Dual Therapy With Renally Adjusted Lamivudine and Dolutegravir

A Switch Strategy to Manage Comorbidity and Toxicity in Older, Suppressed Patients?

M Tan; S Johnston; J Nicholls; M Gompels

Disclosures

HIV Medicine. 2019;20(9):634-637. 

In This Article

Abstract and Introduction

Abstract

Objectives: The aim of the study was to evaluate the efficacy of dual therapy with lamivudine (3TC), with dose adjustment for renal function, and dolutegravir (DTG) in a subgroup of patients fully suppressed on treatment who were switched because of concerns about comorbidity and toxicity on their current triple drug regimen.

Methods: A retrospective evaluation of clinical and pathological parameters from an electronic patient record from a single centre was carried out.

Results: There were no virological failures in 52 patients with a median age of 60.5 years. The median duration of follow-on dual therapy was 2.29 years (28 months; range 1.10–3.34 years). In 25 of 52 (48%) cases, the dose of 3TC was adjusted taking into account reduced renal function, and none of these patients experienced virological failure. Four additional patients discontinued early, because of side effects of the switch, with no failure.

Conclusions: This retrospective review suggests that 3TC and DTG may be effective in controlling viral load in older patients with comorbidities. This regimen appears to be a useful option in the context of comorbidities (including renal impairment) and polypharmacy in older patients. However, this review has been conducted in one centre and in a small population of patients. Therefore, further multicentre trials involving larger populations of patients are needed.

Introduction

The life expectancy of people living with HIV has improved dramatically with the advent of effective therapy and an increasing proportion of people are aged 50 years or older. The requirement for lifelong therapy and the management of non-HIV-related comorbidities has become increasingly important as patients are living well with HIV. As a result, there is more interest in simplified antiretroviral therapies (ARTs) that are efficacious, well tolerated, and free from drug interactions.

Dual therapy as maintenance is an approach that is being evaluated as a means of reducing potential side effects and increasing tolerability by reducing the number of agents, as well as reducing drug–drug interactions. Data have been reported on the use of dolutegravir (DTG) combined with rilpivirine (RPV)[1] and lamivudine (3TC).[2]

The analysis of 48-week data from the GEMINI 1 and 2 studies, investigated DTG and 3TC in ART-naïve patients, demonstrated noninferiority of this regimen when compared with DTG and tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC). Good tolerability was also demonstrated.

The aim of this review was to assess the efficacy, durability and tolerability of simplifying to once a day (OD) therapy with DTG and 3TC in a real-life cohort of patients on fully suppressive ART and switched for the purposes of simplification or because of toxicities or comorbidities. This cohort is of interest as 3TC was used in an adjusted dose according to renal function, and this cohort included individuals who may have been deemed ineligible for prospective clinical trials.

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