Dolutegravir plus lamivudine for the treatment of HIV-1 infection

Expert Rev Anti Infect Ther. 2020 Apr;18(4):279-292. doi: 10.1080/14787210.2020.1729742. Epub 2020 Feb 18.

Abstract

Introduction: Recent data on the 2-drug regimen (2DR) with dolutegravir (DTG) plus lamivudine (3TC) have shown high efficacy and tolerability both in treatment-naïve and experienced HIV-positive patients. Current guidelines recommend DTG+3TC as an alternative to triple antiretroviral therapy (ART) in selected patients to reduce long-term toxicity and costs.Areas covered: This review is intended to provide insight about the efficacy, safety, and tolerability of a 2DR with DTG+3TC in naïve and treatment-experienced patients.Expert opinion: Data from clinical trials and from real-life show that DTG+3TC is an effective and safe switch option for the treatment of experienced patients. In treatment-naïve patients, DTG+3TC has shown non-inferiority compared to standard 3-drug regimens but is less effective in severely immunocompromised naïve patients (i.e. with a CD4+ cell count below 200 cell/mm3); furthermore, current guidelines have upgraded this dual regimen to recommended first-line strategy, but indicate that it should not be used without genotypic resistance results. Moreover, this regimen is not feasible for HBV-coinfected individuals and should not be used during pregnancy. Currently, out of 2-drug regimens, DTG+3TC is one of clinicians' preferred option as it requires no pharmacokinetic booster, has a low risk of drug interaction, and does not require food intake.

Keywords: 2-drug regimens; HAART; HIV; dolutegravir; lamivudine.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Anti-HIV Agents / administration & dosage
  • Anti-HIV Agents / adverse effects
  • CD4 Lymphocyte Count
  • Drug Resistance, Viral / genetics
  • Drug Therapy, Combination
  • Genotype
  • HIV Infections / drug therapy*
  • HIV Infections / virology
  • HIV-1 / isolation & purification
  • Heterocyclic Compounds, 3-Ring / administration & dosage*
  • Heterocyclic Compounds, 3-Ring / adverse effects
  • Humans
  • Lamivudine / administration & dosage*
  • Lamivudine / adverse effects
  • Oxazines / administration & dosage*
  • Oxazines / adverse effects
  • Piperazines / administration & dosage*
  • Piperazines / adverse effects
  • Pyridones / administration & dosage*
  • Pyridones / adverse effects

Substances

  • Anti-HIV Agents
  • Heterocyclic Compounds, 3-Ring
  • Oxazines
  • Piperazines
  • Pyridones
  • Lamivudine
  • dolutegravir