Tolerability of bictegravir/tenofovir alafenamide/emtricitabine versus dolutegravir/lamivudine as maintenance therapy in a real-life setting

'With age comes wisdom': effectiveness and tolerability of dolutegravir + lamivudine in virologically-suppressed people with HIV

OBJECTIVES

Results from clinical trials and observational studies suggest that dolutegravir plus lamivudine is a well tolerated option for simplification in people with HIV (PWH). We aimed to assess long-time effectiveness and safety in our cohort.

METHODS

We performed an observational study enrolling HIV-1-infected, virologically suppressed PWH, switching to dolutegravir plus lamivudine. Exclusion criteria were HBV-coinfection and the presence of the M184V mutation before the simplification. We performed survival analysis to evaluate time to virological failure (VF, defined by a single HIV-RNA ≥200 copies/ml or by two consecutive HIV-RNA ≥ 50 copies/ml) and treatment discontinuation (TD, defined as the interruption of either 3TC or DTG).

RESULTS

Six hundred thirty-one PWH were considered for the analysis: 446 were males (70.7%), with a median age of 51.1 years [interquartile range (IQR) 42.6-57.6]. Estimated probabilities of maintaining virological suppression at 192 and 384 weeks were 95.1% [95% confidence interval (CI) 92.0-96.2] and 91.5% (95% CI 87.1-94.4), respectively. At multivariable analysis, including zenith HIV-RNA, time of virological suppression before switch, risk factors for HIV infection and age, only intravenous drug users (IDU) [versus other risk factors, adjusted hazard ratio (aHR) 3.58, 95% CI 1.38-9.28, P  = 0.009] independently predicted VF. A border-line significant association with VF emerged for age (per 10-years more, aHR 0.72, 95% CI 0.51-1.01, P  = 0.058) and zenith HIV-RNA >500 000 cps/ml (versus. <500 000 cps/ml, aHR 2.31, 95% CI 0.98-5.46, P  = 0.056).As to treatment tolerability, estimated probabilities of remaining on study regimen at 192 and 384 weeks were 87.8% (95% CI 84.5-90.5) and 85.1% (95% CI 81.0-88.5), respectively.

CONCLUSIONS

Our findings confirm the long-term effectiveness and tolerability of dolutegravir plus lamivudine in virologically suppressed PWH.

Impact of different antiretroviral therapy regimens on bone mineral density in people living with HIV: a retrospective and longitudinal study in China

BACKGROUND

HIV infection and antiretroviral therapy (ART) are associated with bone loss of people living with HIV (PLWH), but limited studies exist on the impacts of ART regimens on bone mineral density (BMD) in China. This study evaluated BMD changes with three common ART regimens: tenofovir disoproxil fumarate (TDF) + lamivudine (3TC) + efavirenz (EFV), tenofovir alafenamide (TAF)-containing, and dolutegravir (DTG)-containing (non-TDF/non-TAF) therapies.

METHODS

In this retrospective study, the prevalence of low BMD was analyzed in PLWH who underwent dual-energy X-ray absorptiometry (DXA) before ART initiation. BMD changes were assessed in participants who had follow-up DXA scans after ≥ 1 year of ART with TDF + 3TC + EFV, TAF-containing, or DTG-containing regimens. We used multivariate logistic regression to evaluate the impact of different ART regimens on > 3% BMD reduction, adjusting for demographic and clinical variables that were significant in univariate analysis (P < 0.10).

