Pharmacology · Fixed-dose antiretroviral combinations
Dolutegravir + lamivudine + tenofovir disoproxil (TLD) !
A complete HIV regimen in one daily tablet: two NRTIs and an integrase inhibitor. It is WHO's preferred first line.
Updated 2026-11-01
Also called: TLD
The figure shows the dolutegravir component in the HIV-1 intasome; lamivudine and tenofovir act on reverse transcriptase (see their pages).
Mechanism of action
It hits two steps of the HIV cycle: lamivudine and tenofovir end the DNA chain made by reverse transcriptase, and dolutegravir stops that DNA integrating into the chromosome. To escape, the virus would have to resist both mechanisms at once.
- Lamivudine and tenofovir end the viral DNA chain
- Dolutegravir blocks integration into the chromosome
- Two blocked steps make resistance hard
Pharmacokinetics
- Elimination
- Lamivudine and tenofovir leave via the kidney; in kidney failure the fixed tablet may not be suitable
Indications
- HIV-1 infection in adults and adolescents, as preferred first line HIV infection and AIDS →
- Hepatitis B co-infection (lamivudine and tenofovir also suppress it) Viral hepatitis →
Adverse effects
Common
- Insomnia, headache
- Nausea
- Weight gain
- Mild creatinine rise
Contraindications
- Use with dofetilide (because of dolutegravir)
- Hypersensitivity to any component
Key interactions
- Aluminium or magnesium antacids, calcium or iron supplements
- They chelate the drug and lower absorption: doses are separated
- Metformin
- Dolutegravir raises metformin
- Rifampicin
- Lowers dolutegravir: in tuberculosis co-infection the team adjusts the regimen
- Nephrotoxic drugs and NSAIDs
- Higher kidney risk from tenofovir
What is monitored
- HIV and hepatitis B tests before starting
- Kidney function
- Viral load (the goal is undetectable)
- Weight
Administration and safety
- By mouth, one tablet a day, with or without food
- Separate antacids, calcium, iron and mineral-containing multivitamins in time, as the label directs
- Do not add other products already containing lamivudine, emtricitabine or tenofovir
Nursing care
- Reinforce adherence: one tablet daily at the same time
- Check kidney function and mineral supplements
- In tuberculosis on rifampicin, confirm the dolutegravir adjustment ordered by the team
- Explain that a sustained undetectable viral load does not transmit HIV sexually
Pregnancy and breastfeeding
WHO recommends dolutegravir regimens as preferred also in pregnant women and women of childbearing potential.
Test yourself
Think of the answer, then tap the question to see it.
Which two HIV enzymes does TLD block?
Reverse transcriptase (lamivudine and tenofovir) and integrase (dolutegravir).
Why is TLD useful in HIV-hepatitis B co-infection?
Lamivudine and tenofovir also suppress hepatitis B virus.
Which adjustment does rifampicin require in someone on TLD?
A dolutegravir adjustment ordered by the team, because rifampicin induces UGT1A1 and CYP3A and speeds its elimination.
Related drugs
Related conditions
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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: WHO recommends dolutegravir as preferred HIV treatment option in all populations (World Health Organization, 2019); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); eEML - Electronic Essential Medicines List (World Health Organization, 2025); Dolutegravir: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2025).
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Representative model, for educational purposes only.