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Trial design

AVERTAS was a randomized controlled parallel open-label phase 4 trial comparing weight change in PWH switching from dolutegravir, ABC and lamivudine (DTG/ABC/3TC) to dolutegravir and lamivudine (DTG/3TC) vs. continuing DTG/ABC/3TC and followed up after 24 and 48 weeks (Supplementary Fig. 1). The trial protocol has been published elsewhere [10]. The trial was reported according to the CONSORT statement [11].

Owing to slowing accrual, a decline in eligible participants and fewer study sites than planned, the sample size was re-estimated by allowing a statistical power of at least 80%, corresponding to 66 participants. Originally, the power was set to 90%, corresponding to 90 participants. This decision was made by the sponsor. Other minor amendments to the study protocol occurred during the study period. The Ethics Committee of the Capital Region and the Danish Medicines Agency approved all amendments. Please refer to Supplementary Table 1 for protocol amendments.

Participants

Participants were eligible if they were 18 years or older with HIV-1 infection and had been treated with DTG/ABC/3TC for at least 6 months. The female participants had to agree to contraception during the study. The exclusion criteria were preexisting resistance to 3TC or DTG, the presence of hepatitis B antigen (HBsAg) or HBV DNA, cancer within the past five years, unstable cardiovascular disease or diabetes (evaluated by the treating physician), pregnancy, or breastfeeding.

Participants were screened and recruited from outpatient clinics at the Departments of Infectious Diseases at Copenhagen University Hospital – Amager and Hvidovre and Rigshospitalet. Eligible subjects received oral and written information and were subsequently invited to participate in the study. All participants provided oral and written informed consent. All study visits and data collection were conducted at Copenhagen University Hospital – Amager and Hvidovre.

Data collection

Data were collected at baseline, week 24, and week 48, including body weight, body composition (assessed by dual-energy X-ray absorptiometry [DEXA]), and fat distribution (analyzed via visceral adipose tissue [VAT] and subcutaneous adipose tissue [SAT] via low-dose computed tomography [CT]). Liver fibrosis and fat infiltration were evaluated via liver elastography, whereas coronary artery calcium (CAC) was assessed via CT. Blood tests were used to measure metabolic and cardiac parameters, with plasma HIV-RNA and CD4 cell counts taken at each visit and at week four for participants on DTG/3TC. The participants fasted for at least 6 h before the visits. To reduce cumulative X-ray exposure, individuals who had a CT scan within the past decade were not offered a non-enhanced cardiac CT scan. Owing to a radiographer strike, some participants missed baseline or follow-up cardiac CT scans. Additional details on data collection are available in the study protocol [10]. DEXA technicians and CT reviewers were blinded to the treatment allocation.

Intervention

Participants were randomized to either switch treatment to coformulated DTG 50 mg and 3TC 300 mg daily (Dovato, intervention arm) or to the control arm continuing treatment with coformulated DTG 50 mg, ABC 600 mg, and 3TC 300 mg daily (Triumeq). Study treatment was dispensed at the study site at baseline and week 24 and administered by participants.

Adherence

Adherence was assessed by measurement of plasma HIV RNA at baseline, week four (for the DTG/3TC group exclusively), week 24, and week 48. Participants were withdrawn from study participation in cases of virological failure, which was defined as a plasma viral load > 50 copies/ml measured by two consecutive blood samples within 30 days.

Outcomes

The primary outcome was defined as the difference in change in body weight from baseline to week 48 between the two treatment arms. The secondary outcomes included differences in fat distribution, body composition, metabolic parameters, cardiac conditions, liver stiffness and liver steatosis. Details on the secondary outcomes are listed in the study protocol [10].

Sample size

The estimated weight change at 48 weeks was from 0 to −1 kg for the DTG/3TC arm, and + 2 kg for the DTG/ABC/3TC arm.

Based on a 2:1 randomization ratio between the intervention and control arm, a significance level (α) of 5%, a power (β) of 80%, a mean difference in weight of 2 kg (Δ), and a standard deviation of 2.7 kg, the estimated sample size was 64 participants (intervention arm n = 44 and control arm n = 20).

To account for a 5% withdrawal/dropout, the total sample size was set at 70 participants.

Randomization

The participants were randomized after informed consent was obtained by one of two investigators. Randomization was performed electronically in REDCap by study personnel. The participants and the study personnel were unblinded to the randomization. The randomization list was generated by a statistician via block randomization with an allocation of 2:1 (intervention: control) stratified by study center and sex. The blocks had a uniform distribution for all combinations of three to six.

