2DR has been adopted as a simplification strategy in many clinical guidelines for people living with HIV with chronic renal, bone and/or cardiometabolic conditions where use of tenofovir should be avoided. This has particularly been the case for elderly populations affected by multiple chronic comorbidities and at risk of drug interactions due to polypharmacy (43). Hepatitis B serological status must be determined as a key eligibility criterion, and if active hepatitis B/HIV coinfection is present, a hepatitis B-active drug should be added. The use of point-of-care technologies and integration with other screening policies are recommended to facilitate implementation (44). Overall, people living with HIV who are on 3DR, have undetectable viral load and no active hepatitis B coinfection are eligible for 2DR simplification. The use of 2DR as initial therapy may also be considered and is supported by recent clinical trials, even in those with more advanced disease and without previous drug resistance screening (6,15,16). However, experience in LMICs is limited and close clinical and viral load monitoring advised. DTG+3TC is recommended as the preferred 2DR option due to its clinical and programmatic advantages as well as more extensive clinical experience compared to other 2DR options. In addition, unlike other DTG-based 2DR, trials indicated that switching to DTG+3TC is not associated with more withdrawals due to adverse events compared to continuing on a 3DR. DTG+DRV/r and DTG+RPV also have other important limitations, such as drug interactions with rifampicin and other medicines, issues with dosing in pregnant women, higher comparative costs, limited access to generic formulations and less experience in the LMIC context. DTG+3TC can be used in people living with HIV-associated TB following a rifamycinbased treatment for TB disease, but the DTG dose should be adjusted (45). In people with severe renal impairment, the 3TC dose should also be adjusted (46).