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Can dolutegravir dual therapy or monotherapy produce and maintain HIV suppression?
Liz Highleyman, 2015-10-23 08:00:00

The potent integrase inhibitor dolutegravir taken with a single well-tolerated NRTI was able to fully suppress viral load in people initiating antiretroviral treatment for the first time, while dolutegravir alone was able to keep HIV suppressed in most treatment-experienced people who started with undetectable viral load, according to a set of studies presented yesterday at the 15th European AIDS Conference in Barcelona, Spain.

After these presentations, experts offered evidence in favour of and opposed to simplifying treatment by reducing drug burden, disagreeing about whether this strategy is beneficial or too risky.

As people living with HIV continue to face decades on treatment, researchers have attempted to find regimens that are better tolerated, simpler and easier to take. Non-standard antiretroviral therapy (ART) may be especially beneficial for heavily treatment-experienced patients with drug-resistant virus and those who cannot tolerate drug side-effects. Using a single potent drug alone would reduce pill burden and toxicities, but protease inhibitor monotherapy studies to date have yielded conflicting results.

ViiV Healthcare's integrase inhibitor dolutegravir (Tivicay, also in the Triumeq single-tablet regimen) has demonstrated potent antiviral activity – reducing viral load by an impressive 2.5 log10 in an early 10-day monotherapy study – and a high barrier to resistance, making it an attractive prospect for streamlined therapy. It is well-tolerated and does not have the toxicities and drug-drug interactions seen with the protease inhibitor class.