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Tenofovir/Lamivudine
Antiretroviral — Nucleoside/Nucleotide Reverse Transcriptase Inhibitor (NRTI) CombinationNigerian brand names:TLD (Tenofovir/Lamivudine/Dolutegravir)DuovirLamivir-TDFTenvir-L
Reviewed by the PMC Medical Team · Promise Medical Centre
Overview
Tenofovir disoproxil fumarate (TDF) and lamivudine (3TC) are two antiretroviral drugs that are almost always used together as the backbone of combination HIV treatment in Nigeria. They work by blocking reverse transcriptase, an enzyme HIV needs to replicate. Without this enzyme, the virus cannot make copies of itself. In Nigeria, TDF/3TC is most commonly prescribed as a fixed-dose combination together with dolutegravir (TLD) — the first-line regimen recommended by the Nigerian Federal Ministry of Health and the WHO. Lamivudine is also used alone to treat hepatitis B virus (HBV) infection.
Uses
Tenofovir and lamivudine (usually as TDF/3TC/DTG — TLD) are used to:
- Treat HIV-1 infection in adults and children (as part of combination antiretroviral therapy — ART)
- This combination forms the backbone of first-line ART regimens in Nigeria's national HIV programme
- Pre-exposure prophylaxis (PrEP): TDF/3TC (Truvada or generic equivalents) taken daily by HIV-negative people at high risk of HIV to prevent infection
- Hepatitis B treatment: Tenofovir (and lamivudine alone) are effective against hepatitis B virus — people with HIV/HBV coinfection particularly benefit
ART suppresses HIV to undetectable levels, prevents progression to AIDS, and prevents transmission of HIV to others (Undetectable = Untransmittable, U=U).
How to Use
HIV treatment (adults):
The standard first-line regimen in Nigeria is one TLD tablet (tenofovir 300 mg + lamivudine 300 mg + dolutegravir 50 mg) once daily.
Important ART rules:
- Take EXACTLY once daily, at the same time every day — consistency is critical. Missing doses allows HIV to replicate and develop resistance
- Take with or without food — though taking with food may reduce nausea initially
- Never stop ART without discussing with your doctor: Stopping allows viral rebound and can cause AIDS-defining illnesses. If you are struggling to take your medication, talk to your healthcare worker or counsellor
- Collect refills before you run out: Plan ahead — allow at least 2 weeks before your tablets run out to collect from the clinic
- Pharmacy/clinic: ART is provided free through government ART clinics in Nigeria (Federal and State hospitals, PHCs). Always use the same clinic for continuity of care and viral load monitoring
Side Effects
Common side effects of TDF/3TC (usually mild and improve after the first few weeks):
- Nausea, vomiting, or stomach upset (most common when starting)
- Headache
- Dizziness or fatigue
- Diarrhoea
- Flatulence (gas)
Tenofovir-specific concerns:
- Kidney toxicity: Tenofovir can affect kidney function over time — regular kidney function monitoring (creatinine, eGFR) is essential; dose adjustment or switch to TAF (tenofovir alafenamide) needed if kidneys are affected
- Bone density loss: Long-term use may reduce bone mineral density — ensure adequate calcium and vitamin D intake
Lamivudine: Very well tolerated; rarely causes significant side effects alone.
Serious:
- Lactic acidosis (rare, potentially fatal): Severe nausea, vomiting, abdominal pain, weakness, difficulty breathing — stop ART and seek emergency care immediately
- Hepatomegaly (enlarged liver with fat accumulation — steatohepatitis): Associated with lactic acidosis risk
Warnings & Precautions
Critical warnings for ART:
- NEVER take only one or two drugs from a combination — always take the full prescribed combination. Incomplete regimens cause drug resistance, which is permanent and may leave you with fewer treatment options
- Adherence is life-saving: Studies show that missing doses even 5% of the time (about 2 doses per month) significantly increases viral rebound risk. Use pill organisers, phone alarms, or treatment supporters to maintain adherence
- Hepatitis B flare: If tenofovir or lamivudine is stopped in someone with hepatitis B coinfection, a dangerous hepatitis B flare can occur — life-threatening liver inflammation. Never stop ART without medical guidance in coinfection
- Drug interactions: Some medicines significantly reduce the effect of antiretrovirals — always inform every doctor, pharmacist, or herbalist about your ART
- Resistance testing: Viral load should be checked after 6 months on ART and then annually. A detectable viral load may indicate resistance — discuss with your HIV specialist
- Stigma and privacy: ART tablets should be stored discreetly. You do not have to disclose your status to anyone you do not choose to trust. Most Nigerian ART clinics maintain confidential services
Drug Interactions
Important interactions (ART has many — always use an HIV pharmacist or specialist):
- Rifampicin (TB treatment): Significantly reduces dolutegravir levels — requires dolutegravir 50 mg twice daily (not once daily) during TB treatment with rifampicin
- Antacids and calcium/iron supplements: Reduce dolutegravir absorption — take dolutegravir 2 hours before or 6 hours after antacids/iron/calcium
- Metformin: Dolutegravir can raise metformin levels — monitor blood sugar; metformin dose may need reduction
- NSAIDs and nephrotoxic drugs: Increase risk of tenofovir kidney toxicity — avoid prolonged use of NSAIDs; stay well hydrated
- Adefovir: Do not combine with tenofovir for hepatitis B — no additive benefit and may increase kidney risk
- St. John's Wort (herbal remedy): Reduces levels of many antiretrovirals significantly — AVOID
- Alcohol: Increases liver stress — limit consumption, especially with hepatitis B coinfection
Storage
Store at room temperature (below 30°C) in a dry place, away from heat, moisture, and direct sunlight. Keep in original packaging. Keep out of reach of children.
Buy only NAFDAC-registered medications
Nigeria has a significant problem with counterfeit and substandard drugs. Always purchase medications from a licensed pharmacy and check the NAFDAC registration number on the package — verify at nafdac.gov.ng.