Lamivudine with tenofovir disoproxil and doravirine

How it works

Lamivudine and tenofovir are phosphorylated and incorporated into viral DNA to terminate reverse transcription, while doravirine binds non-competitively to reverse transcriptase, inhibiting the enzyme at a separate allosteric site.

Prescribing in practice

• Tenofovir disoproxil can cause renal impairment, including proximal tubulopathy, and reduced bone mineral density, so renal function and bone risk must be assessed before and during treatment.
• Doravirine exposure is markedly reduced by strong CYP3A4 inducers such as rifampicin and certain anticonvulsants, which are contraindicated or require regimen review.
• Both lamivudine and tenofovir are active against hepatitis B, so co-infection should be identified and discontinuation managed carefully to avoid a severe hepatitis flare.

Monitoring

Monitor HIV viral load and CD4 count alongside renal function, serum phosphate and hepatitis B status, with attention to bone health in those at risk.

Counselling the patient

• Take the single daily tablet consistently to maintain viral suppression.
• Avoid starting medicines or herbal products that may interact, and mention rifampicin or anti-seizure drugs to your team.
• Report new bone pain, muscle weakness or symptoms suggesting kidney problems.

Evidence & guidelines

Doravirine-based regimens are supported by the DRIVE programme of trials and are recommended options within UK HIV treatment guidance.