Effectiveness, Safety, and Cost-Effectiveness of the Tenofovir/Lamivudine/Dolutegravir (TLD) Regimen Compared to Tenofovir/Lamivudine/Efavirenz (TLE) in HIV Patients: A Narrative Review

Ardianta Selasa, September 08, 2026
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FORMOSA NEWS

TLD Regimen Outperforms TLE in HIV Treatment: Higher Efficacy, Superior Safety, and Long-Term Cost Savings

JAKARTA, Formosa News — The fixed-dose combination regimen of Tenofovir, Lamivudine, and Dolutegravir (TLD) provides superior viral suppression, better immune system recovery, fewer side effects, and greater economic value compared to the traditional Tenofovir, Lamivudine, and Efavirenz (TLE) treatment for HIV patients. A comprehensive narrative review conducted by Mardhiyah Fithriana Mufti, Diana Laila Ramatillah, and Sylvia Rizky Prima from the Department of Pharmacy at the University of 17 Agustus 1945 Jakarta, published in the Indonesian Journal of Contemporary Multidisciplinary Research (MODERN) in 2026, synthesized 50 international studies comparing both antiretroviral therapies. The findings deliver strong scientific support for health authorities and global health organizations to prioritize TLD as the primary first-line antiretroviral regimen.

Human Immunodeficiency Virus (HIV) remains a major global public health challenge that requires lifelong antiretroviral therapy (ART) to control viral replication, prevent clinical progression to Acquired Immunodeficiency Syndrome (AIDS), and eliminate transmission risks. For decades, efavirenz-based combinations, particularly TLE, served as the global standard for first-line HIV management. However, TLE regimens are frequently associated with central nervous system toxicities, severe neuropsychiatric adverse events, and a low genetic barrier to drug resistance. The emergence of dolutegravir, an integrase strand transfer inhibitor (INSTI), introduced a promising alternative. Evaluating the clinical effectiveness, safety profile, and pharmacoeconomic value of TLD versus TLE is essential for health policy experts and healthcare providers seeking to optimize long-term clinical outcomes while maintaining sustainable health system expenditures.

To evaluate the comparative performance of both antiretroviral treatments, researchers from the Faculty of Pharmacy at the University of 17 Agustus 1945 Jakarta conducted a systematic narrative review. The research team searched major medical and scientific databases, including PubMed, PubMed Central, ScienceDirect, and Google Scholar, identifying relevant peer-reviewed studies published between 2021 and 2026. Out of the initial literature search, 50 studies met the inclusion criteria, encompassing diverse patient demographics, including adults, pregnant women, and pediatric populations. The researchers extracted, categorized, and analyzed data focused on virological outcomes, CD4+ T-cell count recovery, drug safety, metabolic side effects, organ function, and cost-effectiveness ratios.

The comprehensive literature synthesis by the University of 17 Agustus 1945 Jakarta researchers revealed five key clinical and economic findings:

  • Superior Virological Suppression: Patients on TLD achieved undetectable viral load levels faster and maintained long-term suppression more consistently than those on TLE due to dolutegravir’s high genetic barrier to resistance.
  • Enhanced Immune Recovery: TLD treatment yielded greater increases in CD4+ cell counts compared to TLE, accelerating immune system restoration and reducing the risk of opportunistic infections.
  • Fewer Neuropsychiatric Side Effects: TLD demonstrated superior tolerability with a significantly lower incidence of depression, anxiety, and sleep disturbances compared to efavirenz-based therapy.
  • High Pharmacoeconomic Value: Cost-effectiveness evaluations consistently showed that TLD lowers overall healthcare expenditures over time by reducing treatment failure rates, minimizing regimen switching, and decreasing hospitalization costs.
  • Weight and Metabolic Considerations: Patients taking TLD showed a higher tendency for weight gain and altered lipid profiles, highlighting the necessity for routine metabolic monitoring during long-term therapy.

The real-world implications of this study offer direct benefits to healthcare systems, clinical practitioners, and public health policymakers. Adopting TLD as the standard first-line antiretroviral treatment enhances patient adherence, improves long-term quality of life, and preserves national healthcare resources through reduced downstream clinical complications. Furthermore, evidence supporting TLD safety in pregnant women and children facilitates standardized, universal treatment guidelines across all patient populations. Healthcare institutions implementing TLD programs are advised to incorporate routine weight, blood glucose, and lipid monitoring to proactively manage potential metabolic changes while maximizing therapeutic efficacy.

Emphasizing the value of TLD in modern clinical pharmacy and HIV care, the research team highlighted its dual impact on health outcomes and economic sustainability. "The Tenofovir/Lamivudine/Dolutegravir (TLD) regimen demonstrates superior clinical efficacy, higher tolerability, and more favorable cost-effectiveness compared to Tenofovir/Lamivudine/Efavirenz (TLE)," stated Mardhiyah Fithriana Mufti and co-authors from the University of 17 Agustus 1945 Jakarta. "These findings reinforce TLD as the preferred first-line antiretroviral therapy, supporting broader implementation to improve long-term HIV management and healthcare resource efficiency."

Author Profiles

  1. Mardhiyah Fithriana Mufti, S.Farm. Affiliation: Department of Pharmacy, Faculty of Pharmacy, University of 17 Agustus 1945 Jakarta, Indonesia, Field of Expertise: Clinical Pharmacy, Antiretroviral Therapy, and Pharmacoeconomics
  2. Dr. apt. Diana Laila Ramatillah, M.Sc. Affiliation: Department of Pharmacy, Faculty of Pharmacy, University of 17 Agustus 1945 Jakarta, Indonesia, Field of Expertise: Clinical Pharmacy and Drug Utilization Evaluation
  3. apt. Sylvia Rizky Prima, M.Farm. Affiliation: Department of Pharmacy, Faculty of Pharmacy, University of 17 Agustus 1945 Jakarta, Indonesia, Field of Expertise: Pharmacology and Pharmacy Practice

Research Source Information

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