Statistical methods

Baseline characteristics are presented as mean with standard deviation (SD) and were compared by treatment arm via unpaired t tests for normally distributed continuous variables. Skewed variables are shown as median with interquartile range (IQRs) and were compared by the Mann‒Whitney U test. Categorical variables are presented as frequencies and percentages and were analyzed by chi-square tests.

The primary outcome was assessed in the intention-to-treat (ITT) and modified ITT/complete case (CC) populations. The ITT analysis included all randomized participants, regardless of adherence, accounting for those lost to follow-up, those who dropped out, or those who withdrew consent. The modified ITT/CC analysis focused on complete cases adhering to the protocol.

To analyze repeated measurements, a linear mixed model was employed, comparing changes in weight across treatment arms from baseline to week 24 and week 48, assuming a linear relationship over time. Missing data in the ITT analysis were treated as “missing at random” (MAR) and addressed with multiple imputation. The secondary continuous outcomes were analyzed similarly. Within-treatment arm changes were compared from baseline to week 48 via paired t tests or Mann‒Whitney U tests for continuous variables and McNemar tests for categorical paired data. No interim analysis was conducted.

Software

The data were entered and stored in a REDCap database. Data handling and statistical analyses were performed via RStudio 2022.12.0 Build 353.

’Tis the season for tighter budgets.

Holiday spending in the U.S. is expected to fall 5% this year, driven largely by Gen Z’s sharp 23% pullback, according to a survey from a leading consulting and accounting firm.

Households plan to be more deliberate in their spending over the holidays, prioritizing value and deciding what to splurge on and where to scale back, says PwC’s 2025 Holiday Outlook, which was released Wednesday.

The decline in planned spending underscores how economic uncertainty is affecting consumer sentiment heading into the most important retail season of the year.

Gen Z’s outlook this year is a stark reversal from 2024, when their projected holiday budgets surged 37%. (Their actual holiday spending rose a more modest 6%, according to PwC’s analysis of credit and debit card panel data.) PwC’s new survey found that 25% of Gen Z say their financial situation is worse than it was last year, compared with 17% who said the same in 2024.

Inflation, job insecurity and new financial responsibilities are driving Gen Z to rein in spending, said Ali Furman, consumer markets industry leader at PwC. Many young adults are navigating major life transitions amid a tough job market for recent graduates, often without much savings. “It’s a coming of age story for this generation,” with some buying homes and starting families for the first time, forcing them to budget more carefully, Furman said.

Millennials and Gen Xers are keeping their holiday budgets roughly the same as last year, the survey found. Baby boomers are the only generation projecting an increase, with average spending up 5%.

Anzhelika Parenchuk, a 23-year-old first-year doctoral student at George Washington University, said she’s approaching the holidays with a tighter budget and turning more to discount retailers like Dollar Tree and Five Below for gifts.

“They have the same things as other retail stores, but cheaper,” she said.

Parenchuk said she learned her lesson after overspending last year. Now, without income from her former job since starting graduate school, she said she is stricter with her budget. Inflation has forced her to buy fewer things, and news about tariffs has her worried prices could climb even higher, she said.

Gen Z’s tighter holiday budgets are also driven by spending habits that prioritize splurging on experiences while seeking affordability elsewhere, curbing their appetite for lavish holiday shopping, PwC’s Furman said.

Gen Z is reluctant to cut back on concerts and events, even as ticket prices surge. A recent survey from the marketing agency Merge found that 86% of young adults admit to overspending on events. “Those experiences are taking up a lot more of their wallet share,” Furman said, “so they have less money to spend on holiday than they have in the past.”

Teens and young adults, shaped by an era of constant price increases, are drawn to value and embrace “dupe” culture, seeking cheaper alternatives to brand names, which allow them to stretch their budgets. Even for high-status items, Gen Z prefers them at a reasonable price, a concept that Furman called “affordable exclusivity.” She pointed to Labubus as a prime example of this phenomenon.

These value-oriented spending patterns reflect a larger trend across the economy. Retailers catering to budget-conscious consumers have been among the winners this past earnings season, with Dollar General, Five Below, TJ Maxx and Walmart reporting better than expected sales. On the other hand, companies that target middle- to higher-income shoppers, such as Target, have struggled.

A recent survey conducted by the digital coupon company RetailMeNot also found that shoppers plan to spend less this holiday season, with average budgets down 15%. Rising prices topped respondents’ concerns, and many said they would switch to different brands or start shopping earlier if tariffs drive costs higher. Shoppers are “spending with purpose, planning ahead, and saying yes to the right deals, just not all the deals,” said Stephanie Carls, retail insights expert at RetailMeNot.

