Initial Antiretroviral Therapy in an Integrase Inhibitor Era: Can We Do Better?

Infect Dis Clin North Am. 2019 Sep;33(3):681-692. doi: 10.1016/j.idc.2019.05.003. Epub 2019 Jun 22.

Abstract

With the second-generation integrase inhibitors (dolutegravir and bictegravir) extending the attributes of earlier integrase inhibitors, three-drug regimens containing integrase inhibitors plus two nucleos(t)ide reverse transcriptase inhibitors are now widely recommended for first-line (initial) treatment of human immunodeficiency virus-1 infection. Led by dolutegravir plus lamivudine, two-drug therapy is emerging as a way to reduce antiretroviral therapy cost and adverse effects without compromising treatment options should virologic failure occur. Initial two-drug therapy has limitations, including the relative incompatibility with the coemerging concept of same-day antiretroviral therapy initiation.

Keywords: Bictegravir; Dolutegravir; Dual therapy; Integrase stand transfer inhibitors; Rapid start.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Retroviral Agents / administration & dosage*
  • Anti-Retroviral Agents / adverse effects
  • Anti-Retroviral Agents / economics
  • Anti-Retroviral Agents / pharmacology*
  • Antiretroviral Therapy, Highly Active / methods*
  • HIV Infections / drug therapy*
  • HIV Integrase Inhibitors / administration & dosage*
  • HIV Integrase Inhibitors / adverse effects
  • HIV Integrase Inhibitors / economics
  • HIV Integrase Inhibitors / pharmacology*
  • HIV-1 / drug effects
  • Humans
  • Treatment Outcome

Substances

  • Anti-Retroviral Agents
  • HIV Integrase Inhibitors