Key Facts
- Drug Class
- NRTI + NRTI + INSTI combination
- Prescription
- Required
- NAFDAC Status
- NAFDAC Registered
- Forms
- Tablet
- Price Range
- ₦500 - ₦5,000
- WHO Essential
- Yes
What is Tenofovir/Lamivudine/Dolutegravir?
Tenofovir/Lamivudine/Dolutegravir, commonly known as TLD, is a fixed-dose combination antiretroviral tablet used for the treatment of HIV-1 infection. It combines three powerful antiretroviral medicines into a single pill: Tenofovir disoproxil fumarate (300mg), an NRTI that blocks the HIV reverse transcriptase enzyme; Lamivudine (300mg), another NRTI that works similarly to tenofovir but targets a different step in viral replication; and Dolutegravir (50mg), an integrase strand transfer inhibitor (INSTI) that prevents HIV from inserting its genetic material into human cells. Nigeria has the second largest HIV burden in the world, with approximately 1.9 million people living with HIV, and TLD has become the cornerstone of the national antiretroviral therapy programme. The shift to TLD represents a major advance in HIV treatment in Nigeria, offering superior viral suppression with fewer side effects compared to older regimens.
TLD was adopted as the preferred first-line antiretroviral regimen in Nigeria following World Health Organisation (WHO) recommendations in 2018, replacing the previously standard TLE combination (Tenofovir/Lamivudine/Efavirenz). The transition from TLE to TLD was driven by several advantages: dolutegravir has a higher barrier to resistance than efavirenz, meaning the virus is less likely to develop resistance to TLD; it causes fewer central nervous system side effects such as dizziness, nightmares, and depression that were common with efavirenz; and it achieves viral suppression faster. Across Nigeria, from teaching hospitals in Lagos, Abuja, and Ibadan to primary health centres in rural communities in Benue, Nasarawa, and Akwa Ibom states, TLD has been rolled out as the standard of care. The Nigerian government, supported by PEPFAR (the U.S. President's Emergency Plan for AIDS Relief) and the Global Fund, provides TLD free of charge to all eligible patients through designated treatment centres.
Access to TLD in Nigeria is primarily through government-supported antiretroviral treatment centres found in general hospitals, teaching hospitals, and accredited primary health centres across all 36 states and the Federal Capital Territory. Patients do not need to pay for TLD when accessing it through these channels, as the medication is fully subsidised. However, some patients may purchase TLD from private pharmacies, where prices typically range from ₦500 to ₦5,000 per month's supply depending on the brand. It is critically important that patients understand TLD must be taken every single day, at approximately the same time, for the rest of their lives. Missing doses or stopping treatment can lead to drug resistance, treatment failure, and disease progression. Adherence counselling is a fundamental component of HIV care at treatment centres throughout Nigeria, and patients are encouraged to use pill reminders, join support groups, and attend regular clinic appointments to maintain optimal adherence.
What is Tenofovir/Lamivudine/Dolutegravir used for?
In Nigeria, Tenofovir/Lamivudine/Dolutegravir is commonly used for:
- First-line treatment of HIV-1 infection in adults and adolescents weighing at least 20kg
- Transition therapy for patients previously stable on TLE (Tenofovir/Lamivudine/Efavirenz) or other first-line regimens
- Post-exposure prophylaxis (PEP) following occupational or non-occupational HIV exposure
- Treatment of HIV in patients co-infected with Hepatitis B (tenofovir and lamivudine are also active against Hepatitis B virus)
- Part of the national ART programme for prevention of mother-to-child transmission (PMTCT) of HIV
- HIV treatment in TB-HIV co-infected patients, with appropriate dose adjustment of dolutegravir when used alongside rifampicin
Dosage
IMPORTANT
Always follow your doctor's or pharmacist's instructions. The information below is for general reference only.
