Dolutegravir plus lamivudine as simplification dual therapy in virologically suppressed HIV-1 infected subjects

Introduction: The use of combination antiretroviral therapy (cART) containing three active drugs from at least two different classes is the standard of care for HIV treatment worldwide. The availability of newer drugs with improved potency and tolerability and higher barrier to the development of resistance allows exploring the feasibility of ARV-sparing strategies, namely dual therapies. A dual therapy based on dolutegravir plus lamivudine could be an intriguing simplification strategy for individuals with stable HIV suppression on cART. Results: Seven studies of dual therapy regimens based on dolutegravir plus lamivudine were critiqued. All of them report a low rate of therapeutic failure due to any cause and a small number of virologic failures. More important virologic failures were not associated with loss of future option as no resistance inducing mutation to ongoing drugs emerged. On the safety side, after the switch, very few short-term adverse events leading to treatment discontinuation were observed and surrogate markers of long term toxicities such as changes in lipid profile and renal function were minimally influenced or improved. Discussion: Dolutegravir plus lamivudine as a switch option in patients with sustained viral control is still to be considered an experimental approach. Although small in number and heterogeneous in nature the studies that evaluated the effectiveness of dolutegravir plus lamivudine dual therapy have documented substantial virologic efficacy and tolerability of the regimen without exposing patients to the risk of selecting for INSTI-inducing resistance mutations.