A new systematic review and meta-analysis published in Infectious Diseases and Therapy has validated the real-world effectiveness of the two-drug combination of dolutegravir (DTG) and lamivudine (3TC) for treating HIV infection, confirming results previously observed in phase 3 clinical trials.
The comprehensive analysis examined data from 43 studies conducted between January 2013 and March 2024, incorporating both treatment-naïve and experienced patients across diverse geographical populations. The research included data from multiple medical databases and 21 regional and international HIV/AIDS conferences.
Treatment Efficacy in Different Patient Populations
The study population represented a broad spectrum of HIV patients, with 32.6% of treatment-naïve individuals having viral loads of 100,000 or more copies/mL, and 24.1% presenting with viral loads exceeding 500,000 copies/mL. Among treatment-experienced patients switching to DTG+3TC, only 2.6-3.4% had detectable viral loads at the time of transition.
Strong Viral Suppression Rates
The meta-analysis revealed impressive viral suppression rates across all patient groups:
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Treatment-naïve patients:
- 96.4% success rate at 48 weeks (95% CI, 0.945-0.979)
- 90.2% success rate at 96 weeks (95% CI, 0.816-0.966)
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Treatment-experienced patients:
- 96.6% success rate at 48 weeks (95% CI, 0.950-0.980)
- 97.1% success rate at 96 weeks (95% CI, 0.946-0.990)
Minimal Treatment Failures
Virologic failures, defined as two consecutive viral load readings of 50 copies/mL or more, were exceptionally rare:
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Treatment-naïve patients:
- 0.1% at 48 weeks (95% CI, 0.000-0.013)
- 0.1% at 96 weeks (95% CI, 0.000-0.008)
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Treatment-experienced patients:
- 0.9% at 48 weeks (95% CI, 0.005-0.015)
- 1.5% at 96 weeks (95% CI, 0.007-0.024)
Treatment Discontinuation Rates
The analysis tracked discontinuation rates for any reason:
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Treatment-naïve patients:
- 5.2% at 48 weeks (95% CI, 0.019-0.097)
- 13.0% at 96 weeks (95% CI, 0.084-0.183)
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Treatment-experienced patients:
- 6.7% at 48 weeks (95% CI, 0.042-0.098)
- 8.4% at 96 weeks (95% CI, 0.047-0.130)
Study Limitations
The researchers noted several limitations to their analysis. The study relied solely on reported data, and treatment-emergent resistance could not be included due to unavailable genotypic resistance test results. Additionally, the analysis did not differentiate between treatment-related and unrelated discontinuations, and there were potential limitations in the publication bias analysis.
Despite these limitations, the findings strongly support DTG+3TC as a well-tolerated and effective treatment option for people living with HIV. The real-world results align with randomized controlled trial outcomes while representing a more diverse patient population with varying demographics, behaviors, and comorbidities.
