Dolutegravir and rilpivirine for the maintenance treatment of virologically suppressed HIV-1 infection.
Dolutegravir and rilpivirine for the maintenance treatment of virologically suppressed HIV-1 infection
Introduction: Triple combinations of antiretroviral (ART) drugs are the standard treatment for HIV infection, but the challenges include long-term side effects, high costs, and adherence. The recent advent of potent and well tolerated ART has renewed the interest for newer ART strategies. A dual regimen with the combination of dolutegravir (DTG) and rilpivirine (RPV), two well tolerated, metabolic-friendly, and potent drugs could offer additional benefits.
Areas covered: A review of recent randomized trials and observational cohorts concerning the use of a dual therapy with DTG plus RPV as a switching strategy in patients with viral suppression.
Expert commentary: Currently, data of more of 900 patients switched to this dual regimen are available. This combination shows a high rate of virological suppression, above 90% at 48 weeks, few discontinuations due to adverse events, improvement in bone and kidney parameters for patients discontinuing tenofovir disoproxil fumarate (TDF), lack of loss of the inflammatory control achieved with triple therapy, and a neutral effect on lipid parameters. Thus, for the first time, a dual regimen without protease inhibitors is effective, avoiding metabolic side effects and drug interactions. Longer follow-up is needed, but this dual regimen appears as a promising strategy for aging HIV-infected patients.