Two medicines are as good as current three-medicine combinations to treat children living with HIV
25 Feb 2026
Taking two HIV medicines, dolutegravir & lamivudine, is as good as taking a combination of three HIV medicines, in keeping the virus under control in children living with HIV. These results were presented yesterday at the Conference on Retroviruses and Opportunistic Infections (CROI) in Denver, USA.
People living with HIV need to take medicines for the rest of their lives. It is important to ensure that these medicines work well and are safe to take for children living with HIV. Finding new ways to make HIV treatment less toxic and easier to take could improve children’s quality of life and long-term health.
Clinical trials in adults living with HIV have shown that a combination of two medicines (dolutegravir and lamivudine) is as good as three medicine regimens at keeping the virus suppressed. The D3 (Penta 21) trial tested whether a new tablet containing these two medicines was safe and as effective as the currently recommended three medicine regimens (dolutegravir plus two other medicines), for children living with HIV.
A total of 386 children aged two to under 15 years from Uganda, South Africa, Thailand, Spain and UK took part in D3 (Penta 21). All participants had their virus already suppressed for at least six months. They were allocated to one of these groups:
- Group 1 took one tablet that contained two medicines (dolutegravir and lamivudine)
- Group 2 took one or two tablets that contained three medicines (dolutegravir plus two other medicines)
Results from the trial showed that one tablet with two HIV medicines works as well as the standard three-drug combinations in keeping the virus undetectable over 96 weeks. Safety was similar between the two groups and there were no differences in the development of drug-resistance mutations. Overall satisfaction with HIV treatment was high in both groups, although marginally higher in those taking one tablet with two medicines. Switching virologically suppressed children to this two-drug regimen could also reduce treatment costs.
Other studies have shown that adding a third medicine to the HIV treatment can cause problems for some people. Taken together with evidence from adult studies, these are encouraging results because the treatment is easier to take, may be safer in the long term, works just as well and can reduce the cost of the treatment.
The D3 (Penta 21) team will share this new evidence with the World Health Organization and Ministries of Health, who will review the findings and decide whether this approach should become an option in the future.
D3 (Penta 21) is funded by ViiV Healthcare and sponsored by Fondazione Penta ETS. The trial is coordinated by the MRC CTU at UCL in close collaboration with Penta and PHPT CTU (Thailand).
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