DUAL ANTIRETROVIRAL THERAPY WITH DOLUTEGRAVIR PLUS LAMIVUDINE: REAL WORLD EXPERIENCE FROM THE NORTH EAST OF ENGLAND

Background

UK HIV treatment guidelines have included interim guidance supporting dolutegravir (DTG) plus lamivudine (3TC) dual therapy in the context of a ‘supressed switch’ since 2019 (1). We evaluated our experience of using DTG+3TC in routine clinical care at a regional centre managing more than 1000 people living with HIV (PLWH) in the North East of England.

Methods

We identified patients prescribed DTG+3TC from 2019-present using our HARS dataset, cross-referencing pharmacy records. Demographics and clinical outcomes were extracted from individual patient records. Post-switch suppression was defined as HIV viral load < 200 copies/mL.

Results

Since 2019, 24 patients have been prescribed DTG+3TC (2% of the cohort, 21% of cases discussed at the MDT). The majority were men (83%) aged over 50 (70%). Reasons for treatment switch included osteopaenia/porosis (29%); renal dysfunction (21%); increasing cardiovascular risk (12%), and side effects from other HIV therapies (12%). A minority described side-effects (n = 3: headache, disturbed sleep and gastrointestinal upset). Of the 22 patients switching to DTG+3TC in 2021 or earlier, all were virologically suppressed at 4 weeks and there have been no cases of subsequent virological failure.

Discussion

DTG+3TC is a novel antiretroviral combination which may be used to mitigate both renal and cardiovascular risk. In this clinical series, it was well tolerated and virological suppression was maintained. DTG+3TC dual therapy was recommended in a significant proportion of recent MDT case discussions, thus we anticipate increased use in our cohort in future. It will be important to evaluate the experience of women and younger patients.

References

https://www.bhiva.org/file/5d97749ea9e89/LauraWaters.pdf BHIVA treatment guidelines: interim statement on two-drug regimens Laura Waters, Consultant GU/HIV Medicine Mortimer Market Centre, CNWL NHS Trust London, UK