Adults
One tablet taken once daily, with or without food. The tablet should be swallowed whole with water. It is recommended to take TLD at the same time every day to maintain consistent drug levels in the blood. For patients co-infected with TB who are taking rifampicin, an additional 50mg dose of dolutegravir must be taken 12 hours after the TLD dose, as rifampicin significantly reduces dolutegravir levels.
Children
TLD in its standard fixed-dose combination is approved for adolescents weighing at least 20kg. For children below this weight, individual component antiretrovirals are prescribed in age- and weight-appropriate doses. Paediatric formulations of dolutegravir (such as dispersible tablets) are now available in Nigeria for younger children. Always follow the prescribing clinician's instructions for paediatric dosing.
Elderly
There is limited data on TLD use in elderly patients. The standard adult dose is generally used, but kidney function should be monitored closely as tenofovir can affect renal function. Elderly patients with reduced kidney function may require dose adjustment or alternative regimens. Consult the treating physician for guidance.
TLD must be taken every day without interruption for the rest of the patient's life. Do not stop taking TLD even if you feel well, as the virus can rebound quickly. If you miss a dose, take it as soon as you remember on the same day, then continue your normal schedule. Do not take two tablets to make up for a missed dose. Dolutegravir should be taken at least 2 hours before or 6 hours after taking antacids, calcium supplements, or iron supplements, as these can reduce absorption. Regular viral load monitoring is essential — attend your clinic appointments as scheduled.
Side Effects
Common side effects
- •Headache — usually mild and resolves within the first few weeks of treatment
- •Nausea — typically improves after the body adjusts to the medication
- •Diarrhoea — usually transient and manageable
- •Insomnia or difficulty sleeping — reported more frequently with dolutegravir
- •Weight gain — a recognised side effect of dolutegravir-based regimens, particularly in women
- •Fatigue and dizziness — usually mild and temporary
Serious side effects — seek medical help immediately
- Kidney problems (renal toxicity) — tenofovir can cause kidney damage, including Fanconi syndrome. Symptoms include excessive thirst, frequent urination, muscle weakness, and bone pain.
- Lactic acidosis — a rare but life-threatening condition associated with NRTIs. Symptoms include unusual tiredness, muscle pain, difficulty breathing, and abdominal pain.
- Hepatotoxicity — liver inflammation or worsening of Hepatitis B if treatment is stopped abruptly in co-infected patients
- Severe hypersensitivity reaction — rash with fever, blistering, or involvement of mucous membranes
- Bone mineral density loss — long-term tenofovir use can reduce bone density, increasing fracture risk
- Immune reconstitution inflammatory syndrome (IRIS) — paradoxical worsening of pre-existing infections as the immune system recovers, common in patients starting ART with very low CD4 counts
When to see a doctor
Contact your healthcare provider immediately if you experience persistent vomiting, severe abdominal pain, dark-coloured urine, yellowing of the eyes or skin, unexplained muscle pain or weakness, difficulty breathing, excessive weight gain, or signs of allergic reaction such as rash with fever. In Nigeria, you can visit your ART treatment centre, the nearest general hospital emergency department, or call your treatment supporter. Do not stop taking TLD on your own — always consult your healthcare provider first, as abrupt discontinuation can lead to viral rebound and, in Hepatitis B co-infected patients, a dangerous liver flare.
