Edited by Shreyasi Asthana | September 23, 2025
TOPLINE:
In routine care clinics across the US, the fixed-dose, three-drug combination regimen bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) and the two-drug regimen dolutegravir/lamivudine (DTG/3TC) effectively maintained virologic suppression in people with HIV infection, although discontinuations were more common with the DTG/3TC regimen.
METHODOLOGY:
- Researchers conducted an observational study in the US comparing the virologic efficacy and discontinuation rates of the three-drug B/F/TAF regimen and the two-drug DTG/3TC regimen in people with HIV infection who were virologically suppressed (viral load < 200 copies per mL).
- The study included 3713 people who switched to B/F/TAF (median follow-up duration, 16 months) and 2327 who switched to DTG/3TC (median follow-up duration, 15 months) between August 2020 and June 2022.
- Participants were followed up until regimen discontinuation, defined as any modification in the regimen components or an antiretroviral therapy gap of over 45 days, loss to follow-up (12 months after last contact), death, or study end.
- Confirmed virologic failure was defined as two consecutive viral loads of ≥ 200 copies per mL or discontinuation after a viral load of ≥ 200 copies per mL.
TAKEAWAY:
- Incidence rates of virologic failure were 1.7 and 2.1 per 100 person-years among participants who received B/F/TAF and DTG/3TC, respectively. Participants on B/F/TAF were 16% less likely to experience virologic failure compared with those on DTG/3TC (adjusted hazard ratio [aHR], 0.84; 95% CI, 0.59-1.18).
- Incidence rates of discontinuation were 12.4 and 14.8 per 100 person-years for participants treated with B/F/TAF and DTG/3TC, respectively. Treatment with B/F/TAF was associated with a 17% lower likelihood of discontinuation than treatment with DTG/3TC (aHR, 0.83; 95% CI, 0.73-0.94).
- Treatment-related discontinuations accounted for 6% vs 9% of B/F/TAF vs DTG/3TC discontinuations, with the higher proportion of virologic non-suppression largely attributable to the DTG/3TC group.
IN PRACTICE:
“In conclusion, this large study of real-world data in the US confirms that while the likelihood of discontinuation was statistically higher with DTG/3TC than B/F/TAF, both regimens are well tolerated and effective treatment options for virologically suppressed individuals in routine clinical care,” the authors of the study wrote.
SOURCE:
The study was led by Gerald Pierone, Jr, Whole Family Health Center in Vero Beach, Florida. It was published online on August 30, 2025, in HIV Medicine.
