Simplification of ART in a patient living with multidrug resistant HIV-1: A case report using twice daily cobicistat and darunavir

Multidrug-resistant (MDR) HIV can be complicated to manage. Patients are often on a high pill burden regimen, taking antiretrovirals twice daily, and often have other comorbidities. This study is a case report of a patient living with MDR HIV, and considerations are taken into account when simplifying the patient from a ten-pill regimen to a unique and unconventional six-pill regimen. The patient was living with HIV/AIDS with an MDR virus on a five-tablet, twice-daily (ten total pill burden) regimen who was simplified to a unique and novel regimen of elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide + darunavir 600 mg twice daily + cobicistat + maraviroc twice daily. This unique regimen, which decreased the patient's HIV pill burden from ten to six, has maintained virologic suppression 1 year after his antiretroviral therapy transition. When consolidating therapy in patients with MDR HIV, one regimen will not fit each individual patient. Our case demonstrates unique and unconventional dosing of darunavir 600 mg along with cobicistat as twice-daily pharmacokinetic enhancing which assisted in consolidating our patient's regimen by a 40% decrease in pill burden. This change most importantly maintained virologic suppression and provides evidence for a potential option for similar patients with MDR HIV.