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Dolutegravir + rilpivirine (Juluca°) dual therapy in HIV infection

FEATURED REVIEW First-line therapy for patients with HIV infection is usually based on triple therapy. When sustained virological suppression has been achieved, treatment "simplification" can sometimes be considered. Is the two-drug regimen dolutegravir + rilpivirine (Juluca°) any better than other treatment options?
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  •  NOTHING NEW  In patients who have an undetectable viral load for at least one year and no history of HIV resistance after taking triple antiretroviral therapy, two comparative trials in a total of 1024 patients showed that switching to dolutegravir + rilpivirine dual therapy is no less effective in the short term than continuing triple therapy. However, dolutegravir + rilpivirine has not been compared with triple therapy in patients who did not tolerate a previous three-agent regimen, and the trials did not show that decreasing the number of antiretroviral drugs from 3 to 2 offered any particular clinical advantage. Combining rilpivirine with a single antiretroviral rather than two may increase the risk of resistance, especially in case of poor adherence.

©Prescrire 1 November 2019

"Dolutegravir + rilpivirine (Juluca°) dual therapy in HIV infection. Risk of resistance to rilpivirine must be taken into account" Prescrire Int 2019; 28 (209): 257-259. (Pdf, subscribers only).

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