# Tenofovir/Lamivudine/Dolutegravir in Nigeria

Tenofovir/Lamivudine/Dolutegravir has 4 active NAFDAC registrations in our October 2026 copy of the register, from 4 registration holders; 4 further listings have lapsed.

- Source: https://ogbogwu.com/drugs/tenofovir-lamivudine-dolutegravir/
- Drug class: NRTI + NRTI + INSTI combination (Anti-HIV/ARVs)
- Also known as: TLD, Tenolam-D, Tenofovir-Lamivudine-Dolutegravir
- Prescription required: yes
- On the WHO Model List of Essential Medicines
- Last updated: February 2026

## Price in Nigeria

TLD — the standard first-line HIV regimen in Nigeria — is supplied free of charge through the public ART programme: patients at accredited treatment sites pay nothing for it, which is why private retail listings are scarce and why we quote no price. If you are being charged for TLD, ask for the nearest accredited treatment centre; institutional supply moves through programme channels and registered distributors.

## 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, at prices that vary widely by 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?

- 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

Always follow a doctor's or pharmacist's instructions; this is general reference information.

- 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: 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 (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

Do not take if: 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.

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 in Nigeria

Well-known NAFDAC-registered brands: Tenolam-D (Mylan/Viatris, made in India); Acriptega (Aurobindo Pharma, made in India).
Full searchable brand list: https://ogbogwu.com/drugs/tenofovir-lamivudine-dolutegravir/brands/

## How to verify it is genuine

1. Check 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.
2. Verify the product using the NAFDAC Mobile Authentication Service (MAS) where available: scratch the security panel and send the code via SMS to 38353.
3. Obtain your ARVs only from designated government ART treatment centres, accredited pharmacies, or recognised non-governmental organisations (NGOs) involved in HIV care.
4. Do 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.
5. Check the expiry date, batch number, and ensure the blister packs are intact and not tampered with.
6. If 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.

Verify any NAFDAC number free (no login): https://ogbogwu.com/nafdac-checker/

## FAQs

### Where can I get free ARV drugs (TLD) in Nigeria?

Free ARVs including TLD are available at government-designated antiretroviral treatment centres across all 36 states and the FCT. These include teaching hospitals (such as LUTH in Lagos, UCH in Ibadan, ABUTH in Zaria, and UNTH in Enugu), general hospitals, and many primary health centres. The free ARV programme is supported by PEPFAR, the Global Fund, and the Nigerian government through NASCP (National AIDS and STIs Control Programme). To access free treatment, visit any ART centre with a referral or walk in for HIV testing and counselling. Once confirmed positive, you will be enrolled in care and started on TLD at no cost. You do not need to pay for the medication, CD4 count test, or viral load test at these centres.

### What are the side effects of TLD, and how do they compare to TLE?

TLD generally has fewer and milder side effects than TLE. The most common side effects of TLD include headache, mild nausea, insomnia, and weight gain. These are usually temporary and resolve within the first few weeks. TLE, which contained efavirenz, was associated with significant central nervous system side effects including vivid nightmares, dizziness, depression, and suicidal thoughts, which affected many patients' quality of life and adherence. Weight gain, particularly in women, has been reported more frequently with dolutegravir-containing regimens than with efavirenz-based ones. Overall, most patients tolerate TLD much better than TLE, and the transition has improved treatment adherence across Nigeria.

### What happens if I miss a dose of TLD?

If you miss a dose of TLD, take it as soon as you remember on the same day. If it is almost time for your next dose (within a few hours), skip the missed dose and take your next dose at the usual time. Never take two tablets at once to compensate for a missed dose. Occasional missed doses are unlikely to cause immediate problems, but frequent or repeated missed doses can allow the virus to multiply and potentially develop resistance to the medication. This could lead to treatment failure, requiring a switch to more expensive and less available second-line regimens. Use reminders on your phone, a pill box, or ask a trusted person to help you remember. If you are struggling with adherence, speak honestly with your healthcare provider or adherence counsellor — they are there to help, not to judge.

### Is TLD better than TLE, and why was Nigeria switched to TLD?

Yes, TLD is considered superior to TLE for several important reasons, which is why Nigeria and most countries globally have transitioned to TLD as the preferred first-line HIV regimen. Firstly, dolutegravir (the 'D' in TLD) has a much higher barrier to drug resistance than efavirenz (the 'E' in TLE), meaning the virus is far less likely to become resistant. Secondly, TLD achieves viral suppression faster, with most patients becoming undetectable within 3 to 6 months. Thirdly, TLD has fewer neuropsychiatric side effects — the dizziness, nightmares, and depression caused by efavirenz significantly affected quality of life for many patients. The WHO recommended TLD as the preferred first-line regimen in 2018, and Nigeria's Federal Ministry of Health, supported by PEPFAR and implementing partners, completed the nationwide transition for the majority of patients. If you are still on TLE, speak with your healthcare provider about transitioning to TLD.

## Sources

- NAFDAC Greenbook (official register of approved products in Nigeria)
- WHO Model List of Essential Medicines
- British National Formulary (BNF)
- Nigerian Standard Treatment Guidelines (Federal Ministry of Health)