No change in residual viremia after switch to 2-drug regimen.
In the ASPIRE trial patients on antiretroviral therapy (ART)
with three drugs and suppressed viremia were randomized
to continue their present ART or to switch to a combination
of dolutegravir and lamivudine. After 24 and 48 weeks, the
virologic outcome was comparable in the 2 arms. An ultrasensitive
assay was used to evaluate if there were any differences in residual
viremia between the two arms. At entry, the residual viremia
did not differ, with 5.0 versus 4.2 HIV-RNA copies/mL
in the respective arm. There were no significant changes in
residual viremia after 24 or 48 weeks and also no difference
between the two arms.
Ref; Li et al. Open Forum Infectious Diseases, Volume 6, Issue 3, March 2019, ofz056, https://doi.org/10.1093/ofid/ofz056
Comment: One potential consequence of switching from a
“traditional” 3-drug regimen to a 2-drug regimen may be an
increase of low level viremia and in the long run virological failure.
It is reassuring that no evidence of increasing low level
viral replication was found after switching to dolutegravir and
lamivudine after 48 weeks. Dual therapy with dolutegravir and
lamivudine seems to be an attractive switch option in virologically
suppressed patients without prior resistance, but a longer
follow-up would be even more convincing.