Virological control and metabolic improvement in HIV-infected, virologically suppressed patients switching to lamivudine/dolutegravir dual therapy: Table 1.

Sir, We read with interest the paper by Gubavu et al.1 on the experience of a single centre in France with dolutegravir monotherapy and dolutegravir-based dual therapies in different types of patients. Given the high virological potency and genetic barrier to resistance of dolutegravir in combination ART (cART),2,3 multiple studies are now exploring the efficacy of dolutegravir in simplification regimens. Despite the lack of long-term data, dolutegravir monotherapy seems a risky strategy due to the onset of virological failure and integrase inhibitor resistance mutations in treatment-experienced patients.4 Conversely, dolutegravir-based dual therapies in combination with lamivudine have shown promising results in small prospective, pilot studies in both naive5 and treatment-experienced6 patients. Gubavu et al.1 explored dual therapies with different combinations, different dolutegravir doses and both in patients with detectable and undetectable viral loads. We evaluated the efficacy and safety of lamivudine plus dolutegravir in a cohort of virologically suppressed patients. This was a retrospective, observational study, in which we included hepatitis B surface antigen-negative participants on stable cART, with undetectable HIV-RNA (<50 copies/mL) and no previous failures with integrase inhibitors, switching to lamivudine plus dolutegravir with at least one virological follow-up. The primary endpoint was the cumulative incidence of treatment discontinuation and virological failure (confirmed viral load >50 copies/mL); participants who did not reach the endpoint were observed until the last available follow-up. Student's t-test for paired samples or the Wilcoxon test was employed to identify significant changes in immunological, renal, hepatic and metabolic functions, as appropriate. Linear regression was used to analyse predictors of such changes. Participants were selected within a cohort of patients switching for clinical reasons to dolutegravir, who signed an informed consent to allow data recording for an observational clinical study. The study was approved by the local Ethics Committee (protocol number 5284/15).