Watch for Dovato, a New Two-Med Combo for HIV

Dovato (doh-VAH-toh) will be a new complete HIV regimen with TWO meds in one pill...for treatment-naive patients.

It combines the integrase inhibitor dolutegravir with the nucleoside reverse transcriptase inhibitor lamivudine.

Dovato will try to compete with Biktarvy and Triumeq. These THREE-med one-pill combos have an integrase inhibitor...plus TWO nucleoSIDE/nucleoTIDE reverse transcriptase inhibitors.

Dovato seems to reduce viral load similarly to a three-med regimen. It costs $2,300/month...versus about $3,000 for Biktarvy or Triumeq.

But expect most patients to stick with a three-drug regimen for now. Caution that there's not long-term evidence on resistance with Dovato yet.

Keep in mind, Juluca (dolutegravir/rilpivirine) is also a two-med, one-pill complete regimen. But it's only for certain treatment-experienced patients.

Watch for meds that may reduce dolutegravir levels...such as CYP3A4 inducers (phenytoin, rifampin, etc) or cations (calcium, iron, etc).

For example, advise taking Dovato 2 hours before or 6 hours after antacids or other products with aluminum or magnesium.

Educate patients to take Dovato once daily with or without food.

Counsel to report signs of hypersensitivity (severe rash with fever, aches, etc)...or liver injury (pale stools, abdominal pain, etc).

• Commentary: Dovato: A Two-Drug Complete Regimen for Treatment Naive HIV-Infected Patients