South Africa: The Evolution of HIV Treatment - From Multi-Pill Regimens to Better, Single Pill Combos

HIV treatment has been improved and simplified significantly over the years yet a small fraction of people living with HIV still take complex multi-pill regimens. Spotlight reports on a new combination pill that could make life easier for some in this group. But as two leading experts point out, the development comes against a backdrop where the traditional categorisation of HIV medicines is dissolving.

Twenty years ago, antiretroviral treatment involved taking multiple pills, sometimes multiple times a day. Though these medicines saved many lives, they did cause a variety of side effects, and many people developed resistance to some of the drugs.

Since then, we've seen significant scientific advances. The drugs that cause notable side effects have largely been phased out. In 2013, government introduced a one pill, once a day regimen as the standard first-line treatment.

In 2019, first-line treatment was further strengthened when a breakthrough new antiretroviral drug called dolutegravir was included in a new daily combination pill. Apart from high potency and having very few side effects, the new combination is also remarkably robust against the development of drug-resistance.

Dolutegravir made it possible for many people who were on second-line regimens to switch away from multiple tablets to a single tablet containing the drug, Professor Francois Venter tells Spotlight. Venter is a clinician researcher at Ezintsha at the University of the Witwatersrand.

This regimen, a combination of the drugs tenofovir disoproxil fumarate, lamivudine, and dolutegravir (TLD), is still the backbone of South Africa's HIV treatment programme, with over five million people taking it every day. It is also recommended by the World Health Organisation for treatment of almost all people living with HIV.

HIV & KIDS | The potent antiretroviral drug dolutegravir has become the backbone of SA's HIV treatment programme. New estimates suggest that most children aged one to four living with HIV have now been switched to the drug, reports @elri-voigt.bsky.social.

There is however a subset of people living with HIV for whom TLD doesn't work and who accordingly may need more complex treatment regimens. Such complex treatment regimens have typically required taking multiple pills, multiple times a day, but new research suggests that might not be the case for much longer.

A phase three study, called ARTISTRY 1, published in the Lancet medical journal in February, looked at the safety and efficacy of a combination pill containing the drugs bictegravir and lenacapavir compared to s