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Dual therapy HIV treatment introduced in SA for the first time

By May 19, 2022No Comments

Two fixed-dose dual therapy antiretrovirals (ARVs) – a first in South Africa – for the treatment of HIV, have been launched recently. In a case of “less is more”, these innovative treatments will help to improve adherence to medication, currently one of the biggest problems in terms of HIV treatment¹.

The combinations of dolutegravir / lamivudine and dolutegravir / rilpivirine will be available as fixed-dose dual therapies for the first time in South Africa. This makes big strides towards more patient-centric management of HIV. The less drugs needed to control the virus is better for patients as it reduces the probabilities of side effects and drug-to-drug interactions.

It’s been roughly forty years since the human immunodeficiency virus (HIV) was first detected², and now, an estimated 27.5 million people living with HIV globally are using antiretrovirals (ARVs)³. Access to affordable ARVs over the years has changed HIV from a perceived death sentence to a chronic disease which can be managed⁴. At the height of the HIV/AIDS⁵ pandemic in 2001, Cipla introduced a world-first 3-in-1 fixed dose combination (stavudine, lamivudine and nevirapine) which was made available at less than $1 per day compared to over $12,000 per patient per year prevailing in most countries throughout the world⁶.

Triple combinations have been the standard care in terms of HIV treatment for the past 20 years⁷, but complex therapeutic regimens could cause challenges in terms of side effects and drug adherence⁸. Therefore, in Cipla’s continued focus on being patient centric, the company has launched the dual-therapy treatment to spearhead safer ARVs and simpler HIV regimens.

Over the years, research has been done to establish whether virological suppression could be achieved with fewer ARVS, and thereby also minimizing any potential long-term side effects and reducing the cost of ARVs. Studies have established that dual therapy HIV treatment is effective for people with a suppressed viral load using triple combinations⁹.

CEO of Cipla South Africa, Paul Miller, said: “We’re delighted to introduce an option for a simplified treatment regime to make treatment more comfortable for people living with HIV. In line with our ethos of “caring for life”, we’re looking at ways to make a tangible difference in a patient’s life, and this includes reducing the number of drugs to be taken without compromising in terms of adherence or efficacy.

* The combination of dolutegravir / lamivudine is indicated for people over the age of 18 who:

  • are virally suppressed on traditional triple combination first-line therapy as a switch,
  • have never been on any antiretroviral therapy¹⁰.

References

  1. Clutter, DS., Jordan, MR., Bertagnolio, S. & Shafer, R. W. HIV-1 drug resistance and resistance testing. (2016) doi:10.1016/j.meegid.2016.08.031.
  2. Sharp, PM., & Hahn, BH, 2011. Origins of HIV and the AIDS pandemic. National Library of Medicine. Accessed online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234451/
  3. UNAIDS Fact sheet World Aids Day 2021. Accessed online: https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf
  4. Pebody, R. 2019. HIV treatment and drug interactions. Aidsmap. Accessed online: https://www.aidsmap.com/about-hiv/hiv-treatment-and-drug-drug-interactions
  5. Voight, E, 2021. Are two medicines instead of three the future of HIV treatment?. Spotlight. Accessed online: https://www.spotlightnsp.co.za/2021/12/01/are-two-medicines-instead-of-three-the-future-of-hiv-treatment/
  6. HIV/Aids. Cipla website. Accessed online: https://www.cipla.com/our-offerings/our-therapies/hiv-aids
  7. Soriano, V, Fernandez-Montero, JV, et al. Dual antiretroviral therapy for HIV infection. National Library of Medicine. Accessed online: https://pubmed.ncbi.nlm.nih.gov/28621159/#:~:text=Expert%20opinion%3A%20Some%20dual%20antiretroviral,before%20supporting%20dolutegravir%20plus%20lamivudine.
  8. Iacob, SA, Iacob DG and Jujulete, G, 2017.Improving the Adherence to Antiretroviral Therapy, a Difficult but Essential Task for a Successful HIV Treatment—Clinical Points of View and Practical Considerations. PubMed Central. Accessed online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5703840/  
  9. Alcorn, K, 2019. Aidsmap. Options for two-drug simplification expand. Accessed online: https://www.aidsmap.com/news/nov-2019/options-two-drug-simplification-expand#:~:text=Dolutegravir%2Femtricitabine%20dual%20therapy%20is,(SIMPL’HIV%20study).
  10. Highleyman, L. 2019. Aidsmap. Dolutegravir dual therapy works well for both first line and maintenance treatment. Accessed online: https://www.aidsmap.com/news/jul-2019/dolutegravir-dual-therapy-works-well-both-first-line-and-maintenance-treatment