Dolutegravir/lamivudine/tenofovir

Dolutegravir/lamivudine/tenofovir (DTG/3TC/TDF) is a fixed-dose combination antiretroviral medication used to treat HIV/AIDS.[1] It is a combination of dolutegravir, lamivudine, and tenofovir disoproxil.[1] As of 2019, it is listed by the World Health Organization (WHO) as the first line treatment for adults, with tenofovir/lamivudine/efavirenz as an alternative.[2] It is taken by mouth.[3]

This article is about the combination medication dolutegravir/lamivudine/tenofovir disoproxil. For the combination medication dolutegravir/lamivudine/tenofovir alafenamide, see Tenofovir alafenamide § combinations.
Dolutegravir/lamivudine/tenofovir
Combination of
DolutegravirIntegrase strand transfer inhibitor
LamivudineNucleoside reverse transcriptase inhibitor
Tenofovir disoproxilNucleoside reverse transcriptase inhibitor
Clinical data
Other namesTenofovir/lamivudine/dolutegravir (TLD)
Routes of
administration		By mouth
ATC code

Side effects may include trouble sleeping, weight gain, and rash.[2][3] While there are concerns that use during pregnancy results in a 0.2% increased risk of neural tube defects in the baby, this does not rule out its use.[2] Use remains recommended after the first trimester.[2] Use is not recommended in those with kidney problems.[3] The combination is a type of antiretroviral therapy.[2]

It is on the World Health Organization's List of Essential Medicines.[4] In some countries it is available as a generic medication.[5] It is tentatively approved in the United States as of 2019, full approval is pending expiration of the US patents on dolutegravir (Tivicay) and tenofovir disoproxil (Viread).[6][7]

Medical uses

As of 2019, it is listed by the World Health Organization (WHO) as the first-line treatment for adults with HIV/AIDS, with tenofovir/lamivudine/efavirenz as an alternative.[2] It may be used in people with both HIV and tuberculosis, however if the person is on rifampicin a larger dose of dolutegravir is needed.[2]

Side effects

Side effects may include trouble sleeping and weight gain.[2] While there are concerns that use during pregnancy results in a 0.2% increased risk of neural tube defects in the baby, this does not rule out its use.[2] Use remains recommended after the first trimester.[2] It should not be used with dofetilide.[3]

Society and culture

Economics

In the developing world it costs about US$75 per year.[8] It is considered more cost effective than tenofovir/lamivudine/efavirenz as of 2019.[2]

References
  1. "Dolutegravir (DTG) and the fixed dose combination (FDC) of tenofovir/lamivudine/dolutegravir (TLD)" (PDF). World Health Organization (WHO). Retrieved 15 November 2019.
  2. World Health Organization (2019). "Policy brief: update of recommendations on first- and second-line antiretroviral regimens". World Health Organization. hdl:10665/325892. WHO/CDS/HIV/19.15; License: CC BY-NC-SA 3.0 IGO. {{cite journal}}: Cite journal requires |journal= (help)
  3. "WHO-PQ Recommended summary of product characteristics" (PDF). July 2019. Archived from the original (PDF) on November 16, 2019. Retrieved 16 November 2019.
  4. World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  5. "TDF/3TC/DTG" (PDF). Retrieved 16 November 2019.
  6. "NDA 209618 Tentative Approval" (PDF). U.S. Food and Drug Administration (FDA). 25 March 2019. Retrieved 16 November 2019.
  7. "NDA 210796 Tentative Approval" (PDF). U.S. Food and Drug Administration (FDA). 18 August 2017.
  8. Vitoria, M; Hill, A; Ford, N; Doherty, M; Clayden, P; Venter, F; Ripin, D; Flexner, C; Domanico, PL (31 July 2018). "The transition to dolutegravir and other new antiretrovirals in low-income and middle-income countries: what are the issues?". AIDS. 32 (12): 1551–61. doi:10.1097/QAD.0000000000001845. PMID 29746295. S2CID 13674631.
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