Dolutegravir for second-line treatment: Programmatic implications of new evidence.

Copyright: © 2022. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License. Dolutegravir, an integrase strand transfer inhibitor, with an optimised nucleoside reverse transcriptase inhibitor (NRTI) backbone is the World Health Organization (WHO)-recommended second-line antiretroviral therapy (ART) regimen for adults after failing a first-line regimen based on a non-nucleoside reverse transcriptase inhibitor (NNRTI), either nevirapine or efavirenz.1 This WHO recommendation is based on the DAWNING study, which showed that dolutegravir was superior in both safety and efficacy compared to lopinavir-ritonavir, when administered with two NRTIs, at least one of which had to be fully active on resistance testing.2 The World Health Organization recommends substituting tenofovir with zidovudine when switching to second-line ART to ensure that there will be at least one fully active NRTI because the signature tenofovir resistance mutation K65R does not compromise zidovudine’s effectiveness and there is limited access to resistance testing in high-burden, resource-limited settings to select an optimised NRTI backbone.3