The DoDo Experience: An Alternative Antiretroviral 2-Drug Regimen of Doravirine and Dolutegravir

Abstract

Abstract Background: Currently available antiretroviral 2-drug regimen (2DR) fixed dose combinations may not be suitable for specific situations including the presence of resistance associated mutations (RAM) or drug-drug interactions. Data on the use of the non-nucleoside reverse transcriptase inhibitor doravirine (DOR) and the integrase inhibitor dolutegravir (DTG) as an alternative 2DR remain scarce. Methods: People living with HIV with DOR+DTG as a 2DR are being followed in a prospective observational study. Results: This analysis describes 85 participants with a median age of 57 years. Median CD4-nadir was 173/µl and a majority (66%) had a history of HIV-associated or AIDS-defining conditions. Antiretroviral history was mostly extensive, and documentation of RAM was frequent. Main reasons for choosing DOR+DTG were DDI (29%), tolerability (25%), and cardiovascular risk reduction (21%). Plasma viral load at switch was <50 cp/ml in all but 3 instances, median CD4 count was 600/µl. DOR+DTG was later changed to another regimen in 10 participants after a median of 265 days, the other 75 participants have remained on DOR+DTG for a median of 947 days. Conclusion: DOR+DTG as a 2DR proved to be a durable treatment option even in extensively pre-treated individuals.