Two-drug regimen with dolutegravir plus lamivudine for HIV treatment in children: a narrative review

Abstract

The treatment landscape for HIV is rapidly evolving, particularly with the advent of two-drug regimens (2DR). Traditionally, three-drug regimens (3DR) have been the standard, providing effective treatment but often at the cost of tolerability and increased pill burden. Recent studies demonstrate that 2DR can achieve non-inferior virological suppression compared to 3DR, while potentially offering enhanced safety and reduced long-term drug exposure. This review evaluates the current evidence on the efficacy and safety of dolutegravir (DTG) plus lamivudine (3TC) in both adult and pediatric populations. The pediatric population presents unique challenges due to complexities in treatment adherence and limited available options, underscoring the urgency for effective treatments tailored to their needs. Emerging data from ongoing clinical trials highlight the potential of DTG/3TC to maintain viral suppression with fewer side effects and improve treatment adherence through simplified regimens. The review highlights the need for further research to support the use of 2DR in children and adolescents, particularly regarding long-term safety and efficacy. With increasing focus on quality of life and affordability, the integration of 2DR into pediatric HIV care may represent a critical advance in improving treatment outcomes for this vulnerable population and warrants continued clinical investigation and careful implementation into practice.

Keywords: Two-drug regimen; adolescents; antiretroviral therapy; children; lamivudine/dolutegravir.