Dolutegravir best for resuppressing HIV

Findings from four large African trials suggest Dolutegravir is more effective than other antiretroviral drugs at resuppressing HIV.

What is the research about?

The most effective antiretroviral drug (ARV) for resuppressing someone’s viral load (the amount of HIV in the blood) if they have a viral rebound. A viral rebound is when a person on antiretroviral treatment (ART) gets detectable levels of HIV in their blood after having such a low a level that it was undectable in blood tests.

The study, which is yet to be published, looked at trials in Cameroon, South Africa, Uganda and Zambia. The trials compared dolutegravir to other types of ART (protease inhibitor or efavirenz).

Why is this research important?

If someone experiences viral rebound one option is to swap them to a different type of ART. But doing this is expensive. So it is important to know how likely it is that someone can become resuppressed if they stay on their original treatment.

What did they find out?

Researchers analysed data on people who had experienced ‘viral failure’ and did not change treatment. Viral failure was defined as having a viral load above 1000 copies/ml blood.

In the South African trial, for example, 41-59% of people on dolutegravir became resuppressed, compared to 23% of people on efavirenz. In Cameroon, 60% of people on dolutegravir became resuppressed compared to 27% on efavirenz.

In three of the four trials, people on ART who were not on dolutegravir were more likely to remain in viral failure than people on dolutegravir.

What does this mean for HIV services?

Although more people with HIV can get dolutegravir, not everyone can. This is despite many countries now recommending that dolutegravir should be the first type of HIV treatment people are offered. This makes dolutegravir access an important advocacy issue to take up. Not only do these results suggest that dolutegravir is more effective than other ARVs at resuppressing HIV, it also has a much lower chance of leading to drug resistant HIV. And it causes fewer side effects than other ARVs.

The findings also show how important it is for someone to have regular monitoring and enhanced adherence counselling if they experience treatment issues. Doing this means they might be able to become undectable again without switching treatment, particularly if they are on dolutegravir.

Regularly monitoring someone will also show whether treatment is failing to re-suppress HIV even if they are taking their treatment correctly, in which case they do need to swap to a different ARV. But more research is needed to assess how long people on dolutegravir should wait before they change treatment.