Dr. Josep M. Llibre, researcher and doctor of the Fight AIDS Foundation, is the first author of a paper published in the last volume of the scientific journal The Lancet, one of the most important in the world.
The paper talks about the results of the SWORD 1 and 2 studies, conducted with the aim of evaluating the efficacy and safety of a change of therapy from the current (based on a combination of three or four drugs) to a combination with only two medications: Dolutegravir (DTG) and Rilpivirine (RPV).
Generally, HIV therapy consists of a combination of at least three drugs from different families, to ensure its effectiveness and prevent the emergence of resistance. Antiretrovirals are classified into several families based on which specific stage of the life cycle of the virus they fight.
Being able to reduce the number of antiretroviral drugs used in therapy is an objective that can be very beneficial for the patient: if the person is exposed to two drugs instead of three or four, the possibility of side effects and associated toxicities is reduced. Considering that HIV therapy must be taken for life to control the infection, the interest in simplification studies is more than justified.
1024 patients, in 14 countries around the world, participated in the SWORD 1 and 2 studies, which lasted 3 years. The study presented its main results at 48 weeks. 511 people continued with therapy with 3-4 drugs (control group), and 513 went on to the combination of Dolutegravir (DTG) and Rilpivirine (RPV). The power, security and capacity not to create resistance of the DTG made it the optimal basic agent; and RPV was an ideal partner for its proven safety, tolerability and efficacy in treatment changes. Treatment had to be taken only once dayly and was applicable to patients who had kept their viral load undetectable (below 50 copies/ml) at least in the last 12 months and who had never had a virological failure.
The SWORD studies conclude that the simplified treatment with DTG + RPV demonstrates a high efficacy, not inferior to that of the therapy with three or four drugs, offering the potential advantages of the reduction in cumulative exposure to more drugs than strictly necessary. Therefore, as long as the patient meets the indicated criteria (being in viral suppression and not having any virological failure in his history) he could benefit from the change to simplified treatment with this combination of two drugs.