Dolutegravir as Second-Line Therapy in Persons with HIV Who Are Virally Suppressed

Dolutegravir-based antiretroviral therapy (whether initial or second line) is preferred in most of the world. In sub-Saharan Africa, most persons with HIV (PWH) who have failed initial therapy are receiving ritonavir-boosted protease inhibitor (PI)–based therapy. In a trial in Kenya, investigators studied the efficacy of switching (in the absence of genotypic resistance data) previously treated PWH with viral suppression on a ritonavir-boosted PI regimen to a dolutegravir-based regimen. The baseline nucleoside reverse transcriptase inhibitor (NRTI) backbone was maintained in all participants. The primary endpoint was virologic failure at week 48 (defined as viral loads ≥50 copies/mL).

Of 795 participants, about half were randomized to switch…