Lamivudine plus dolutegravir as a switch strategy in children: three case reports

New Microbiol. 2024 May;47(1):111-115.

Abstract

Lamivudine (3TC)/dolutegravir (DTG) single tablet regimen (STR) has shown long-term efficacy and tolerability in people living with HIV (PLWH). Dolutegravir has been approved for use in children, while data on the efficacy of 3TC plus DTG in maintaining virological suppression in this population are still under evaluation. In this case series, we describe three children with perinatally acquired HIV who maintained virological suppression after switching antiretroviral therapy to DTG/3TC. We present three case reports of three children enrolled in the Italian Register for HIV Infection in Children: a 9-year-old boy, a 10-year-old girl, and a 2-year-old girl with perinatally acquired HIV who immediately started antiretroviral therapy with a three-drug regimen upon diagnosis, which occurred at delivery, after 6 months of life, and after 2 years of life, respectively. They achieved and maintain virological suppression after 1, 6, and 7 months of therapy, respectively; then a switch strategy was performed with a two-drug regimen with DTG/3TC STR at the age of 7 years for the first child and at the age of 9 years for the second, while the third was switched to a DTG plus 3TC not STR, owing to weight requirements, at the age of 2 years and 10 months. All children maintained virological suppression at last follow-up visit (January 2024), showing an excellent growth curve and maintaining good adherence and tolerability to DTG plus 3TC. A two-drug regimen with DTG/3TC demonstrated efficacy in maintaining virological suppression in a switch strategy in these children, with important advantages such as better tolerability and comfort of taking a single tablet once daily.

Keywords: Dolutegravir; children living with HIV; lamivudine; perinatally acquired HIV; two-drug regimen.

Publication types

  • Case Reports

MeSH terms

  • Anti-HIV Agents* / administration & dosage
  • Anti-HIV Agents* / therapeutic use
  • Child
  • Child, Preschool
  • Female
  • HIV Infections* / drug therapy
  • HIV Infections* / virology
  • HIV-1 / drug effects
  • Heterocyclic Compounds, 3-Ring* / administration & dosage
  • Heterocyclic Compounds, 3-Ring* / therapeutic use
  • Humans
  • Lamivudine* / administration & dosage
  • Lamivudine* / therapeutic use
  • Male
  • Oxazines*
  • Piperazines*
  • Pyridones*

Substances

  • Lamivudine
  • dolutegravir
  • Pyridones
  • Heterocyclic Compounds, 3-Ring
  • Oxazines
  • Piperazines
  • Anti-HIV Agents