Is Dolutegravir Monotherapy Effective in Treating HIV?

The authors of the multicenter study performed in the Netherlands hypothesised that Dolutegravir (DTG) monotherapy (DTG 50 mg by mouth daily) was non-inferior to ART in sustaining virologic suppression. The results of this study was reported at CROI 2017.

Although #dolutegravir (#DTG) is known for its high genetic barrier to resistance, its durability to sustain virologic suppression had not previously been evaluated. Typically, effective ART consists of 3 antiretrovirals from at least two drug classes. Simplification of ART comes with the advantages of reduced costs, toxicity, pill burden, and a potential for drug-drug interactions.

A total of 96 patients received DTG-monotherapy, where 94 reached 24 weeks with viral load less than 200 copies/mL. 77 out of 96 participants made it to weeks with viral load less than 200 copies/mL of DTG-monotherapy. In total, 8 participants developed virological failure, and 3 participants were found to have developed integrase resistance.

The results of this study demonstrate that although DTG-monotherapy was non-inferior to ART at 24 weeks with viral load less than 200 copies/mL, virological failure continued to develop after 24 weeks leading to the development of integrase resistance in 3 patients. Therefore, the genetic barrier to resistance against DTG was inferior and should not be used as monotherapy for HIV maintenance therapy.