The pressure on consumers could become even stronger in the coming months, which is probably bad news for someone like Parenchuk, who said rising prices have weighed on her shopping experience.

“It’s depressing,” she said, noting that what used to cost $10 now feels closer to $20, and she’s had to buy fewer items. She said she is trying to manage stress by setting stricter budgets.

“Get cash, and once you’re out, you’re out,” Parenchuk said, “just be more strict with myself for my own good.”

(Bloomberg) — The fraternity of corporate chiefs ousted over an office romance just added a new member.

Nestlé SA CEO Laurent Freixe lost his job this week after an investigation found he had had an undisclosed romantic relationship with a subordinate. Freixe is not alone. Whether it’s exposed via social media or by a whistleblower, C-Suite dalliances continue to cause turmoil atop some of the world’s biggest companies, raising the question of whether internal corporate alarm systems are working — or not.

Astronomer CEO Andy Byron lost his job in July, after being caught in a clinch on a stadium ‘kiss cam’ with the technology firm’s chief people officer at a Coldplay concert. That followed the exit of Kohl’s Corp. CEO Ashley Buchanan in May, after the board determined that he had directed millions of dollars of business to a vendor with whom he had an undisclosed romantic relationship.

“It confounds me that in 2025 they think they can get away with this,” said Kabrina Chang, who teaches courses on business ethics and law at Boston University’s Questrom School of Business. “I always wonder if they feel untouchable on some level? Like, I won’t get caught, or the rules don’t apply to me?”

CEOs behaving badly is hardly a new trope, but the #MeToo movement — which led to the exit of Les Moonves of CBS and others — put boards under greater pressure to show they investigate any complaints thoroughly. Even consensual relationships can cause problems, particularly when a manager gets involved with a subordinate. More than two-thirds of HR professionals see the perception of favoritism or unfair treatment as their top concern regarding workplace romance, according to the Society for Human Resource Management’s 2025 report.

Companies can’t wipe out office relationships entirely — after all, many of us meet our future spouses at work and more than half of US employees have dated coworkers, SHRM found — but they do have a duty to keep their workplaces safe and fair. When the CEO is involved, the “risk skyrockets,” according to Andy Challenger, CEO of outplacement and coaching firm Challenger, Gray & Christmas.

“Office dating isn’t suddenly more common,” said Roxanne Bras Petraeus, CEO of Ethena, a workplace compliance-training platform. “What’s new is employees are asking sharper questions about boundaries.” Ethena, which runs some employee hotlines, has seen a sharp rise recently in employee questions about workplace romances. Policies around workplace relationships vary, with only about a third of workers saying their employers demand disclosure, according to a separate SHRM survey.

In Nestlé’s case, the relationship was first brought to company officials’ attention through an internal system called “speak up,” according to a person familiar with the situation. After an initial probe couldn’t substantiate the tip, further concerns were raised via the internal system and the investigation with external counsel was launched, according to the person familiar with the situation, who asked not to be identified discussing an internal matter.

Such hotlines where employees can anonymously report issues are common at big employers, with 93% of organizations having one, according to a survey of 284 employers by HR Acuity, a hotline provider. The 2002 Sarbanes-Oxley Act required public companies to establish procedures for employees to report potential securities violations, and employees can also use those to report inappropriate behavior.

Once a report is submitted, it typically goes to HR or compliance for investigation. But those probes are not always thorough: Just over half of firms said they use a “required, structured” process, HR Acuity found, while 38% simply follow “suggested” guidelines and 4% just wing it.

“It’s hard to tell how effective they are,” said Laszlo Bock, the former HR chief at Google. “The investigations can be quite deep or shallow, depending on the level of detail the complainant provides.”

And while anonymity encourages more employees to come forward, it can also make it more difficult for the HR department to substantiate claims and confirm details, the HR Acuity report found.

“Hotlines only work if they’re anonymous and backed by a culture that protects reporters,” Petraeus said, citing a report that found only half of employees actually reported misconduct after witnessing it, with many citing fear of retaliation.

For boards, a boss’s lack of transparency, and not his libido, is often the deciding factor. At BP Plc, where CEO Bernard Looney resigned in 2023 after the oil group’s board reviewed allegations relating to Looney’s past personal relationships in 2022, it later emerged that Looney hadn’t been fully transparent with the previous investigation. He was sacked only after further allegations were received — leading to another investigation.

