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Receiving a stable failing regimen for ≥ 8 weeks with most recent (within 8 weeks of PA request) HIV-1 viral load ≥ 400 copies/mL • Drugs included in the failing regimen: • Start date of failing regimen: _________ ☐ Documented resistance to ≥ 2 medications from ≥ 3 of the following 4 classes of antiretrovirals (ARVs): NRTI, NNRTI, PI, Insti（附加所有当前和先前的电阻测试结果）document≤2由于电阻，不耐受性或安全性问题，来自NRTI，NNRTI，PI和Insti类的完全活性ARV。（提交所有当前和先前的阻力测试结果以及过敏，不耐受，药物访问或安全问题的文献）☐≥1个可与Lenacapavir一起使用的完全活跃剂。列出了将与Lenacapavir一起使用的其他抗逆转录病毒：☐患者不使用任何禁忌或不建议与Lenacapavir一起使用的伴随药物（请参阅Sunlenca处方信息 https://www.gilead.com/-/media/files/pdfs/medicines/hiv/sunlenca/sunlenca_pi.pdf for details) List all other medications the patient is taking: NRTI = nucleoside reverse transcriptase inhibitor, NNRTI = non-nucleoside reverse transcriptase inhibitors, PI = protease inhibitor, INSTI =整合酶链转移抑制剂
Lenacapavir事先授权表格
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