Warnings & Precautions
Do not take Tenofovir/Lamivudine/Dolutegravir if you have:
- Known hypersensitivity to tenofovir, lamivudine, dolutegravir, or any component of the formulation
- Severe renal impairment (creatinine clearance below 50ml/min) — tenofovir is nephrotoxic and requires dose adjustment or alternative regimen
- Co-administration with dofetilide — dolutegravir increases dofetilide levels, leading to potentially fatal cardiac arrhythmias
- Co-administration with certain anticonvulsants (carbamazepine, phenytoin, phenobarbital) that significantly reduce dolutegravir levels
Drug interactions
- •Rifampicin — significantly reduces dolutegravir blood levels; an additional 50mg dolutegravir dose is required 12 hours after TLD in TB-HIV co-infected patients
- •Antacids containing aluminium, magnesium, or calcium — reduce dolutegravir absorption; take TLD at least 2 hours before or 6 hours after antacids
- •Iron and calcium supplements — reduce dolutegravir absorption; observe the same timing restrictions as with antacids
- •Metformin — dolutegravir increases metformin levels; dose adjustment of metformin may be needed, especially when starting or stopping TLD
- •St John's Wort (Hypericum perforatum) — significantly reduces dolutegravir levels and must be avoided
- •Polyvalent cation-containing products (multivitamins with minerals) — may reduce dolutegravir absorption if taken simultaneously
Pregnancy & Breastfeeding
TLD is now recommended for use in pregnancy by the WHO and Nigerian treatment guidelines, following extensive safety data. Earlier concerns about a potential link between dolutegravir and neural tube defects at conception have been largely resolved by subsequent studies showing the risk is very small (approximately 0.19%). The benefits of effective viral suppression for prevention of mother-to-child transmission far outweigh the small potential risk. Women who become pregnant while on TLD should continue their treatment. Women who are breastfeeding should also continue TLD, as effective viral suppression significantly reduces the risk of HIV transmission through breast milk. Discuss any concerns with your healthcare provider at your antenatal clinic.
Brands of Tenofovir/Lamivudine/Dolutegravir in Nigeria
3 brands available in Nigeria.
| Brand Name | Manufacturer | Strength | Form | NAFDAC Reg. No. |
|---|---|---|---|---|
| TLD (Generic) | Various | Tenofovir 300mg/Lamivudine 300mg/Dolutegravir 50mg | Tablet | |
| Tenolam-D | Mylan/Viatris | Tenofovir 300mg/Lamivudine 300mg/Dolutegravir 50mg | Tablet | |
| Acriptega | Aurobindo Pharma | Tenofovir 300mg/Lamivudine 300mg/Dolutegravir 50mg | Tablet | B4-9927 |
How to Verify Your Tenofovir/Lamivudine/Dolutegravir is Genuine
- 1Check the NAFDAC registration number on the packaging. All genuine antiretroviral medicines distributed in Nigeria must be NAFDAC-registered or exempted for specific donor-funded programmes.
- 2Verify the product using the NAFDAC Mobile Authentication Service (MAS) where available: scratch the security panel and send the code via SMS to 38353.
- 3Obtain your ARVs only from designated government ART treatment centres, accredited pharmacies, or recognised non-governmental organisations (NGOs) involved in HIV care.
- 4Do not purchase ARVs from open markets, roadside vendors, or unverified online sellers — counterfeit antiretrovirals are a serious risk and can lead to treatment failure and drug resistance.
- 5Check the expiry date, batch number, and ensure the blister packs are intact and not tampered with.
- 6If the packaging looks different from what you usually receive, or the tablets look or taste different, report to your pharmacist or healthcare provider immediately and do not take the medication until it has been verified.
Tenofovir/Lamivudine/Dolutegravir Price in Nigeria
Tenofovir/Lamivudine/Dolutegravir prices in Nigeria typically range from ₦500 to ₦5,000 per pack, depending on the brand, strength, and where you buy it.
₦500 – ₦5,000
per pack
Prices vary by location and vendor. Last updated: 2026-02-01
Where to Buy
Purchase Tenofovir/Lamivudine/Dolutegravir only from licensed pharmacies and verified distributors. Avoid buying medicines from unverified sources, roadside vendors, or unregistered market stalls.
Frequently Asked Questions
Sources
- •NAFDAC Greenbook — National Agency for Food and Drug Administration and Control registered products database
- •WHO Model List of Essential Medicines (23rd List, 2023)
- •British National Formulary (BNF)
- •Nigerian Standard Treatment Guidelines