A predictive model of immune recovery for DTG + 3TC and DTG + RPV used as switching strategies in HIV+ patients.

Current antiretroviral strategies of dual therapy containing dolutegravir have achieved high virological suppression targets of over 91% in naive patients,1 and maintained virological suppression of over 95% in pretreated patients at 48 weeks.2,3 In clinical trials, immune system restoration has been favoured by the early start of ART after HIV diagnosis and the presence of CD4+ lymphocyte counts above 500 cells/mm3. However, in the real-life world, a high percentage of HIV+ patients are diagnosed or live with lower CD4+ counts, in many cases below 350 cells/mm3.4 In these patients, immune recovery is not always fast, it may be delayed and be subject to multiple factors including antiretrovirals. At a time of maximum efficacy and potency of antiretroviral strategies, therapeutic goals should probably be directed not only to the long-term efficacy and tolerability but also to the normalization of the immune status, especially in those patients with low CD4+ count. As dual therapy has become the standard treatment in many switching strategies, the possibility of anticipating immune recovery, especially among those patients with low CD4+ lymphocyte count, could be of great interest. In this sense, we propose a predictive model of immune recovery for dolutegravir plus lamivudine and dolutegravir plus rilpivirine used as switching strategies.