Managing HIV in the extreme: Viral load and drug monitoring in a patient with BMI > 60 on long-acting cabotegravir/rilpivirine therapy.
Leah D Baker, Patricia Pecora Fulco
✦ AI-curated · Sources linked
Case in brief
A morbidly obese patient with a BMI of 62 kg/m² and a history of poor adherence to oral antiretroviral therapy presented with unsuppressed HIV viral load. The patient was switched to long-acting injectable cabotegravir/rilpivirine therapy, which initially failed to achieve viral suppression. Through therapeutic drug monitoring and dose titration, the regimen was adjusted, leading to successful viral load suppression.
What made this case unusual
The case highlights the challenges of managing HIV in patients with extreme obesity, particularly the need for tailored dosing strategies due to the risk of viral load rebound.
Diagnostic / clinical pearl
Therapeutic drug monitoring can be crucial in optimizing long-acting injectable antiretroviral therapy for patients with high BMI to achieve and maintain viral load suppression.
Why it matters
This case underscores the importance of individualized treatment approaches in managing HIV, especially in populations at higher risk for treatment failure due to obesity.