Looney was also accused of promoting women with whom he had had undisclosed past relationships, according to the Financial Times. “Mr Looney knowingly misled the board,” the company said in a statement at the time.

“Boards are often in a tough situation when these sorts of lapses occur, especially if the company is otherwise doing well and the ethics policy leaves some room for interpretation,” said Eric Talley, Stern Professor of Law and Business at Columbia University.

A study of 219 examples of management misdeeds from 1978 to 2012 found nearly half of the instances were reports of sexual indiscretions, ranging from accusations of sexual harassment to an inappropriate relationship with a subordinate. The average executive charged with an indiscretion was 52 years old, and 96% were male.

When the CEO was implicated, the fallout cost shareholders $226 million, the study found.

“By the time a company’s ethical problems are apparent in the boardroom, they have resulted in a dramatic loss of shareholder value,” the study said. “The collateral damage goes further: at least some shareholders seem to hold board members responsible for indiscretions associated with the firm’s executives.”

That was the case at McDonald’s Corp., whose former boss Steve Easterbrook was ousted in 2019 after having sexual relationships with subordinates. He was later fined by the Securities and Exchange Commission for not fully disclosing violations of company policy leading up to his termination.

Shareholders criticized former McDonald’s chairman Rick Hernandez and other board members for paying Easterbrook severance. The company sued to claw some compensation back after concluding it had been misled about the extent of Easterbrook’s misbehavior.

In 2024, Norfolk Southern Corp. Chief Executive Officer Alan Shaw was ousted after having a relationship with the company’s chief legal officer, while Intel Corp. boss Brian Krzanich was fired in 2018 after allegations he failed to disclose a past relationship with an employee.

Still, CEOs rarely lose their jobs for bad behavior, according to data from Exechange.com, which tracks CEO departures at big US companies. Since 2017, when exechange.com began tracking the data, fewer than 2% of 2,542 CEO exits were because of misconduct allegations.

The departure of Freixe marks the eighth unexpected exit of a CEO in the European consumer sector since last September, according to RBC, beginning with Freixe’s appointment to replace former Nestlé boss Mark Schneider.

“When he took over as CEO just over a year ago following Mark Schneider’s ejection from the role, we thought of him as a Nestlé lifer who would restore the company’s reputation of slightly boring predictability,” wrote RBC Europe analyst James Edwardes Jones in a note. “How wrong we were.”

©2025 Bloomberg L.P.

In 2011, Joey La Neve DeFrancesco had been working in room service at a luxury hotel in Providence, Rhode Island, for nearly four years, whisking delicacies on demand to guests’ rooms, when he reached breaking point. He was paid a measly $5.50 (£4) an hour, made to work punishingly long shifts and, to top it off, had managers taking a cut of his hard-earned tips.

The poor treatment ratcheted up after DeFrancesco and colleagues tried to unionise workers at the hotel. In response, managers would berate those involved for making tiny mistakes. Things got so petty that workers on shift who had to take calls from guests were banned from sitting down.

DeFrancesco decided to call it quits. On the day he finally bid farewell, he snuck into the hotel’s employee quarters with a seven-strong marching band and surprised his boss with a musical ambush. “I’m here to tell you that I’m quitting,” he said, before walking out to the triumphant soundtrack of his band in full swing and chanting “Joey quits”.

DeFrancesco, who was 22 years old at the time, hastily organised a friend to film the encounter. After sitting on the video for a few days, he uploaded it to YouTube where it quickly went viral. Thirteen years on, the video has amassed nearly 10m views.

“We really didn’t think it was going to get much attention,” says DeFrancesco. The 36-year-old labour organiser and musician, who lives in New York, says he felt “liberated” after he quit and turned the tables on his managers. “Now I’m going to embarrass you for treating everyone terribly here,” he says.

Did leaving in a viral blaze of glory hamper his ability to get another job? Not in the slightest. Soon after leaving, DeFrancesco began working in a museum. He says the incident has “honestly never come up” in job interviews since. In fact, he says it might be something to “put on the résumé”.

While DeFrancesco’s tale holds a strong position in the job resignation hall of fame, it faces increasing competition from a new generation of workers leaving their jobs with viral aplomb. The phenomenon of revenge quitting, where frustrated or unhappy employees show how they really feel about their workplaces, is on the rise. Even clergymen are not immune to such temptations: in July, Father Pat Brennan provided a “parting gift” to his congregation in the form of a poem that doubled up as a resignation letter, where he took aim at “disgruntled, unlikable” parishioners who spread “gossip” from their “holy lips”.

