Lamivudine with dolutegravir

How it works

Lamivudine is intracellularly phosphorylated and incorporated into viral DNA to cause chain termination during reverse transcription, while dolutegravir inhibits HIV integrase, preventing integration of viral DNA into the host genome.

Prescribing in practice

• Suitability depends on confirmed absence of resistance to either component and exclusion of hepatitis B co-infection, since neither agent fully suppresses HBV and stopping can cause a hepatitis flare.
• Dolutegravir absorption is reduced by polyvalent cations, so antacids, iron, calcium and similar products require separated dosing as detailed in the SPC.
• Dolutegravir can cause hypersensitivity reactions and modest rises in serum creatinine through reduced tubular creatinine secretion without a true fall in renal function.

Monitoring

Monitor HIV viral load and CD4 count, hepatitis B status, renal and hepatic function, and review for hypersensitivity and neuropsychiatric effects.

Counselling the patient

• Take every day as prescribed to keep the virus suppressed and reduce the risk of resistance.
• Separate antacids, indigestion remedies and iron or calcium supplements from your dose as advised.
• Report rash with fever or feeling generally unwell, and tell your team if you become pregnant or plan to.

Evidence & guidelines

Use as a two-drug regimen is supported by the GEMINI trials and reflected in BHIVA and NICE-endorsed HIV treatment guidance.