Background: The importance of two-drug combination in viral suppression of HIV is to simplify dosing regimen and reduce pill burden for patients with HIV. Reducing the number of drugs in a regimen reduces long term drug exposures and potential drug toxicity or drug interaction as well as protecting the activity of drugs spared for the future. Subjects switching to this two-drug regimen experienced a significant benefit in bone biomarkers.
Methods: Several clinical trials are performed for DTG+RPV they demonstrate NON INFERIORITY in two phase -3 switch studies known as sword - 1 and sword - 2 with 95% efficacy at 48 weeks. (LLIBRE is the lead author on sword - 1 and sword - 2 the studies referenced above). Sub studies evaluating bone, kidney, lipid profile, cardio vascular health and health related quality of life are ongoing.
Results: During clinical studies on these two- drug combination of dolutegravir and rilpivirine, the virologic suppression rates were similar between two-drug combination and triple and quadruple combination. The virologic failure rates were >1% in DTG+RPV and 1% in the three or four antiretroviral drug. In DTG+RPV no integrase strand inhibitor resistance(INSTI) - associated mutations were reported.
Conclusions: Life long HIV antiretroviral therapy has prompted an interest in two-drug regimen to minimize cumulative drug exposure and toxicity. The safety, tolerability and efficacy of dolutegravir and rilpivirine suggest potential comapatability and effectiveness as a two-drug regimen.