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First-line ART in resource-limited settings — DTM&H MCQ

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HardHIV/AIDS in tropical settingsFirst-line ART in resource-limited settingsDTM&H

A man in Kenya starts tenofovir disoproxil, lamivudine and dolutegravir for HIV, then begins rifampicin-based treatment for pulmonary tuberculosis. How should the dolutegravir component be managed?

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Correct answer: A — Dolutegravir 50 mg twice daily until two weeks after rifampicin ends

The best answer is “Dolutegravir 50 mg twice daily until two weeks after rifampicin ends”. Rifampicin induces dolutegravir metabolism and lowers exposure. WHO guidance therefore doubles dosing frequency, commonly by adding a separate 50-mg dose 12 hours after the fixed-dose TLD tablet, and continues the adjustment for two weeks after rifampicin. Withholding the integrase inhibitor, substituting unboosted atazanavir or changing to an unstudied once-daily dose is inappropriate.

Reference: WHO updated recommendations on HIV clinical management: https://www.who.int/news/item/07-01-2026-who-releases-updated-recommendations-on-hiv-clinical-management; WHO consolidated HIV guidance: adult antiretroviral dosages: https://www.ncbi.nlm.nih.gov/books/NBK572728/table/annex1.tab1/