Dolutegravir in Second-Line Therapy

In much of the world, first-line therapy for HIV consists of two nucleoside reverse transcriptase inhibitors (NRTIs) plus a non-nucleoside RTI (NNRTI). In people who have virologic failure on this treatment, the WHO has recommended switching to a boosted protease inhibitor plus two NRTIs. Investigators conducted the manufacturer-funded DAWNING trial to compare this second-line regimen with dolutegravir-based treatment.

A total of 627 adults who had virologic failure on an NNRTI plus two NRTIs were randomized to receive ritonavir-boosted lopinavir or dolutegravir, each in combination with two investigator-selected NRTIs (including at least one fully active NRTI based on resistance testing). At week 48, 84% of the dolutegravir group and 70% of…