title: State of the Art of Dual Therapy in 2015.
abstract: Dual therapy refers to combinations of two antiretroviral drugs applied in different clinical settings; they are considered and studied due to possibly reduced drug toxicities. In antiretroviral-naive patients, dual combinations have lower virologic efficacy than standard therapy; the sole efficacious regimen is lamivudine plus lopinavir/ritonavir. Due to a higher possibility of virologic failure, these regimens are generally not allowed in this clinical setting. In antiretroviral-experienced patients, dual regimens are examined in studies with a small sample size, centered on clinical practice, and should be ritonavir-boosted protease inhibitor-based. These combinations have a good virological efficacy; combinations with the integrase inhibitor raltegravir have small sample size and demonstrated efficacy only with etravirine. Virological aspects involving dual therapy should always consider genetic barriers, particularly in simplification strategies, and ritonavir-boosted protease inhibitors are mandatory. As far as immunological aspects are concerned, nucleoside reverse transcriptase inhibitor-sparing regimens have some encouraging data, probably due to the bone marrow toxicity of this class. Combinations with maraviroc were effective in reducing inflammation, but data about immunological recovery are conflicting. The choice of regimen should focus on specific class toxicity since dual regimens are studied in particular for improving safety and tolerability. This review will analyze different dual regimens in the clinical setting, with a peculiar focus on ameliorating toxicities and improving quality of life.
authors.affiliation: Clinic of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Nozza
authors.affiliation: University of Tor Vergata, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Svicher
authors.affiliation: Clinic of Infectious Diseases, University of Bari, Bari, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Saracino
authors.affiliation: Clinic of Infectious Diseases, Policlinico Umberto I, Rome, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: d'Ettorre
authors.affiliation: University Hospital of Siena, Siena, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: De Luca
authors.affiliation: Hospital Giovanni XXIII, Bergamo, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Maggiolo
authors.affiliation: Clinic of Infectious Diseases, University of Turin, Turin, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonora
authors.affiliation: Clinic of Infectious Diseases, Genova, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: di Biagio
authors.affiliation: Clinic of Infectious Diseases, University of Milan, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rusconi
authors.affiliation: Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Mussini
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D002986:Clinical Trials as Topic; D004334:Drug Administration Schedule; D004347:Drug Interactions; D024882:Drug Resistance, Viral / Q000187:drug effects*; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000523:psychology; D017320:HIV Protease Inhibitors / Q000008:administration & dosage*; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage; D061466:Lopinavir / Q000008:administration & dosage; D018579:Patient Selection; D011788:Quality of Life; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage*; D019438:Ritonavir / Q000008:administration & dosage
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors; D061466:Lopinavir; D019259:Lamivudine; D019438:Ritonavir