Antiretroviral Therapy in 2019: Which Is the Best Regimen for the Global Roll-Out?

Globally, efavirenz–based antiretroviral therapy (ART) has been the most commonly used antiretroviral regimen. Due to concerns about toxicity, dolutegravir-based and low-dose efavirenz–based ART have been proposed as alternatives. Two studies have now tested these alternatives in Sub-Saharan Africa.

In the NAMSAL study conducted in Cameroon, 613 patients (median age, 37 years; 65.9% women; median viral load, 5.3 log₁₀ copies/mL; median CD4 cell count, 281 cells/μL) were randomized to efavirenz 400 mg/day (EFV400) or dolutegravir (DTG), both in combination with tenofovir disoproxil fumarate (TDF)/lamivudine. At 48 weeks, 74.5% of the DTG arm and 69% of the EFV400 arm has a viral load <50 copies/mL, which met the noninferiority criteria. Among…