Choosing between dual and three-drug antiretroviral therapy in aging and comorbid people with HIV: a narrative review - Report - MDSpire

Choosing between dual and three-drug antiretroviral therapy in aging and comorbid people with HIV: a narrative review

  • By

  • Maria Vittoria Cossu

  • Maddalena Matone

  • Valentina Iannone

  • Chiara Fusetti

  • Valeria Colombo

  • Andrea Gori

  • Anna Lisa Ridolfo

  • Cristina Gervasoni

  • June 22, 2026

  • 0 min

Share

Clinical Report: Evaluating Dual Versus Triple Antiretroviral Therapy for Older Adults

Overview

This comprehensive review evaluates the efficacy and safety of dual antiretroviral therapy (2DR) compared to triple antiretroviral therapy (3DR) in older adults with HIV and comorbidities.

Background

The demographic profile of people with HIV (PWH) has shifted, with a significant increase in those aged 50 years and older. This transition necessitates a reevaluation of HIV care goals, which now include managing multimorbidity and reducing polypharmacy-related risks.

Data Highlights

No specific numerical data or trial results were provided in the source material.

Key Findings

  • Older PWH often experience a higher burden of non-AIDS comorbidities.
  • Dual antiretroviral therapy (2DR) has been shown to have non-inferior virological efficacy compared to triple therapy (3DR) in selected populations.
  • Long-term exposure to multiple antiretroviral agents may increase the risk of organ toxicity and drug-drug interactions.
  • Current guidelines endorse specific 2DR strategies based on randomized controlled trials.
  • Individualized therapy selection should incorporate geriatric considerations.

Clinical Implications

Healthcare providers should consider the unique needs of older PWH when selecting antiretroviral therapy.

Conclusion

The review discusses the adaptation of HIV treatment strategies for older adults.

Related Resources & Content

  1. The Journal of Infectious Diseases, 2023 -- In-depth Analysis of the HIV Reservoir Confirms Effectiveness and Safety of Dolutegravir/Lamivudine in a Phase 4 Randomized Controlled Switch Trial (RUMBA)
  2. Open Forum Infectious Diseases, 2023 -- Bimonthly Administered Long-Acting Cabotegravir and Rilpivirine Are Highly Effective and Well-Tolerated in People With Human Immunodeficiency Virus Above 65 Years
  3. Infection, 2023 -- Management Strategies for Older Adults with HIV in Europe: Perspectives from Healthcare Providers
  4. Open Forum Infectious Diseases, 2023 -- Switching to B/F/TAF as Initial Therapy for HIV in Older Adults Aged 60 and Above in Kenya (the B/F/TAF-Elderly Trial)
  5. What to Start: Initial Combination Antiretroviral Regimens | NIH
  6. Optimizing Antiretroviral Therapy in the Setting of Viral Suppression | NIH
  7. IAS-USA Recommendations: Antiretrovirals for Treatment and Prevention of HIV in Adults
  8. Major revision version 13.0 of the European AIDS Clinical Society guidelines 2025 - PMC
  9. BHIVA guidelines on
  10. Durable Efficacy of Dolutegravir Plus Lamivudine in Antiretroviral Treatment–Naive Adults With HIV-1 Infection: 96-Week Results From the GEMINI-1 and GEMINI-2 Randomized Clinical Trials - PMC
  11. Efficacy and Safety of Switching to Dolutegravir/Lamivudine Versus Continuing a Tenofovir Alafenamide–Based 3- or 4-Drug Regimen for Maintenance of Virologic Suppression in Adults Living With Human Immunodeficiency Virus Type 1: Results Through Week 144 From the Phase 3, Noninferiority TANGO Randomized Trial - PMC
  12. Brief Report: Durable Suppression and Low Rate of Virologic Failure 3 Years After Switch to Dolutegravir + Rilpivirine 2-Drug Regimen: 148-Week Results From the SWORD-1 and SWORD-2 Randomized Clinical Trials - PMC
  13. Cabotegravir plus Rilpivirine for Persons with HIV and Adherence Challenges | New England Journal of Medicine
  14. Optimizing Antiretroviral Therapy in the Setting of Viral Suppression
  15. Virological outcomes of dolutegravir-based versus other antiretroviral regimens in people living with HIV: A systematic review and meta-analysis - PMC
  16. Special Populations: HIV and the Older Person | NIH
  17. Introduction: Cardiovascular and Metabolic Complications | NIH
  18. Overview: Drug-Drug Interactions between Antiretrovirals and Other Drugs | NIH
  19. Major revision version 13.0 of the European AIDS Clinical Society guidelines 2025

Original Source(s)

Choosing between dual and three-drug antiretroviral therapy in aging and comorbid people with HIV: a narrative review

  • by Maria Vittoria Cossu, Maddalena Matone, Valentina Iannone, Chiara Fusetti, Valeria Colombo, Andrea Gori, Anna Lisa Ridolfo, Cristina Gervasoni

  • June 22, 2026

Related Content

HHS has sent drug for Ebola clinical trial

Clinical Evaluation of a Real-Time Wearable System for Monitoring In-Hospital Ambulatory Patients With COVID-19: Retrospective Data Study

CD4 T cell phenotype after AS01-adjuvanted immunization is shaped by prior antigen or pathogen exposure