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Dolutegravir plus Lamivudine versus Dolutegravir-based triple therapy: comparable viral decay

The aim of a study was to expand understanding of the virological potency of initial Dolutegravir plus Lamivudine dual therapy ( Dolutegravir / Lamivudine; Dovato ).
Researchers have compared the viral decay seen in the pilot ACTG A5353 study with the decay observed with Dolutegravir plus two NRTIs in the SPRING-1 and SINGLE studies, while also exploring the impact of baseline viral load ( VL ).

Change in viral load from baseline was calculated for timepoints shared by A5353 ( n = 120, including 37 participants with pretreatment viral load more than 100 000 copies/mL ), SPRING-1 ( n = 51 ) and SINGLE ( n = 417 ).

The mean viral load change from baseline to week 24 was -2.9 log10 copies/mL for Dolutegravir / Lamivudine versus -3.0 log10 copies/mL for Dolutegravir-based three-drug therapy ( P less than 0.001 ).

In the decay model, baseline viral load more than 100 000 copies/mL was associated with a slower initial decay rate ( d1 ).

A faster initial decay rate was seen with Dolutegravir / Lamivudine, which was partially offset when baseline viral load was more than 100 000 copies/mL as indicated by a significant interaction between baseline viral load and drug therapy group.

The secondary decay rate ( d2 ) was not significantly different from zero, with no significant associations.

In conclusion, viral decay with Dolutegravir / Lamivudine was comparable to viral decay with Dolutegravir-based triple therapy, even in individuals with higher pretreatment viral load ( more than 100 000 copies/mL ). ( Xagena )

Gillman J et al, J Antimicrob Chemother 2019; Epub ahead of print