Lavem is a single-tablet HIV treatment combining tenofovir disoproxil fumarate 300 mg, lamivudine 300 mg and dolutegravir 50 mg. This is the combination known as TLD, South Africa’s standard first-line treatment for HIV. It is taken once daily, long term, and is available free at public health facilities.
What is Lavem?
Lavem is Schedule 4 — prescription-only — and contains three antiretroviral medicines in one tablet:
| Ingredient | Class |
|---|---|
| Tenofovir disoproxil fumarate 300 mg | NRTI (nucleotide reverse transcriptase inhibitor) |
| Lamivudine 300 mg | NRTI (nucleoside reverse transcriptase inhibitor) |
| Dolutegravir 50 mg | Integrase inhibitor |
This combination is widely called TLD — Tenofovir, Lamivudine, Dolutegravir — and it is South Africa’s recommended first-line HIV treatment. Equivalents include Acriptega and other generics. Being dispensed one rather than another is ordinary generic substitution.
HIV is treated with combinations rather than single medicines, because the virus replicates rapidly and mutates. A single medicine would select for resistant virus within weeks. Attacking three points in the life cycle at once makes resistance far less likely.
The three ingredients block two different stages:
- Tenofovir and lamivudine block reverse transcriptase, the enzyme HIV uses to convert its RNA into DNA. Without it, the virus cannot make a copy of its genetic material.
- Dolutegravir blocks integrase, the enzyme that inserts that viral DNA into the cell’s own chromosomes. Without integration, the infection cannot be established in the cell.
Dolutegravir is what makes this combination effective. It works quickly, suppresses the virus reliably, has a high barrier to resistance, and is generally well tolerated — which is why it replaced efavirenz-based regimens in South African guidelines.
Treatment does not cure HIV, but it suppresses the virus so effectively that most people reach an undetectable viral load. Undetectable means untransmittable — someone with a sustained undetectable viral load cannot pass HIV on through sex. This is well established, and it is one of the most important things treatment achieves.
What is Lavem commonly used for?
- Treating HIV infection in adults and adolescents — its main and registered use, taken once daily for life.
- Post-exposure prophylaxis (PEP), in some cases. A tenofovir/lamivudine/dolutegravir combination is used in South Africa as a 28-day course started as soon as possible — ideally within hours, and no later than 72 hours — after a possible exposure, such as a needlestick injury or sexual assault. This must be started by a healthcare provider, who will also arrange testing and follow-up.
A point worth being clear about, since people often ask: this combination is not the standard medicine for PrEP (pre-exposure prophylaxis, taken before exposure by HIV-negative people). PrEP in South Africa is normally tenofovir with emtricitabine, and there are now long-acting injectable options. PrEP and HIV treatment are different regimens with different monitoring, and taking a treatment regimen as PrEP without medical guidance is not appropriate.
Anyone should be tested for HIV before starting any of these. Taking treatment without knowing your status — or taking someone else’s tablets — risks resistance developing, which can compromise future treatment options.
HIV treatment is free at public health facilities in South Africa, along with testing and counselling. Cost should never be the reason someone goes without it.
How Lavem fits into this medicine category
| Class | Examples | What it blocks |
|---|---|---|
| NRTIs | Tenofovir, lamivudine, emtricitabine, abacavir | Reverse transcriptase |
| NNRTIs | Efavirenz, nevirapine, doravirine | Reverse transcriptase, differently |
| Integrase inhibitors | Dolutegravir, raltegravir | Integrase |
| Protease inhibitors | Lopinavir/ritonavir, atazanavir | Protease, at assembly |
| Single-tablet regimens | Lavem, Acriptega | Three medicines combined |
Single-tablet regimens matter more than convenience alone. Taking one tablet daily rather than several makes consistent adherence far easier, and consistent adherence is the single biggest factor in whether treatment works. See the HIV and antiviral medicines hub.
What to check before using Lavem
Take it at the same time every day. Missed doses allow the virus to replicate and are the main route to resistance. If you miss one, take it as soon as you remember unless it is nearly time for the next — do not double up.
