Do you favor a certain NRTI to pair with dolutegravir and lamivudine in persons with HIV to minimize the risk of resistance to dolutegravir?

The data are strong to support DTG/lamivudine as a stand-alone regimen with low risk of resistance development as long as patients remain adherent, so there isn't necessarily a reason to add another NRTI. That said, the Beck et al., PMID 40898778 study would suggest that tenofovir is associated with...

Any nucleoside reverse transcriptase inhibitor (NRTI) may be paired with dolutegravir in the treatment of human immunodeficiency virus (HIV), but the choice of NRTI backbone should be guided by clinical context, resistance profile, comorbidities, and guideline recommendations. The most commonly reco...

I agree that dolutegravir/lamivudine can stand alone as an effective regimen as long as there is no 184 mutation. Multiple studies comparing it to 3 drug combos, including Biktarvy, show noninferiority, and also recent studies support using it at higher viral loads > 500000 and CD4 < 200 without fai...

As stated in the quoted article, tenofovir would be the best choice to reduce the resistance to dolutegravir. Even in the setting of extensive resistance to lamivudine and tenofovir, these two agents in conjunction still have excellent efficacy, as shown by the DEFT and NADIA trials.