The triumph of HIV treatment: Another new antiretroviral.

October 11, 2017 at 7:52 am

Lancet August 31, 2017   

Comment

Boffito M and Venter F.

Since the approval of the first integrase strand inhibitor (INSTI) raltegravir for the treatment of HIV 10 years ago, INSTIs have become agents of choice in combination with two nucleoside reverse transcriptase inhibitors (NRTIs) in many international guidelines.1, 2 This was driven by the sound real-world experience of this antiretroviral class, especially following the introduction of the most recently licensed INSTI, dolutegravir.

Dolutegravir has shown superiority to other major alternative third agents belonging to the classes of protease inhibitors and non-NRTIs, and it has become the gold standard against which other drugs need to prove their efficacy. It is dosed once daily in most patients, and it is coformulated with either abacavir and lamivudine or tenofovir disoproxil fumarate and lamivudine. Importantly, dolutegravir does not require the coadministration of a pharmacoenhancer and is characterised by a low potential for drug–drug interactions, unlike elvitegravir. The high barrier to the development of resistance3 might go some way to address the recent concern over rising resistance to efavirenz (the current primary recommendation for low-income and middle-income countries), resulting in WHO looking for alternative treatments, with dolutegravir appearing to be the current leading cost-effective candidate.4, 5, 6 The tide is changing and middle-income countries like Brazil, Botswana, and South Africa are starting to adopt INSTIs for first-line treatment.5 …

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http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32297-3/fulltext

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Entry filed under: Antirretrovirales, HIV/SIDA, HIV/SIDA HAART.

Antiretroviral therapy in pregnant women living with HIV: A clinical practice guideline. Coformulated bictegravir, emtricitabine, and tenofovir alafenamide versus dolutegravir with emtricitabine and tenofovir alafenamide, for initial treatment of HIV-1 infection (GS-US-380–1490): A randomised, double-blind, multicentre, phase 3, non-inferiority trial.


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