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7. Simplified Dolutegravir Therapy Looks Promising

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The potent HIV integrase inhibitor dolutegravir (Tivicay) taken with a single well-tolerated NRTI fully suppressed viral load in people starting antiretroviral therapy for the first time, while dolutegravir monotherapy was able to keep HIV suppressed in most treatment-experienced people who started with undetectable viral load, according to studies presented at the European AIDS Conference in October.

Pedro Cahn of Fundacion HUESPED in Buenos Aires reported findings from the PADDLE study, which evaluated a 2-drug regimen of 50 mg dolutegravir plus 300 mg lamivudine (Epivir or 3TC) for first-line treatment.

All 20 treatment-naive participants in this small pilot study reached viral loads below 50 copies/mL from week 8 onward. This dual regimen could offer lower cost, reduced toxicity, and smaller pill burden, Cahn said.

Two other small studies looked at dolutegravir alone as maintenance therapy for people whose virus is suppressed on other regimens. Both studies enrolled heavily treatment-experienced patients, many of whom had extensive drug resistance and were on non-standard regimens. Most switched due to resistance, comorbidities incompatible with antiretroviral toxicities, or risk of drug interactions.

Most participants -- 97% in the Spanish study and 89% in the French study -- maintained viral suppression. Larger randomized clinical trials are now underway to further explore this simplified treatment strategy.

NEXT: 8. Long-term HIV Remission and Post-Treatment Control