The 2016 WHO “Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection” promote earlier treatment initiation and better tolerated regimens to be used for people living with HIV, including adults, pregnant and breastfeeding women, infants, children and adolescents.
In 2016, WHO included DTG-based HIV treatment as an alternative first-line regimen. Clinical trials show that DTG is more effective, better tolerated and more protective against treatment discontinuation from adverse drug reactions than efavirenz (EFV) at standard dose (600 mg/day) and boosted (PIs).1 Further, DTG is associated with fewer drug interactions, has a higher genetic barrier to resistance, and is being launched as a low-cost, once-daily generic formulation for low- and middle-income countries.
New trial data are also emerging suggesting that DTG could be used as an alternative to standard second-line treatment with 2 nucleoside reverse transcriptase inhibitors (NRTIs) + lopinavir (LPV/r).2 However, further research is needed to determine whether DTG + 2 NRTIs or DTG + boosted PIs are viable options for people for whom first-line non-nucleoside reverse transcriptase inhibitors (NNRTI) based treatment has failed with high-level NRTI resistance. Thus, DTG use in second line is not part of the WHO consolidated ARV guidelines.
1: Kanters S, Vitoria M, Doherty M, Socias ME, Ford N, Forrest J et al. Comparative efficacy and safety of first-line antiretroviral therapy for the treatment of HIV infection: a systematic review and network metaanalysis. Lancet HIV. 2016;3:e510–20.
2: DAWNING Study: dolutegravir versus lopinavir/ ritonavir as second-line treatment. Bethesda (MD): clinicaltrials.gov, National Institutes of Health; 2017 (https://clinicaltrials.gov/ct2/show/NCT02227238?term=dolutegravir&rank=110, accessed 1 July 2017).