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.