A choice to follow Astarion? Perish the thought. Seriously though, no idea. But being forced to play through Karlach's scene (once I got myself halfway together which took way longer than I'd like to admit) made me so mad. As a consequence she isn't part of my current playthrough. Well, her head technically is.
It's like the writing says "this kind of person deserves all the attention while that kind of person deserves none", right? And it's unfortunate that they got so much of him right, and then the ending...well, practically needs a trigger warning for someone who can relate to him.