Enhancing HIV care as the treatment landscape evolves

6 minute read


With advancements in HIV care, it is important to broaden the perspective beyond viral suppression alone.


The predominant focus for modern HIV treatment and care has long centred around achieving viral suppression.

Ongoing advancements in HIV care have transformed HIV from a once fatal diagnosis to a chronic, but manageable condition for most. However, there are still unmet patient needs concerning overall health that must be addressed.

As the treatment landscape evolves, healthcare professionals must ensure that people living with HIV are able to live and age well whilst maintaining viral suppression. While combination therapies with three antiretroviral agents have been the standard treatment for HIV for the last two decades, certain two drug regimens (2DR) are equally as effective in maintaining viral suppression.1-4 As 2DRs contain less medicines there are potentially additional benefits as discussed below.

People living with HIV may experience a complex range of health concerns that often require polypharmacy, which may heighten the risk of drug-drug interactions, adverse drug reactions, and challenges in medication adherence.5 Additionally, antiretroviral treatments may have an impact on a patient’s metabolic profile – which may increase their risk for certain conditions such as cardiovascular disease, type 2 diabetes, and chronic kidney disease.6 

A 2DR, such as Dovato, a fixed dose combination of Dolutegravir 50mg and lamivudine 300mg, may address patient polypharmacy concerns by reducing the number of administered antiretroviral drugs. Additionally, Dovato has proved to be efficacious, well tolerated with a low drug-drug interaction rate and has no clinically significant metabolic health impact. 1,3,4,7,8

Randomised clinical trials and real-world evidence demonstrate that Dovato has a high barrier to resistance and shows non-inferiority or superiority to traditional 3-drug antiretroviral regimens, in the naïve and virologically suppressed patient setting.1-4,9-12 It is vital that HCPs consider the 2DR option, Dovato, for those individuals who meet the indication.10 Dovato may reduce exposure to unnecessary antiretroviral agents and address other potential concerns including cardiometabolic health.

It is also important to consider the deprescribing benefits for older patients.13 As people living with HIV age, prescription medication often increases as they are at a higher risk of developing cardiometabolic diseases, such as cardiovascular disease and metabolic disorders.14 To assist with quality of life at an older age, healthcare professionals must address these comorbidities and explore deprescribing strategies with antiretroviral and other treatments.

As healthcare professionals, it is important we do everything we can to ensure our patients are able to access suitable and individualised treatment at the right time. The current stage of the HIV/AIDS epidemic shows that access to effective treatment and care can ensure those living with HIV can have equal life expectancy to those living without. By embracing a broader perspective and addressing patients’ health concerns, we can continue improving health outcomes for all people living with HIV.


References:

  1. van Wyk J et al. (2020) Efficacy and Safety of Switching to Dolutegravir/Lamivudine Fixed-Dose 2-Drug Regimen vs Continuing a Tenofovir Alafenamide–Based 3- or 4-Drug Regimen for Maintenance of Virologic Suppression in Adults Living With Human Immunodeficiency Virus Type 1: Phase 3, Randomized, Noninferiority TANGO Study. Clinical Infectious Diseases, 71(8), 1920–1929. https://doi.org/10.1093/cid/ciz1243
  2. Cahn, P., et al. (2022) Three-year durable efficacy of dolutegravir plus lamivudine in antiretroviral therapy – naive adults with HIV-1 infection. 1;36(1):39-48. doi: 10.1097/QAD.0000000000003070
  3. Osiyemi O, De Wit S, Ajana F, et al. Efficacy and safety of switching to dolutegravir/lamivudine (DTG/3TC) versus containing a tenofovir alafenamide-based 3- or 4-drug regimen for maintenance of virologic suppression in adults living with HIV-1: results through week 144 from the phase 3, non-inferiority TANGO randomized trial. Clin Infect Dis. 2022;ciac036 and suppl 1-18. doi:10.1093/cid/ciac036
  4. Llibre JM, et al. (2023). Efficacy and Safety of Switching to the 2-Drug Regimen Dolutegravir/Lamivudine Versus Continuing a 3- or 4-Drug Regimen for Maintaining Virologic Suppression in Adults Living With Human Immunodeficiency Virus 1 (HIV-1): Week 48 Results From the Phase 3, Noninferiority SALSA Randomized Trial. Clin Infect Dis 2022;76:720–9
  5. He, J., Zhu, Z., Sun, M., Liu, X., Yu, J., Zhang, L., & Lu, H. (2023). Barriers and facilitators to maintaining a high level of polypharmacy adherence in people living with HIV: A scoping review. Frontiers in Pharmacology, 14. https://doi.org/10.3389/fphar.2023.1013688
  6. Taiwo BO, et al. (2022) Treatment and comorbidity burden among people living with HIV: a review of systematic literature reviews. Dec 23;12(1):1-11. doi: 10.1080/21556660.2022.2149963
  7. Degroote S, et al. (2022). HIV Glasgow 2022. Poster 150: Favorable metabolic outcomes 48 weeks after switch to DTG/3TC. Available at: https://www.croiconference.org/wp-content/uploads/sites/2/posters/2023/230214_Poster_CROI_metabolic_data_(2)-133209593277694835.pdf
  8. Batterham RL, et al. (2023). Cardiometabolic Parameters 3 Years After Switch to Dolutegravir/Lamivudine vs Maintenance of Tenofovir Alafenamide-Based Regimens. Open Forum Infect Dis. 2023 Jul 12;10(7):ofad359. doi: 10.1093/ofid/ofad359.
  9. ViiV Healthcare. Data on File. REF-223795
  10. ViiV Healthcare. (2023). Australian Product Information: Dovato. Available at: https://viivhealthcare.com/content/dam/cf-viiv/viivhealthcare/en_AU/files/dovato-pi.pdf   [Accessed May 2024]
  11. van Wyk J et al. (2020) Durable Suppression and Low Rate of Virologic Failure 3 Years After Switch to Dolutegravir + Rilpivirine 2-Drug Regimen: 148-Week Results From the SWORD-1 and SWORD-2 Randomized Clinical Trials. 85(3):325-330. doi: 10.1097/QAI.0000000000002449.
  12. Molina JM et al. (2015). Once-daily dolutegravir versus darunavir plus ritonavir for treatment-naive adults with HIV-1 infection (FLAMINGO): 96 week results from a randomised, open-label, phase 3b study. 2(4):e127-36. doi: 10.1016/S2352-3018(15)00027-2.
  13. Greene M, et al. (2014). Polypharmacy, drug-drug interactions, and potentially inappropriate medications in older adults with human immunodeficiency virus infection. 62(3):447-53. doi: 10.1111/jgs.12695
  14. Roomaney RA, van Wyk B, Pillay-van Wyk V. (2022). Aging with HIV: Increased Risk of HIV Comorbidities in Older Adults. 18;19(4):2359. doi: 10.3390/ijerph19042359.

This article was developed for Medical Republic by Dr Don Smith with funding from ViiV Healthcare Pty Ltd. Any views expressed in the article are those of the author and do not necessarily reflect the views of ViiV Healthcare. Dr Smith received honoraria from ViiV Healthcare Pty Ltd for the development of this article.

Please review Product Information before prescribing. Full Product Information is available from ViiV Healthcare Australia at www.viivhealthcare.com.au or on 1800 499 226. For information on ViiV Healthcare products or to report an adverse event involving a ViiV product, please contact Medical Information on 1800 499 226. ViiV Healthcare Pty Ltd, ACN 138 687 448, Melbourne, VIC. PBS Information: This product is listed on the PBS as a section 100 item. Refer to PBS Schedule for full authority information.


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