Never stop without medical advice, and never run out. If you are travelling, changing clinics or your supply is running low, arrange a refill in advance.
Tell your doctor or pharmacist if you:
- Have kidney disease. Tenofovir can affect the kidneys, and function is monitored — this is the most important routine check.
- Have osteoporosis or low bone density. Tenofovir can reduce bone mineral density.
- Have hepatitis B. This is critical: lamivudine and tenofovir also treat hepatitis B, and stopping them suddenly can cause a severe, dangerous flare. Your doctor must know.
- Have hepatitis C or liver disease.
- Have diabetes, as dolutegravir may affect blood sugar in some people.
- Are pregnant, planning pregnancy or breastfeeding. Dolutegravir is used in pregnancy in South Africa — discuss it, but do not stop treatment on your own.
- Take metformin, whose levels dolutegravir raises — the dose may need adjusting.
- Take antacids, calcium, magnesium, iron or zinc supplements. These bind dolutegravir and stop it being absorbed. Take dolutegravir at least 2 hours before, or 6 hours after — a very common and easily missed cause of treatment failure.
- Take rifampicin for TB, carbamazepine, phenytoin or St John’s wort, which reduce dolutegravir levels.
- Take any other medicine or supplement — always mention you are on HIV treatment.
Possible cautions and when to ask a pharmacist or doctor
Common effects, usually mild and often settling in the first weeks, are headache, nausea, diarrhoea, tiredness and difficulty sleeping. Taking it in the morning sometimes helps if it disturbs sleep. Some people gain weight on dolutegravir-based regimens.
Seek medical attention if you develop:
- A rash, particularly with fever, blistering, mouth sores or facial swelling — this needs urgent assessment.
- Yellowing of the eyes or skin, dark urine, pale stools, or persistent abdominal pain — possible liver problems.
- Much less urine than usual, swelling of the legs, or unusual tiredness — possible kidney effects.
- Bone pain, or a fracture from a minor injury.
- Deep or rapid breathing, severe weakness, muscle pain or marked drowsiness — possible lactic acidosis, rare but serious.
- New or worsening depression, anxiety, or thoughts of self-harm. Report these promptly.
- Fever, swollen glands or worsening symptoms in the first weeks — this can be immune reconstitution, where a recovering immune system reacts to an existing infection such as TB. It is treatable and is not a reason to stop treatment, but it needs assessment.
Attend your monitoring appointments. Viral load and kidney function are checked periodically — viral load tells you whether treatment is working, and it is the number that matters most.
If you are struggling to take it consistently, say so. Side effects, stigma, travel, work patterns and mental health all affect adherence, and clinics deal with this routinely. Raising it early is far better than missed doses leading to resistance.
Related medicine guides
Frequently asked questions
What are Lavem tablets used for? Treating HIV infection. It combines tenofovir disoproxil fumarate 300 mg, lamivudine 300 mg and dolutegravir 50 mg — the combination known as TLD — in one daily tablet.
Are Lavem tablets used for PEP? A tenofovir/lamivudine/dolutegravir combination is used for post-exposure prophylaxis as a 28-day course, started as soon as possible after exposure and within 72 hours. It must be started by a healthcare provider.
Are Lavem tablets used for PrEP? No. PrEP in South Africa is normally tenofovir with emtricitabine, or a long-acting injectable. This is a treatment regimen, not a PrEP regimen.
Does it cure HIV? No, but it suppresses the virus. Most people reach an undetectable viral load, and undetectable means the virus cannot be passed on through sex.
What happens if I miss a dose? Take it as soon as you remember unless it is nearly time for the next — do not double up. Repeated missed doses risk resistance.
Why must I separate it from antacids and supplements? Calcium, magnesium, iron and zinc bind dolutegravir and stop it being absorbed. Take it at least 2 hours before or 6 hours after them.
Can I take it during pregnancy? Dolutegravir-based treatment is used in pregnancy in South Africa. Discuss it with your doctor, but do not stop treatment on your own.
Is HIV treatment free in South Africa? Yes, at public health facilities, along with testing and counselling.