Dolutegravir Superior for Maintaining Viral Suppression in Patients With Difficult-to-Treat HIV-1

HIV-1 virions
HIV-1 virions
Investigators conducted a systematic review and meta-analysis comparing dolutegravir with other agents for treatment-naive patients with HIV.

Dolutegravir was found to be the most effective treatment for patients with HIV among common core agents, even in difficult-to-treat individuals, according to the results of a systematic review and meta-analysis published in BMC Infectious Diseases.

Researchers from Pharmerit International and ViiV Healthcare searched publication databases through July of 2019 for phase 3/4 randomized clinical trials of antiretroviral drugs for the treatment of HIV among patients older than 13 years of age. A total of 20 trials were included in this analysis.

At 96 weeks of treatment, significantly more patients treated with dolutegravir achieved viral suppression compared with patients treated with ritonavir-boosted protease inhibitors, efavirenz, or cobicistat-boosted elvitegravir, and more than rilpivirine, raltegravir, and bictegravir, although not significantly. Compared with other core agents, the probability of maintaining viral suppression at 96 weeks was higher than 80% for patients treated with dolutegravir.

Among patients with high viral load (>100,000 copies/mL), dolutegravir was associated with a higher proportion of patients achieving viral suppression at 96 weeks compared with lopinavir (risk difference [RD], 45.3%; 95% credible interval [CrI], 24.1-61.6), atazanavir (RD, 38.3%; 95% CrI, 13.3-57.7), darunavir (RD, 33.1%; 95% CrI, 13.6-50.4), and raltegravir (RD, 16.7%; 95% CrI, 3.3-31.2), and was similarly as effective as bictegravir (RD, 6.8%; 95% CrI, -7.9 to 24.9), rilpivirine (RD, 2.5%; 95% CrI, -13.7 to 14.7), cobicistat-boosted bictegravir (RD, 1.6%; 95% CrI, -18.1 to 20.2), and efavirenz (RD, -0.3%; 95% CrI, -15.4 to 9.7).

Among patients with a low CD4 count (≤200 cells/mL), dolutegravir was associated with a greater increase in CD4 cell count than efavirenz (RD, 32.6%; 95% CrI, 10.7-54.7), bictegravir (RD, 24.7%; 95% CrI, 1.5-47.7), or darunavir (RD, 25.7%; 95% CrI, 3.5-48.1).

This study may have been biased by combining tenofovir-based regimens because of the limited number of studies that included follow-up data through Week 96.

However, the study data indicated that dolutegravir was superior for achieving viral suppression compared with many core therapies in people living with HIV-1, even among those with a high baseline viral load or a low CD4 count.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Nickel K, Halfpenny NJA, Snedecor S J, Punekar YS. Comparative efficacy, safety and durability of dolutegravir relative to common core agents in treatment-naïve patients infected with HIV-1: an update on a systematic review and network meta-analysis. BMC Infect Dis. 2021;21(1):222. doi:10.1186/s12879-021-05850-0