Metabolic Health Consequences of Switching to the Bictegravir/Emtricitabine/Tenofovir Alafenamide and Dolutegravir Plus Lamivudine Regimens in Virologically Suppressed People Living with HIV Aged > 40 Years: A Retrospective Real-World Study

Abstract

Objective: Both B/F/TAF and DTG/3TC are recommended in treatment guidelines for switch therapy in PLWH. This study aimed to evaluate the safety and metabolic health consequences of two switched regimens in a real-world setting among virologically suppressed PLWH previously treated with EFV/TDF/3TC.

Methods: This retrospective real-world study in Hangzhou included 220 virologically suppressed PLWH who switched from EFV/TDF/3TC to DTG/3TC or B/F/TAF between January 1, 2020 and October 30, 2023. All participants were examined the changes in weight, BMI, GLU levels, lipid parameters (TC, LDL-C, HDL-C, and TG), and eGFR at post-12-month.

Results: The mean age of included participants was 50.8 years (SD: 11.3). After 12 months of switching, the HIV RNA level was below the limit of detection (< 20 copies/mL) among all participants. The switch to DTG/3TC or B/F/TAF therapy was associated with significant improvement in LDL-C, GLU levels, and eGFR values (all P < 0.05), while other metabolic indexes did not change significantly. Furthermore, there was a significant difference in the incidence of hyperglycemia (5.7% vs 19.35%; P = 0.004) between the B/F/TAF and DTG/3TC groups, but not included the mean changes of weight, BMI, lipid profiles, GLU levels, and eGFR and incidence of high TC and high TG. For the aged 40-59 years and aged ≥ 60 years PLWH, the differences in metabolic indicators were minimal between DTG/3TC and B/F/TAF groups post-12-month, with no significant differences between the arms in mean change from baseline in TC, TG, HDL-C, LDL-C, GLU, BMI, weight, and eGFR.

Conclusion: In this study, the B/F/TAF or DTG/3TC regimens are safe for virologically suppressed PLWH aged > 40 years. The transition to B/F/TAF demonstrated dual clinical benefits, significantly reducing hyperglycemia incidence while preserving renal function.

Keywords: antiretroviral therapy; metabolic indices; people living with HIV; virological suppression.

Figure 1

Study flow diagram. A total of 220 PLWH were included in the study.

Figure 2

Changes in metabolic indicators from baseline to 12-month. The levels of TC (A), TG (B), HDL-C (C), LDL-C (D), and GLU (E) at baseline and 12-month. The values of BMI (F), weight (G), and eGFR (H) at baseline and 12-month. ns P > 0.05, *P < 0.05, **P < 0.01, ***P < 0.001.

Figure 3

Differences of the mean changes from baseline in metabolic indicators between B/F/TAF and DTG/3TC PLWH. Comparisons of the mean changes in TC (A), TG (B), HDL-C (C), LDL-C (D), and GLU (E), BMI (F), weight (G), and eGFR (H) between two groups. ns P > 0.05.