Comparing a dolutegravir + darunavir combination to the standard treatment for HIV patients who have failed first-line therapy

Ajara waits at the ART clinic. She is coinfected with HIV and TB. Image: John Rae / The Global Fund
Ajara waits at the ART clinic. She is coinfected with HIV and TB. Image: John Rae / The Global Fund

D2EFT Trial – Scaling up optimized second-line combination antiretroviral therapy for HIV patients who have failed first-line treatment.


There is a growing need for a more compact and simpleregimen for use in second-line therapy for people with HIV in resource-limited settings.

This will become increasingly critical as a larger number of people living with HIV encounter drug resistance and treatment failure. These patients will need access to second-line therapy.


The D2EFT project is gathering critical evidence to support the development of guidelines on the use of simplified second-line regimens such as a dolutegravir with darunavir/r and dolutegravir with two fixed nucleoside analogues. It is currently being implemented in over 12 countries across Africa, Asia and Latin America.

Current recommendations for second-line treatment regimens are suboptimal in resource-limited settings, where the vast majority of people with HIV live. This trial is exploring whether an alternative regimen of treatment is clinically superior or equal to the currently recommended treatments. Results have the potential to impact the treatment of millions of people living with HIV.

David Cooper, Founding Director, Kirby Institute

Progress so far

The D2EFT study began in late 2017 and is now being conducted in Africa, Asia, and Latin America. Primary results from this second-line study are expected in 2022.

COHIVE a COVID-19 sub-study was included in the D2EFT trial and also in NAMSAL, DolPHIN-2 and ADVANCE trials) to assess the impact of COVID-19 in people living with HIV. Results should be published in Q4 2021.

The impact we are seeking

The direct impact of the clinical trial will be to increase the evidence base for second-line combination antiretroviral therapy, working from a hypothesis that the simplified regimens are not inferior to the standard of care. The results will assist public health agencies in identifying the optimal approach to providing second-line combination antiretroviral therapy in low- and lower-middle-income countries.

Over the long-term, the grant could offer a pathway for a second-line regimen that is easier to take; a one-pill, once-daily regimen, which has fewer side effects and is more durable to drug resistance.

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