Spegra Tablet

Q1: What is Spegra (DTG/FTC/TAF) used for?

Spegra is a complete single-tablet regimen combining Dolutegravir 50mg (INSTI) + Emtricitabine 200mg (NRTI) + Tenofovir Alafenamide 25mg (NRTI). It is a WHO and DHHS preferred first-line HIV-1 treatment regimen for adults and adolescents.

Q2: How does the Dolutegravir/FTC/TAF combination achieve superior viral suppression?

Dolutegravir blocks HIV integrase with the highest genetic barrier of any INSTI. FTC and TAF synergistically inhibit reverse transcriptase from two complementary angles. Together, they target two critical HIV replication steps with exceptional potency and durability.

Q3: Why is Spegra preferred over TDF-based regimens?

TAF achieves 90% lower systemic tenofovir exposure than TDF while maintaining superior intracellular drug activity. This dramatically reduces the kidney tubular toxicity and bone mineral density loss associated with TDF, making Spegra safer for long-term use.

Q4: How should Spegra be taken?

Take one tablet once daily. Dolutegravir is best taken on an empty stomach or with a light meal. Take at least 2 hours before — or 6 hours after — antacids, iron, calcium supplements, or magnesium supplements, which reduce Dolutegravir absorption.

Q5: What are the most common side effects?

Insomnia and headache are most common from the Dolutegravir component. Nausea and diarrhea occur in some patients early in treatment. Neuropsychiatric effects (anxiety, mood changes, vivid dreams) affect a minority and may require regimen consideration.

Q6: Does Spegra protect against hepatitis B?

Yes. Both FTC and TAF are active against HBV. Spegra provides dual HIV/HBV treatment in co-infected patients. Stopping Spegra in HIV/HBV patients without alternative HBV coverage can cause life-threatening HBV flares.

Q7: What drug interactions are important with Spegra?

Rifampicin and rifabutin are major interactions reducing Dolutegravir levels — an alternative TB regimen or dose adjustment is required. Strong CYP3A4 inducers (carbamazepine, St John's Wort) reduce efficacy. Antacids and mineral supplements require timing separation.

Q8: What weight gain should I expect on Spegra?

Integrase inhibitor-based regimens (particularly Dolutegravir) are associated with modest weight gain compared to NNRTI-based regimens. The clinical significance of this weight gain is being studied. Lifestyle interventions and monitoring are recommended.

Q9: Can Spegra be used during pregnancy?

Dolutegravir-based regimens are now recommended in pregnancy by many guidelines. TAF use in pregnancy has less data than TDF, though it is increasingly accepted. The complete regimen must be managed by an HIV/obstetric specialist team.

Q10: What monitoring is required on Spegra?

CD4 count and viral load at baseline, 4–8 weeks, then every 3–6 months. Renal function (creatinine, eGFR, urinalysis) and liver function at baseline and periodically. Bone density assessment if osteoporosis risk factors present.

Q11: How should Spegra be stored?

Store at room temperature away from light and moisture. Keep in original packaging out of reach of children. Do not use after the expiry date.

Q12: Do I need a prescription?

Yes. Spegra requires specialist HIV prescribing, baseline viral load and CD4 assessment, and regular monitoring throughout treatment.