Reviewed by: HU Medical Review Board | Last reviewed: March 2023
Delstrigo is a combination medication that contains doravirine, lamivudine, and tenofovir disoproxil fumarate. It is used as a standalone antiretroviral therapy (ART) regimen for HIV-1 in adults who have never taken HIV medications before or who have achieved viral suppression (50 copies per mL) on a stable antiretroviral regimen with no history of treatment failure and no known substitutions associated with resistance to ingredients in Delstrigo.1
Although it is not a cure for HIV, when taken as directed, it allows for the virus to be suppressed. This prevents further transmission of HIV and allows an individual’s immune system to improve through increasing CD4 cell counts and decreasing the amount of active virus in the blood (viral load).
What are the ingredients in Delstrigo?
The main ingredients in Delstrigo are doravine, lamivudine, and tenofovir disoproxil fumarate. Doravine is a non-nucleoside reverse transcriptase inhibitor (NNRTI), while lamivudine, and tenofovir disoproxil fumarate are nucleoside reverse transcriptase inhibitors (NRTIs).
How Delstrigo treats HIV
Delstrigo is a combination of two NRTI medications and one NNRTI medication. Both types of drugs stop the reverse transcription step of the HIV life cycle. Normally, HIV uses its reverse transcriptase enzyme to build a strand of DNA from its original RNA form. In order to do this, it uses genetic building blocks called nucleosides that come from the host cell. These nucleosides are strung together one at a time, like beads on a string, to create the final DNA product.
How do NRTIs work?
NRTIs act as nucleoside mimics that stop the DNA-building process. NRTIs look like normal nucleosides, except they’re missing a special chemical group on one side. Without this group, the reverse transcriptase enzyme is unable to attach more nucleosides to the chain after them.
How do NNRTIs work?
NNRTIs bind to the reverse transcriptase enzyme itself to stop the DNA-building process. When an NNRTI binds to reverse transcriptase, the enzyme is unable to attach more nucleosides to the chain. Both of these mechanisms block the full string of DNA from being formed, preventing HIV RNA from making it all the way through the reverse transcription process and into host DNA for further replication.
Possible side effects
The most common side effects of Delstrigo include, but are not limited to:
- Abnormal dreams
These are not all the possible side effects of Delstrigo. Talk to your doctor about what to expect when taking Delstrigo. You also should call your doctor if you have any changes that concern you when taking Delstrigo.
Things to note
Delstrigo has a boxed warning, the strictest warning from the US Food and Drug Administration (FDA). It has this warning because of the possibility of serious side effects as described below.
As with any medication, there are several very rare but serious risks that need to be considered before taking Delstrigo. Your healthcare provider can help determine what issues you may be at risk for and help determine what treatment options are the safest for you. It’s also important to remember that the risk of one or more of these issues occurring is low, and the benefits of treating the virus often greatly outweigh the risks.
If you have hepatitis B virus and start taking Delstrigo, your hepatitis B may get worse. Delstrigo may also cause new or worsening kidney issues. This includes an increased risk of kidney failure. Your healthcare provider will need to monitor your kidney function before you start and while taking Delstrigo.
If you are taking Delstrigo and you are also using or have recently used a medication that can harm your kidneys (like a high dose or multiple nonsteroidal anti-inflammatory drugs, or NSAIDs), you should be cautious. If you need to take pain relievers and are at risk for kidney problems, it's important to consider alternatives to NSAIDs.
Bone issues may also happen while taking Delstrigo, including, but not limited to, bone pain, thinning, or softening. These problems may lead to bone fractures. Bone loss and mineralization defects may also occur while taking Delstrigo. Your doctor may need to monitor your bone mineral density, especially if you have a history of fracture or other risk factors of osteoporosis or bone loss.
Serious drug interactions may occur with Delstrigo. If you are taking one of the following medications, you should not take Delstrigo:
- St. John’s wort
You should also alert your doctor if you’ve taken one of these medications in the past month.
Before starting Delstrigo, tell your doctor if you:
- Have or previously had hepatitis B virus
- Have a history of kidney problems
- Have a history of bone problems
- Are pregnant or planning to become pregnant
- Are breastfeeding or planning to breastfeed
- Are taking any over-the-counter vitamins, supplements, medicines, or herbal remedies
- Are on any other medications or are about to start any other medications, including hormonal birth control or medications for hepatitis viruses
Delstrigo may cause a condition called IRIS (immune reconstitution inflammatory syndrome). IRIS occurs when an individual’s immune system gets stronger after being weak and responds aggressively to previously hidden infections. This heightened response may make the person fighting the infection feel worse. Alert your healthcare provider immediately if you begin to have new symptoms after taking Delstrigo.