Antonio Camiro

Dolutegravir-based ART and Dual ART are both contemporary first line ART strategies that were included in most ART guidelines during the past 5 years. In this oral abstract session, we were presented with clinical trials and cohorts that compare the impact of these schemes with the previous standard of care.

Dr. Marinsoci, talked about the SIMPL’HIV trial, which evaluated the effect of switching virally suppressed patients in triple therapy to dual therapy with Dolutegravir + Lamivudine. The results show that this regimen maintains non-inferior rates of viral suppression when compared to the standard of care at 144 weeks of follow-up. Dr. Figueroa showed the results of the ANDES study, in which a dual therapy of boosted Darunavir plus Lamivudine was compared with a triple therapy regimen of boosted Darunavir plus Lamivudine/Tenofovir for the treatment of naïve patients. Again, the dual therapy showed non-inferiority at 48 weeks when compared with triple drug regimen. Dr. Mpoudi talked about the NAMSAL trial in Cameroon, which compared Dolutegravir-based regimens Vs Efavirenz-based regimens after 192 weeks of follow-up in naïve patients. The study showed Dolutegravir-based regimens’ durable efficacy, whilst also demonstrating a significant larger weight gain when compared with Efavirenz-based ART. Finally, Dr. Brites talked about an observational cohort of Dolutegravir-based vs Efavirenz-based regimens as initial ART in AIDS patients. Patients treated with Dolutegravir had a higher proportion of viral suppression, survival rate, immune restoration and lower discontinuation rates after 48 weeks, suggesting Dolutegravir as a preferential option to treat patients with advanced HIV.

There is a growing body of evidence that reaffirm the safety and efficacy of dual therapy regimens. Further cost-effectiveness analysis and long-term monitoring of non-AIDS related outcomes is necessary to figure out their possible role as the preferred first-line ART. Dolutegravir-based regimens continue to prove superior to Efavirenz-based regimens, and can now be used more confidently in advanced HIV and AIDS. More research is needed to determine if the associated metabolic side effects offset their benefit as well as to find the best strategy to address them. Ethical concerns may rise in future trials using Efavirenz as a comparator.