Efficacy of Dolutegravir Plus Lamivudine in People With TB/HIV Co-Infection Using a Rifampicin or Rifabutin-Based Regimen: A Retrospective Observational Case Series.

INTRODUCTION: Co-infection with tuberculosis (TB) is the leading cause of death in individuals infected with human immunodeficiency virus (HIV)-1. Dolutegravir and lamivudine (DTG + 3TC) has recently been recommended as the preferred first-line regimen for the treatment of new and treatment-experienced HIV-infected patients. The primary objective of this study was to determine the efficacy and safety of DTG (50 mg) + 3TC (300) mg in HIV-positive antiretroviral therapy (ART)-naïve patients with TB who received a rifampicin- or rifabutin-based treatment regimen and characterize viral suppression rates at week 48.

METHODS: A single-center retrospective observational case series, spanning January 1, 2021 to March 1, 2023, was conducted in Guiyang Public Health Treatment Center. Of 46 TB/HIV co-infected patients received DTG + 3TC or DTG/3TC, a total of 42 patients were finally enrolled in the study. The outcomes of interest were successful TB treatment, viral load (VL) suppression, and immunological and biochemical indexes.

RESULTS: All people with HIV infection (PWH) underwent at least 48 weeks of follow-up; all TB treatments were successful. A total of seven PWH (100%) achieved viral suppression (VL&#x2009;<&#x2009;50 copies/mL) from a baseline VL greater than 500,000 copies/mL. Among the PWH who started DTG&#x2009;+&#x2009;3TC after initiating the rifabutin-based anti-TB regimen, 31 (73.8%) achieved viral suppression by week 24. CD4&#x2009;+&#x2009;T-cell counts were greatly improved after antiretroviral treatment. The CD4&#x2009;+&#x2009;/CD8+ ratio increased by 0.38 (p&#x2009;<&#x2009;0.001). Total cholesterol, and high-density lipoprotein cholesterol (p&#x2009;<&#x2009;0.05). There were no significant changes in body mass index, low-density lipoprotein cholesterol, and triglyceride levels from baseline to week 48 (p&#x2009;>&#x2009;0.05). No serious adverse events were observed.

CONCLUSION: This case series preliminarily validated the efficacy of DTG&#x2009;+&#x2009;3TC when combined with rifabutin-based anti-TB regimens in patients with TB and HIV.