Dolutegravir

How it works

It inhibits HIV integrase, preventing integration of viral DNA into the host cell genome and thereby blocking viral replication.

Prescribing in practice

• Follow current MHRA and specialist advice on use around conception and in pregnancy, as a possible signal of neural tube defects with early exposure has been kept under review; weigh the benefits of effective HIV control accordingly.
• Dolutegravir can raise serum creatinine by inhibiting its tubular secretion without reducing true renal function.
• Absorption is reduced by polyvalent cation-containing products, so separate dosing from antacids, and iron or calcium supplements.

Monitoring

Monitor HIV viral load and CD4 count to confirm response, with liver function checks particularly in those with hepatitis co-infection.

Counselling the patient

• Take indigestion remedies, or iron and calcium supplements, well apart from your dose to avoid reducing its absorption.
• If you could become pregnant or are planning pregnancy, discuss this with your HIV team.
• Take the medicine consistently every day to keep the virus suppressed.

Evidence & guidelines

Dolutegravir-based regimens are recommended in UK and international HIV guidelines, supported by large randomised controlled trials.