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The key points from this presentation are:
Currently, the only two-drug option as treatment initiation is 3TC (or FTC) + DTG.
This is non-inferior to three-drug regimens at least to three years. There is a similar safety profile and a small renal advantage.
BUT, have to be careful in who you select for this regimen:
- Viral load must be <500,000 copies/mL.
- CD4 must be <200 cells/mm3.
- Can’t have hepatitis B or TB.
- Must be a true initiation (not re-initiation).
- Should ideally be a patient who you don’t have adherence concerns about.
Patients on other first line therapies who are virally suppressed and have never had any virological failure could be shifted to:
- 3TC + DTG or
- 3TC + RPV or
- CAB + RPV.
- … if this makes sense from a cost or side-effect point of view.
Be careful with: hepatitis B, TB, key drug-interactions with RPV, patient needs to be reliably adherent.