Dolutegravir in sub-Saharan Africa: context is crucial

A new, low-cost, generic, fixed-dose antiretroviral therapy (ART) combination containing tenofovir, lamivudine, and dolutegravir is being introduced in many countries in sub-Saharan Africa.1 In The Lancet HIV, Andrew Phillips and colleagues2 address two important concerns regarding the rollout of this regimen. First, what are the overall risks and benefits of use in women of child bearing potential, given that there is a possible increased risk of neural tube defects?3 Second, what are the risks of functional dolutegravir monotherapy in those who already have resistance to tenofovir and lamivudine4 if people on ART are transitioned to tenofovir, lamivudine, and dolutegravir without confirmation of viral suppression? The authors used the HIV Synthesis Model to compare policy scenarios in a hypothetical southern African population.