Dolutegravir-Rilpivirine,Dual Antiretroviral Therapy for the Treatment of HIV-1 Infection

Objective: To review the efficacy and safety of dolutegravir (DTG) with rilpivirine (RPV) as a dual therapy regimen in the treatment of HIV-1 infection. Data Sources: A literature search was performed using PubMed (1966 to January 2019) and Google Scholar (2014 to January 2019) with the search terms dolutegravir, rilpivirine, dual, and switch. Other resources included review articles and the manufacturer product label. Study Selection and Data Extraction: All relevant English-language articles of studies assessing the efficacy and safety of switch therapy to DTG with RPV and review articles were included. Data Synthesis: The fixed-dose combination tablet of DTG and RPV is the first dual therapy approved for the treatment of HIV-1 infection in adult patients who have achieved virological suppression for least 6 months on current antiretroviral therapy. This single-tablet regimen is dosed once daily and has been compared with standard triple therapy antiretroviral regimens for safety and efficacy. The dual therapy regimen demonstrated comparable maintenance of virological suppression evaluated up to 100 weeks, with low rates of virological failure. Common adverse effects include headache and diarrhea. Relevance to Patient Care and Clinical Practice: This dual therapy represents an attractive option with a high barrier to resistance in patients without hepatitis B coinfection with adverse effects or significant drug-drug interactions on current therapy, polypharmacy, or end-stage renal disease, who are controlled on triple therapy. Conclusions: This dual therapy combination of DTG-RPV provides maintenance of virological suppression as a switch strategy with few drug interactions and positive effects on lipids and renal and bone health.