Used For:

• As first-line ART in treatment-naïve adults and adolescents

Contraindications:

• Do not use in:Known hypersensitivity to dolutegravir, lamivudine, or tenofovirSevere renal impairment (eGFR <30 mL/min) – due to TDFSevere hepatic disease (use with extreme caution)Children <30 kg (fixed-dose tablet unsuitable)

Side Effects:

• Common Side EffectsUsually mild and improve with time:HeadacheNausea, vomitingDiarrheaFatigueDizzinessInsomnia or vivid dreams (DTG-related)Less Common / Serious Side EffectsRenal toxicity (tenofovir): raised creatinine, decreased kidney functionBone mineral loss / osteopenia (tenofovir)Lactic acidosis (rare, NRTI class effect)Hepatotoxicity (especially with hepatitis B or C co-infection)Weight gain (associated with dolutegravir in some patients)Immune reconstitution inflammatory syndrome (IRIS)

Precautions:

• Baseline tests required before starting therapy:HIV viral load, CD4 countRenal function (serum creatinine, eGFR)Liver function testsHepatitis B status (lamivudine & tenofovir are active against HBV)Use with caution in:Renal diseaseHepatitis B or C co-infectionPregnancy (DTG is now considered safe, but first-trimester use should be supervised)Strict adherence is essential to prevent drug resistanceDo not stop abruptly, especially in hepatitis B co-infection (risk of HBV flare)Antacids, calcium, iron supplements reduce dolutegravir absorption→ Take ACRPTEGA 2 hours before or 6 hours after theseRifampicin (TB treatment) → DTG dose adjustment requiredAvoid nephrotoxic drugs (e.g., high-dose NSAIDs)

Dietary Restrictions:

• Can be taken with or without foodAvoid excess alcohol (↑ liver toxicity risk)Maintain adequate hydration (kidney protection)Avoid taking simultaneously with:Calcium supplementsIron tabletsMagnesium/aluminium antacidsMaintain a balanced, nutritious diet to support immunity and weight stability