir (RAL), a regimen she has been on since 2010. Her CD4 cell count is normal, and viral load is <20 copies/mL.

She requests a change in her HIV regimen due to a desire to simplify therapy and take fewer drugs. You are considering switching her antiretroviral therapy (ART) to either dolutegravir (DTG)/rilpivirine (RPV) or DTG/lamivudine (3TC).

Which of the following conditions or factors would make switching Lydia to DTG/3TC a more desirable option than switching to DTG/RPV?

2. Barbara is 48-year-old African American woman who is virologically suppressed on bictegravir (BIC)/tenofovir alafenamide (TAF)/FTC. She has been on this regimen for the past 2 years and was on DTG/TDF/FTC before that. Barbara states that she has gained 9 pounds in the 2 years she has been on BIC/TAF/FTC and is very concerned about her weight gain. Her mother died of heart disease and diabetes, and she is leery about gaining weight. She weighs 168 pounds, and her body mass index is 32.1 kg/m2 . Her glucose is normal and her GFR is 56 mL/min. She also has elevated total cholesterol of 242 mg/dL, low-density lipoprotein cholesterol of 134 mg/dL, and high-density lipoprotein cholesterol of 68 mg/dL. The remainder of her labs are normal.

How would you manage Barbara’s treatment?

3. Joe is a 66-year-old man with HIV who is receiving darunavir/cobicistat (DRV/c)/TAF/FTC. He has a history of intermittent medication adherence due to substance use disorder but has been in recovery for many years, with viral suppression consistently during that time. He has no history of documented resistance on any genotypes. His other medical problems include diabetes mellitus, hypertension, and depression, for which he currently is receiving metformin, amlodipine, citalopram, and intermittent trazodone.

Joe’s provider would like to remove the “booster” from his regimen and switch him to a 2-drug therapy with dolutegravir/lamivudine (DTG/3TC).

What drug interaction will need to be considered?

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