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Antiretroviral therapy (ART) regimens dolutegravir plus lamivudine (DTG/3TC) and bictegravir plus emtricitabine and tenofovir alafenamide (BIC/FTC/TAF) demonstrate comparable long-term effectiveness and tolerability in older patients with HIV who are virologically suppressed prior to switching therapy, according to study results presented at IDWeek 2025, held from October 19 to 22, in Atlanta, Georgia.

Researchers conducted a retrospective, real-world chart review across 7 countries to evaluate the effectiveness of DTG/3TC compared with BIC/FTC/TAF in adults aged 50 years and older. Eligible patients were virologically suppressed at baseline and had at least 24 weeks of follow-up after switching to either ART regimen. The index date was defined as the initiation of DTG/3TC or BIC/FTC/TAF.

The analysis included 1144 patients enrolled from the United States (n=326), China (n=221), Spain (n=189), Germany (n=140), France (n=113), South Korea (n=100), and Taiwan (n=55).

Among patients in the DTG/3TC (n=593) and BIC/FTC/TAF (n=551) cohorts, 24.6% and 18.7% were older than 65 years, 32.9% and 34.0% had at least 3 comorbidities, 74.5% and 69.7% were prescribed at least 1 non-ART comedication, and 6.2% and 7.7% had prior virologic failure.

During total follow-up durations of 1463.3 and 1481.9 person-years for the DTG/3TC and BIC/FTC/TAF cohorts, respectively, the incidence rate of virologic failure was identical at 0.07 (95% CI, 0.00-0.14) per 100 person-years, with a single case observed in each group. Approximately 25% of patients had follow-up of 240 weeks or longer. No cases of treatment-emergent resistance were reported in either cohort.

These findings suggest that switching to either the 2-drug or 3-drug ART regimen can maintain durable viral suppression in older, virologically suppressed patients with HIV who often face complex comorbidities and polypharmacy concerns.

Study limitations include the retrospective design and potential variability in regional treatment practices.

The researchers concluded, “In older, virologically suppressed PLHIV [people living with HIV] with age-related comorbidities and comedications, switching to either two-drug DTG/3TC or three-drug BIC/FTC/TAF maintained long-term viral suppression without resistance.”

Disclosure: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

By Hibah Khaja, PharmD

References:

Fraysse J, Kuretski J, Letang E, et al. The Global REGAL cohort: A retrospective real-world study of the effectiveness and tolerability of the antiretroviral treatment regimens DTG/3TC compared to BIC/FTC/TAF in older persons living with HIV. Presented at: IDWeek 2025; October 19-22; Atlanta, Georgia. Poster 357.