Candidates for inclusion in a universal antiretroviral regimen: dolutegravir

Abstract

Purpose of review: The review addresses the role of dolutegravir (DTG) in first-line therapy. In the era of test and treat, where United Nations AIDS Program and WHO have set the ambitious targets of 90/90/90, new efficacious, well tolerated, and simple therapeutic options are needed.

Recent findings: DTG has been tested in large clinical trials in treatment-naïve patients, showing noninferiority to raltegravir and superiority compared with efavirenz and ritonavir-boosted darunavir, respectively. The main features of DTG are reviewed in this study, including efficacy, safety, high-resistance barrier, daily treatment schedule, and coformulation as single-tablet regimen. Use of DTG in special populations is also reviewed. Tolerability, with focus in neuropsychiatric disturbances is discussed in particular. DTG has shown high efficacy level, tested in males and females, has no limitations in patients with renal and/or hepatic impairment and is available as single drug (to be combined with two nucleoside reverse transcriptase inhibitors in fixed combinations) or as a single-tablet regimen combined with abacavir and lamivudine.

Summary: DTG is an excellent candidate for initial therapy in HIV-infected patients. If safety of DTG in pregnant women are confirmed by ongoing studies, DTG might become the first option in WHO antiretroviral guidelines.