Comparing lamivudine+dolutegravir and bictegravir/emtricitabine/tenofovir alafenamide as switch strategies: preliminary results from clinical practice.

Objective We tried to investigate and compare the safety of a dual therapy (DT) with DTG+3TC versus BIC/FTC/TAF (BIC). Methods We performed a retrospective analysis in a cohort of virologically suppressed HIV+ pts switching to DT or BIC in our center. Primary endpoint was to evaluate time to treatment discontinuation (TD) for any cause. Survival analysis was employed to determine time to TD and its predictors were analyzed by Cox regression. Moreover, we collected viro-immunological parameters as well as markers of renal function and lipid profile at baseline and after 24 weeks and assessed changes via non-parametric tests. Results We analyzed 476 patients: 350 starting a DT and 126 starting BIC. Overall, we registered 21 TD: 15 in the DT group during 170 PYFU (a rate of 8.8 per 100 PYFU) and 6 in the BIC one during 48 PYFU (12.5 per 100 PYFU). Estimated probabilities of maintaining study regimen after 24 weeks were 95.5% (SD±1.1) in the DT group and 94.9% (SD±2.0) in the BIC group, with no significant differences between them (log-rank p=0.639). Concerning metabolic profile, in the DT group, after 24 weeks, triglycerides decreased significantly (median change -14 mg/dL, p<0.001) while HDL cholesterol increased (+3 mg/dL, p=0.031). In the BIC group, meanwhile, we observed a significant decrease in LDL cholesterol after 24 weeks (-13 mg/dL, p=0.026). Conclusions Both optimization strategies showed high tolerability in the short term in experienced pts, with few differences between them. Further studies are needed to properly assess the matter.