Dual therapy with lamivudine plus boosted protease inhibitor for treatment of HIV

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Jose Alfredo de Sousa Moreira1 and Nilesh Bhatt2

1National Institute of Infectious Diseases, Brazil 2National Institute of Health, Mozambique

: J Immunol Tech Infect Dis

Abstract

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Current antiretroviral therapy (ART) effectively suppresses HIV replication. However, standard ART combinations still posse’s enormous challenges in clinical practice. In this context, research on simplified therapies has emerged to fill the gap. The main advantages of simplified regimens include: reduce pill burden, improve patient compliance and avoid longterm toxicity while preserving future treatment options and maintaining virological efficacy. There has been interest in the combination of lamivudine (3TC) and boosted protease inhibitor (bPI) for treatment of HIV infection, because 3TC is well tolerated, widely available and relatively cheap. We aim to examine studies including dual therapy with 3TC + bPI in adults HIV-positive patients with varying degrees of ART experience. We retrieved published English language studies via PubMed, Medline and Google Scholar through March 2015. Our search terms included “HIV”, “treatment simplification” and “dual therapy”. Our research yielded 80 hits, and 7 titles were fully reviewed. The remaining articles were excluded as they evaluated other simplified dual therapy regimens (i.e. Maraviroc + Darunavir/ritonavir; Raltegravir + Lopinavir/ritonavir, Etravirine + Raltegravir). Lopinavir/r + 3TC was the most frequent combination (3 studies), followed by Atazanavir/r (2 studies) and Darunavir/r (2 studies). We found that in ART-naïve patients, there now exists a robust evidence for the use of 3TC plus PI/r dual therapy. In treatment–experienced virologically suppressed patients switching to dual therapy, evidence is sparse and largely driven by small observational or pilot studies. Overall, the evidence suggests that selection of right candidate for dual therapy is critical in the consolidation of this simplified strategy as an accepted HIV treatment approach. Fully powered randomized trials are eminent needed to proper define the place of this simplified regimen in international HIV treatment guidelines. Support: Moreira JAS was supported by a scholarship from “Programa de Estudantes - Convênio de Pós-graduação – PEC-PG, da CAPES/CNPQ – Brazil”.

Biography

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Jose Alfredo de Sousa Moreira has completed his medical specialization in infectious diseases from Evandro Chagas National Institute of Infectious Diseases (INI/ FIOCRUZ). He is currently a first-year master student working on an interdisciplinary research between INI/FIOCRUZ and Mozambique National Institute of Health. Supervised by Prof. Valdilea Veloso (Co-chair of INI/FIOCRUZ clinical research laboratory on HIV/AIDS). His research is sponsored by PEC-PG, Brazil. He has published more than 8 papers in reputed journals and has been serving as a reviewer board member of HIV and infectious diseases journals.

 E mail: jose.moreira@ini.fiocruz.br