RESULTS

22.99% (630/2740) of PLWH before ART initiation had low BMD. Among 571 individuals followed up for over 1 year, BMD at the femoral neck (FN) and total hip (TH) decreased significantly in the TDF + 3TC + EFV [FN: -0.03(-0.07, 0.00) g/cm2, TH: -0.02(-0.05, 0.00) g/cm2, P < 0.001 for both] and TAF-containing regimens [FN: -0.02(-0.05, 0.01) g/cm2, TH: -0.02(-0.04, 0.01) g/cm2, P < 0.001 for both]. Lumbar spine (LS) BMD decreased significantly only with TDF + 3TC + EFV [-0.02(-0.05, 0.01) g/cm2, P < 0.001]. TDF + 3TC + EFV caused greater BMD loss at the FN and LS than the TAF-containing regimen[FN: -3.66% (-8.05%, 0.34%) vs. -2.38% (-5.44%, 1.12%), P = 0.044; LS: -2.11% (-4.50%, 0.62%) vs.-0.06% (-2.05%, 2.57%), P < 0.001]. Compared to TDF + 3TC + EFV, DTG-containing regimens showed smaller BMD reductions across all sites [FN: -1.49% (-4.65%, 3.83%), TH: 0.00% (-3.98%, 3.18%), LS: 0.59% (-2.73%, 3.09%), P = 0.004, 0.008 and 0.004, respectively]. TAF-containing and DTG-containing regimens showed no significant differences in BMD changes. Multivariable logistic regression showed that TDF + 3TC + EFV, compared to DTG-containing regimens, had higher odds of > 3% FN and LS BMD reduction (FN: OR 2.91, 95% CI: 1.33 to 6.37, P = 0.009; LS: OR 2.93, 95% CI: 1.17 to 7.32, P = 0.022), while TAF-containing regimens were not independently linked to > 3% BMD loss (P > 0.05).

CONCLUSIONS

TAF-containing and DTG-containing regimens caused less bone loss than TDF + 3TC + EFV, offering safer options for preserving bone health in Chinese PLWH.

Weight Gain in HIV Adults Receiving Antiretroviral Treatment: Current Knowledge and Future Perspectives

Body weight is impacted by several individual host and environmental factors. In a person living with HIV (PLWH), weight is also influenced by the disease stage. Wasting syndrome is derived from disease progression, and it can be reversed by the effective use of highly active antiretroviral therapy (HAART). Body weight alterations have been studied and compared in several clinical ART trials, and they differ according to antiviral regimens. The newer integrase strand transfer inhibitors (INSTIs), such as bictegravir and dolutegravir, especially when co-administered with tenofovir alafenamide fumarate (TAF), seem to lead to greater weight increases compared to regimens that include tenofovir disoproxil fumarate (TDF), which seem to have an attenuating effect on weight gain. Nevertheless, despite the established association between INSTI and TAF and the negative impact on weight, more recent data suggest a more cautious approach when HAART treatment decisions are taken. In this manuscript, we review weight changes among PLWH receiving HAART and the relevant underlying pathogenic mechanisms described in recent literature. We try to provide a more critical appraisal of the available data and to underline the challenges in assessing the role of HAART in weight changes in both ART initiation and setting switching.

Dolutegravir/Lamivudine versus Tenofovir Alafenamide/Emtricitabine/Bictegravir as a Switch Strategy in a Real-Life Cohort of Virogically Suppressed People Living with HIV

BACKGROUND

The aim of the study is to evaluate the effectiveness, safety, and tolerability of a two-drug regimen (2-DR) dolutegravir/lamivudine (DTG/3TC) versus a three-drug regimen (3-DR) tenofovir alafenamide/emtricitabine/bictegravir (TAF/FTC/BIC) in a real-life cohort of HIV-1 virologically suppressed treatment-experienced (TE) people living with HIV (PLWH).

METHODS

This was a single-center, retrospective, observational study analyzing adult TE PLWH who started the 2-DR or 3-DR between January 2018 and January 2023. All PLWH with a viral load (VL) <50 copies/mL at the time of switching, and a follow-up of more than 6 months or interruption of treatment at any time, were included.

RESULTS

A total of 324 PLWH were included; of these, 110 (34%) were on the 2-DR and 214 (66%) were on the 3-DR. Most patients remained on therapy in both groups (93.6% 2-DR versus 90.2% 3-DR) and, at the last control, 99.1% achieved VL < 50 copies/mL with the 2-DR versus 97.2% with the 3-DR (p = 0.260). No virological failures occurred in either group. Adverse events occurred in a few cases: four (3.6%) in the 2-DR group and five (2.3%) in the 3-DR group (p = 0.500). The median follow-up-time was 19.6 months for the 2-DR and 27.5 months for the 3-DR.

CONCLUSION

Our study shows a similar effectiveness and safety profile in virologically suppressed PLWH switching to DTG/3TC or TAF/FTC/BIC.