Combined antiretroviral therapy (cART) has significantly improved the prognosis and life expectancy of people living with human immunodeficiency virus (PLWHIV). Current international guidelines recommend a triple therapy that conventionally combines two nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) and a third agent that is either a ritonavir- or cobicistat-boosted protease inhibitor (PI), either a non-nucleoside reverse transcriptase inhibitor (NNRTI), or a boosted or unboosted integrase inhibitor (INI). Due to the toxicity of NRTIs, alternative non-NRTI-based therapeutic regimens have been proposed. They initially had limited success compared to the standard triple therapy due to low efficacy, particularly in patients with high viral load and low CD4 cell counts. A new strategy combining lamivudine (3TC) with boosted PI or INI has yielded promising results, suggesting that modern dual therapies will become a reliable first-line treatment option for PLWHIV. Recently, the European AIDS Clinical Society guidelines have recommended dual therapy as the preferred regimen in treatment-naive patients in certain circumstances.
Key Words
Dual antiretroviral therapy, people living with HIV (PLHIV), first-line therapy
What is already known about the topic?
Triple antiretroviral therapy is still recommended as the standard initial treatment strategy for PLWHIV. Nevertheless, due to the efficacy and lower toxicity of new molecules, modern dual antiretroviral therapies have become a reliable therapeutic option, with a similar efficacy, and may be considered in certain circumstances to reduce chronic exposure to antiretrovirals.
What does this article bring up for us?
This article provides an overview of currently available data supporting the use of dual antiretroviral therapy as initial treatment for PLWHIV.