OBJECTIVES : Three-drug regimens (3DRs) have been the mainstay of antiretroviral treatment (ART) for HIV. Dolutegravir-based two-drug regimens (DTG 2DRs) are now being explored as an alternative to 3DRs, with the first single tablet 2DR, Juluca (DTG/rilpivirine [RPV]) approved in the US in November 2017. This study evaluated DTG 2DR treatment patterns in clinical practice to understand the use of these regimens prior to Juluca availability.

METHODS : This was a retrospective medical chart review across 10 US sites identified as using DTG 2DRs. Eligible patients were adults initiated on DTG 2DR prior to 31/July/2017 with follow-up up to 30/Jan/2018. Patient demographics, clinical characteristics and treatment history were entered into a standardized case report form. All analyses were descriptive.

RESULTS : Data were abstracted for 278 patients receiving DTG 2DR. Mean age was 56 years, 30% were female and 49% were black. Most patients were treatment-experienced (2% ART-naïve), with a mean 13.5 years prior ART. DTG was most commonly paired with darunavir (55%) or RPV (27%). Mean time on DTG 2DR was 2.3 years. Most common reasons noted by physicians for initiating DTG 2DR were treatment simplification/streamlining (30%) and avoidance of potential long-term toxicities (20%). Before starting DTG 2DR, 42% of patients were virologically suppressed (<50 copies/ml); of those, 95% maintained suppression while on DTG 2DR. Of the 53% of patients with detectable viral load before starting DTG 2DR, 75% achieved and maintained virologic suppression on DTG 2DR. Viral load prior to starting DTG 2DR was missing in 5% of patients. Only 15 (5%) patients discontinued DTG 2DR by data cut-off. Most common reasons for discontinuation were virologic failure (n=4), toxicity/intolerance (n=3), and treatment simplification/streamlining (n=3).

CONCLUSIONS : Prior to commercial availability of Juluca in the US, DTG 2DRs were primarily used in treatment experienced patients. A high proportion of these patients achieved and maintained virologic suppression.