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Comparative effectiveness of dolutegravir + lamivudine versus three-drug regimens in Swedish clinical practice : a nationwide study

Sörstedt, Erik ; Nduva, George LU ; Månsson, Fredrik LU ; Mellgren, Åsa ; Repits, Johanna LU ; Fernvik, Eva ; Stubbs, Adam ; Schroeder, Melanie ; Brännström, Johanna and Carlander, Christina (2026) In Journal of the International AIDS Society 29(3).
Abstract

Introduction: HIV guidelines recommend switching from a three-drug regimen (3DR) to dolutegravir + lamivudine (DTG+3TC) for eligible individuals. This retrospective national cohort study used Swedish InfCareHIV registry data to evaluate long-term outcomes of adults with HIV RNA <50 copies/ml who switched to DTG+3TC or a guideline-recommended 3DR between July 2019 and May 2023 in routine clinical care. Methods: Demographic and clinical data were obtained from InfCareHIV at baseline, 6, 12, 24, 36 and 42 months post-switch. The primary endpoint was virologic failure (VF) rates at each time point; secondary endpoints included VF rates in prespecified subgroups, time to VF, and incidence of viral blips and treatment-emergent resistance.... (More)

Introduction: HIV guidelines recommend switching from a three-drug regimen (3DR) to dolutegravir + lamivudine (DTG+3TC) for eligible individuals. This retrospective national cohort study used Swedish InfCareHIV registry data to evaluate long-term outcomes of adults with HIV RNA <50 copies/ml who switched to DTG+3TC or a guideline-recommended 3DR between July 2019 and May 2023 in routine clinical care. Methods: Demographic and clinical data were obtained from InfCareHIV at baseline, 6, 12, 24, 36 and 42 months post-switch. The primary endpoint was virologic failure (VF) rates at each time point; secondary endpoints included VF rates in prespecified subgroups, time to VF, and incidence of viral blips and treatment-emergent resistance. Generalized estimating equations modelling was used to assess the effects of clinical predictors on VF. Results: A total of 1125 individuals (46%) switched to DTG+3TC, and 1336 (54%) switched to 3DR. Adjusted VF rates post-switch were 0.1–2.9% in the DTG+3TC group and 0.3–2.2% in the 3DR group in the intent-to-treat analysis (0–0.4% and 0.3–2.3% in the on-treatment [OT] analysis, respectively). In the OT set, the odds of VF were significantly lower for DTG+3TC versus 3DR at 24, 36 and 42 months (p<0.001). Treatment-emergent resistance rates were low in both groups. Conclusions: In this long-term, real-world, national cohort, switching to DTG+3TC was associated with low rates of VF and antiretroviral therapy resistance, indicating that eligible individuals can be switched to DTG+3TC without increased risk of VF.

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author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
antiretroviral therapy, dolutegravir, HIV-1, lamivudine, regimen switch, two-drug regimen
in
Journal of the International AIDS Society
volume
29
issue
3
article number
e70054
publisher
International AIDS Society
external identifiers
  • scopus:105031476698
  • pmid:41755425
ISSN
1758-2652
DOI
10.1002/jia2.70054
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Author(s). Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.
id
fdeaa517-9b1d-4903-a4af-8b4f771463cc
date added to LUP
2026-04-07 15:42:25
date last changed
2026-09-10 11:24:59
@article{fdeaa517-9b1d-4903-a4af-8b4f771463cc,
  abstract     = {{<p>Introduction: HIV guidelines recommend switching from a three-drug regimen (3DR) to dolutegravir + lamivudine (DTG+3TC) for eligible individuals. This retrospective national cohort study used Swedish InfCareHIV registry data to evaluate long-term outcomes of adults with HIV RNA &lt;50 copies/ml who switched to DTG+3TC or a guideline-recommended 3DR between July 2019 and May 2023 in routine clinical care. Methods: Demographic and clinical data were obtained from InfCareHIV at baseline, 6, 12, 24, 36 and 42 months post-switch. The primary endpoint was virologic failure (VF) rates at each time point; secondary endpoints included VF rates in prespecified subgroups, time to VF, and incidence of viral blips and treatment-emergent resistance. Generalized estimating equations modelling was used to assess the effects of clinical predictors on VF. Results: A total of 1125 individuals (46%) switched to DTG+3TC, and 1336 (54%) switched to 3DR. Adjusted VF rates post-switch were 0.1–2.9% in the DTG+3TC group and 0.3–2.2% in the 3DR group in the intent-to-treat analysis (0–0.4% and 0.3–2.3% in the on-treatment [OT] analysis, respectively). In the OT set, the odds of VF were significantly lower for DTG+3TC versus 3DR at 24, 36 and 42 months (p&lt;0.001). Treatment-emergent resistance rates were low in both groups. Conclusions: In this long-term, real-world, national cohort, switching to DTG+3TC was associated with low rates of VF and antiretroviral therapy resistance, indicating that eligible individuals can be switched to DTG+3TC without increased risk of VF.</p>}},
  author       = {{Sörstedt, Erik and Nduva, George and Månsson, Fredrik and Mellgren, Åsa and Repits, Johanna and Fernvik, Eva and Stubbs, Adam and Schroeder, Melanie and Brännström, Johanna and Carlander, Christina}},
  issn         = {{1758-2652}},
  keywords     = {{antiretroviral therapy; dolutegravir; HIV-1; lamivudine; regimen switch; two-drug regimen}},
  language     = {{eng}},
  number       = {{3}},
  publisher    = {{International AIDS Society}},
  series       = {{Journal of the International AIDS Society}},
  title        = {{Comparative effectiveness of dolutegravir + lamivudine versus three-drug regimens in Swedish clinical practice : a nationwide study}},
  url          = {{http://dx.doi.org/10.1002/jia2.70054}},
  doi          = {{10.1002/jia2.70054}},
  volume       = {{29}},
  year         = {{2026}},
}