Dual treatment with lopinavir–ritonavir plus lamivudine versus triple treatment with lopinavir–ritonavir plus lamivudine or emtricitabine and a second nucleos(t)ide reverse transcriptase inhibitor for maintenance of HIV-1 viral suppression (OLE): a randomised, open-label, non-inferiority trial

Impact of the M184V Resistance Mutation on Virological Efficacy and Durability of Lamivudine-Based Dual Antiretroviral Regimens as Maintenance Therapy in Individuals With Suppressed HIV-1 RNA: A Cohort Study

“…Dual therapies (DTs) have been explored in a significant number of randomized clinical trials and are increasingly being used as maintenance therapy, particularly in some European countries. Lamivudine is the companion drug for many of the dual regimens investigated so far [2–7]. A meta-analysis of randomized trials showed a noninferior risk of virological failure with lamivudine plus boosted protease inhibitor (bPI) as compared with continuation of the 3-drug regimen [8].…”

HIV and Aging – Perhaps Not as Dramatic as We Feared?

“…Finally, some HIV clinicians actively stop the “third agent” (TDF, ABC) for reasons of bone, renal, and CV health, arguing that evidence from randomized trial for the virological efficacy of dual therapy – using, e.g., 3TC and a protease inhibitor – is now solid [61, 62]. Those who avoid protease inhibitors are now using 3TC or FTC in combination with dolutegravir with success (dolutegravir monotherapy is not recommended today because the virological failure rate is too high), and virological failure with such dual therapy has been rare [63].…”

Protease inhibitor monotherapy was non-inferior and cost-effective as maintenance therapy compared to triple therapy in viral load suppressed patients with HIV-1 infection

“…Indeed, the higher risk of virological failure, the need of a more frequent monitoring, the uncertainties for long-term virological control in sanctuaries and the advent of less toxic and well-tolerated drugs have tempered the appeal for single-drug regimens. In addition, two recent switch studies2 3 demonstrated that the combination of PI/r plus lamivudine is non-inferior to triple therapy at week 48, being so far the strongest evidence that HIV can be controlled with a less-drug and cost-saving regimen, with a similar risk of virological failure, emergent resistance and LFOs.…”

“…PI-mono is not expected to play a major role for the maintenance strategy of HIV infection over the next few years, as the PI-based dual strategies2 3 compared similarly to triple regimens and it is cheaper, while the next-coming tenofovir alafenamide4 will increase the appeal of widely used three-drug single tablet regimens.…”