Two-Drug Maintenance Therapy with Dolutegravir/Lamivudine in Virologically Suppressed HIV-1 Patients: A Systematic Review and Meta-Analysis

<p><strong>Background:</strong><br />The global burden of HIV remains significant, with approximately 39.9 million people living with the virus. Multi-drug antiretroviral therapy (ART) regimens can complicate treatment due to drug interactions, costs, and adherence issues. Dolutegravir (DTG) and Lamivudine (3TC) represent a promising two-drug regimen that may simplify therapy while maintaining efficacy.</p> <p><strong>Methods:</strong><br />We searched databases PubMed, Cochrane CENTRAL, Science direct and Google scholar for randomized controlled trials (RCTs) assessing the safety and efficacy of switching to a dual therapy regimen of DTG and 3TC in HIV-1 seropositive adults. Primary outcomes included rates of virological suppression (HIV-1 RNA < 50 copies/mL) and virological failure.</p> <p><strong>Results:</strong><br />Five RCTs with 1,654 participants met the eligibility criteria. The rate of virological suppression (HIV-1 RNA < 50 copies/mL) was similar between those switching to DTG/3TC and those remaining on CAR (RR = 1.03, P = 0.11). No significant differences in virological failure rates or CD4+ cell counts were observed (RR = 0.56; P = 0.36; SMD = 0.08; P = 0.11). However, switching to DTG/3TC significantly improved the CD4+/CD8+ cell count ratio (SMD = -0.1; P = 0.04). Adverse event rates were comparable, with notable reductions in total and HDL cholesterol in the DTG/3TC group (SMD = -0.28; P = 0.03).</p> <p><strong>Conclusion:</strong><br />This analysis supports that switching to DTG/3TC is a viable option for maintaining virological suppression in adults with HIV, offering a simplified and effective approach to ART. Further research is needed to explore long-term effects and patient quality of life associated with two-drug regimens.</p>