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Ann Pharmacother. 2018 Jul;52(7):681-689. doi: 10.1177/1060028018758432. Epub 2018 Feb 14.

Dolutegravir Dual Therapy as Maintenance Treatment in HIV-Infected Patients: A Review.

Author information

1
1 University of Alberta Hospital, Edmonton, AB, Canada.
2
2 Royal Alexandra Hospital, Edmonton, AB, Canada.
3
3 University of Alberta, Edmonton, AB, Canada.

Abstract

OBJECTIVE:

To review available evidence for dolutegravir-based dual therapy as maintenance treatment in HIV-1 infected patients.

DATA SOURCES:

A literature search was conducted using PubMed, MEDLINE, and Google Scholar to the end of January 2018. Conference abstracts and article bibliographies were also reviewed.

STUDY SELECTION AND DATA EXTRACTION:

All English-language, randomized, and observational studies were included.

DATA SYNTHESIS:

In all, 12 studies were identified: 10 were observational, and 2 were randomized trials. Rilpivirine or lamivudine were the most common second agent used in combination with dolutegravir. Virological suppression seen in observational studies appear promising; however, the most compelling evidence to date is the 48-week results from 2 large open-label randomized trials (SWORD 1 and 2). These studies found that dual therapy with rilpivirine and dolutegravir was noninferior to 3- or 4-drug combination antiretroviral therapy (cART). The long-term efficacy, safety, and tolerability of dual therapy, as compared with usual cART, are less clear and require further data.

CONCLUSIONS:

Regimen switching in virally suppressed HIV-1-infected patients may be considered to reduce pill burden or dosing frequency, decrease short- or long-term toxicity, prevent or manage drug-drug interactions, and/or decrease cost. Based on available evidence, a switch to dual therapy with dolutegravir and rilpivirine appears viable for virologically suppressed patients without prior resistance mutations to these agents. Randomized studies of other dual-therapy regimens that include dolutegravir and longer-term follow-up as well as cost-effectiveness analyses are needed to provide confirmation that this strategy offers advantages to traditional cART regimens.

KEYWORDS:

HIV; dolutegravir; dual therapy

PMID:
29442543
DOI:
10.1177/1060028018758432
[Indexed for MEDLINE]

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