There is no sign of increased HIV shedding in the genital fluids of people who are on successful regimens containing fewer than three antiretrovirals, or "low drug regimens," a small study published in Clinical Infectious Diseases suggests.
Researchers analyzed genital data from two French trials in which a total of 64 participants (45% women) either stayed on a triple-drug therapy or switched to a low drug regimen. Each trial had two arms, so the 64 participants were effectively divided into four groups of 16: one group took abacavir/lamivudine/dolutegravir, one group took dolutegravir monotherapy, one group took tenofovir/emtricitabine and a third drug, and one group took tenofovir/emtricitabine. Every participant's viral load was less than 50 copies/mL through week 48.
In pooled analyses, 83% of those on mono- or dual therapy had no HIV RNA or DNA detected in genital fluid (even with ultrasensitive testing), compared to 87% of those on triple therapy.
Participants were pre-selected for long-term viral suppression, as well as non-low nadir CD4 count (the mean nadir CD4 was over 200 copies/mL) and a lack of symptomatic sexually transmitted diseases. Thus, the findings may not be applicable to the general population of PLWH, study authors cautioned. They also called for more longitudinal studies into viral shedding under low drug regimens, but concluded: "These results, together with previous reports in the field, suggest that the 'U = U' slogan may not only apply to triple therapy, but also to [low drug regimens], as long as viremia remains undetectable."