Triumeq (Dolutegravir + Abacavir + Lamivudine)

What Is Triumeq?

TRII is a tablet that contains three drugs used to fight HIV: abacavir (Ziagen, see Fact Sheet 416), lamivudine (Epivir, see Fact Sheet 415), and dolutegravir (see Fact Sheet 467). ViiV Healthcare manufactures TRII. TRII is the fourth once-daily tablet that includes a complete antiretroviral regimen. Other single tablet regimens are Atripla (see Fact Sheet 472), Complera (see Fact Sheet 471) and Stribild (see Fact Sheet 473).

The drugs in Trii are an integrase inhibitor (dolutegravir, 50 mg) combined with two nucleoside analog reverse transcriptase inhibitors, or nukes (lamivudine, 300 mg and abacavir, 600 mg). These drugs block the reverse transcriptase enzyme. This enzyme changes HIV's genetic material (RNA) into the form of DNA. This has to occur before HIV's genetic code gets inserted into an infected cell's own genetic codes.

When HIV infects a cell, it combines its genetic code into the cell's own code. Dolutegravir blocks this process. When dolutegravir blocks integration, HIV infects a cell but cannot make more copies of itself.

Who Should Take Triumeq?

TRII was approved in 2014 as an ARV for adults and children older than 12 with HIV infection who weight at least 88 pounds (40 kilograms). TRII is one of the regimens recommended by the US government for first-line HIV treatment.

Before taking TRII, a genetic test called HLA-B5701 should be done by your healthcare provider. People who have a positive HLA-B5701 test should not take TRII because the have a higher risk of developing an allergic reaction to abacavir.

While antiretroviral therapy (ART) is now recommended for all people living with HIV, there are no absolute rules about when to start ART. You and your health care provider should consider your overall health, CD4 cell count, HIV viral load, any symptoms you are having, and your willingness to take ART. Fact Sheet 404 has more information about guidelines for the use of ART. If you take TRII, you can reduce your HIV viral load to undetectable levels, and increase your CD4 cell counts. This should mean staying healthier longer.

The TRII medications were shown to cause fewer side effects that some other HIV treatment combinations. TRII provides three drugs in one pill. It may be more convenient to adhere to TRII than other combinations of other drugs. This could mean fewer missed doses and better control of HIV.

What About Drug Resistance?

Many new copies of HIV are mutations. They are slightly different from the original virus. Some mutations can keep multiplying even when you are taking an ARV. When this happens, the drug will stop working. This is called "developing resistance" to the drug. See Fact Sheet 126 for more information on resistance.

Sometimes, if your virus develops resistance to one drug, it will also have resistance to other ARVs. This is called "cross-resistance." It is likely that HIV that has developed resistance to raltegravir (see Fact Sheet 471) will also be resistant to elvitegravir.

Resistance can develop quickly. It is very important to take ARVs according to instructions, on schedule, and not to skip or reduce doses.

How Is TRII Taken?

TRII is taken by mouth as a tablet, with or without food. The normal adult dose is one tablet, once a day. If you take certain antacids, calcium or iron supplements, there can be timing requirements with TRII. These can be overcome if TRII and the supplement are taken together with food.

What Are the Side Effects?

The medications in TRII are usually very well tolerated. If side effects occur, the most common side effects are diarrhea, nausea, and headache.

Some people with hepatitis B or C virus infection, cases of liver inflammation were observed. Laboratory testing before starting therapy and monitoring for liver toxicity during therapy are recommended in patients with underlying liver disease. Reports from people using dolutegravir include rash. In rare cases, skin rash can be severe and life threatening. Contact your health care provider immediately if you develop a serious rash while taking TRII.

How Does It React With Other Drugs?

The medicines in TRII have been studied to see if they interact with other drugs.

Rifampin, used to treat tuberculosis (see Fact Sheet 518), and the HIV medications efavirenz (see Fact Sheet 432), fosamprenavir/ritonavir (see Fact Sheet 448) and tipranavir/ritonavir (see Fact Sheet 449) decrease blood levels of dolutegravir. If dosed with and of these medications, dolutegravir should be dosed 50 mg twice daily. In these situations, dolutegravir is dosed twice daily. Dolutegravir should not be taken with the heart medication dofetilide.

These interactions can change the amount of each drug in your bloodstream and cause an under- or overdose. New interactions are constantly being identified. Make sure that your health care provider knows about ALL drugs and supplements you are taking.