The employer-rating site Glassdoor warned late last year that “a wave of revenge quitting [is] on the horizon” in 2025 amid falling employee satisfaction. In the UK, a survey of 2,008 workers released in July by the recruitment company Reed found that 15% of British employees had revenge quit their jobs. The firm’s chair, James Reed reckons that social media was accelerating the trend after a flurry of revenge quitters shared their stories online. Brianna Slaughter was one of them, with their video ending with the rallying cry: “These corporations will fire you in one day and leave you with nothing. If you want to leave, leave babe.”

The 26-year-old American, who lives in Kyoto, Japan, was two hours away from teaching their next English class when they quit on the spot. For a while, things had been manageable, but everything changed with the arrival of a meddling new manager. “If I finished a lesson one minute early or one minute late, she would reprimand me,” Slaughter says.

When Slaughter started the job, they had plenty of free time and their colleagues were mostly “chill”, but the cracks soon began to appear. They were paid 2,000 yen (£10) per class, instead of an hourly wage, which meant having to stick around unpaid for hours between classes for a paltry paycheck. Schedules weren’t handed out until the day before, making planning almost impossible. And the job was sedentary, which took a toll. “I went to the doctor and they said, because you’re sitting all the time, you have inflammation in your neck,” Slaughter says.

Slaughter’s breaking point came with the arrival of the new manager. She told Slaughter to wear long-sleeved tops to hide their apparently “offensive tattoos” and often sat in on classes, which, they say, made everyone feel “awkward”. It got to a point where Slaughter was crying every night. Last May, after receiving a measly paycheck of 100,000 yen (£500) for a month of “hardcore classroom teaching”, enough was enough.

Slaughter sent a resignation letter to a higher-up, who “begged” them to stay, before swiftly reminding them of the two-month notice period. In their TikTok video, which has 1.2m views, Slaughter says they told their manager: “Two months? You’re lucky if I give you fucking two weeks. I gave you two hours, babe. I’m leaving now.”

Far from stalling their career, their tale going viral opened up new possibilities. “I made $7,000 on TikTok the month I quit,” says Slaughter, who has since made a living as a content creator, advising people interested in moving to Japan. Some even got in touch and said the video inspired them to say goodbye to their own toxic workplaces. “They said: I think I’m going to quit my job too. This was my sign.” For those still on the fence, Slaughter says: “You should have left yesterday.”

Young people are more likely to revenge quit. Reed said 26% of 18- to 34-year-olds and 22% of 35- to 44-year-olds in the UK admitted to doing it, compared with just 8% of people aged 45 to 54. In June, a survey by business research group the Conference Room found a 15% gap in job satisfaction between the youngest and oldest workers in the US, with 57% of under-25s saying they were satisfied with their jobs, compared with 72% of over-55s.

Four years ago, 25-year-old Carly, who lives in Alabama, US, was unemployed, “kind of broke and willing to take anything”. After contacting a temp agency, she was quickly offered a job as a receptionist, based on her CV alone, and she was asked to start the next day. “That was the first sign that this might not be the best place to work but I was desperate, so I took it,” she says.

The first three months were “fine” and she got a promotion to HR payroll manager, but things soon went south. A new colleague, who was related to the bosses, started badmouthing her and spread a false rumour that she was an alcoholic because she used a lamp in her office instead of the overhead light. “I just like ambience,” says Carly.

She was soon given an additional role on top of her current one: accounts payable manager. “It was just too much for one 21-year-old to manage by herself,” she says. The firm briefly hired a man (who was paid $10 an hour more than her) to take over her role as HR payroll manager but he was swiftly fired after messing up the company’s paychecks. She was forced back into doing both roles again.

“I was constantly stressed, upset, and crying,” she says. Things came to a head when Carly’s problem colleague called for her to attend a manager-wide meeting so he could “air out his frustrations” with her. “It was a ridiculous request,” she says. “He basically wanted to bully me in front of everyone.” She agreed to the meeting but, little did they know, she had other plans.

On the morning of the meeting, Carly woke up early, drove to the office and scheduled an email to all the managers “letting them know how fucked up their business was,” she says. It began fairly graciously. “I have decided that it is time to move on to a different venture,” it said, but soon ramped up. She took aim at her short-lived replacement, calling him “literally dumb as a rock” and said her heavy workload led to “daily stress that often built up into anxiety attacks and tearful nights”. Signing off, it said: “My laptop and keys are on my desk.”

After the email was sent, her boss tried to call her. She didn’t pick up the phone. “I never heard from them again,” she says. After Carly left the office for the final time, she felt euphoric. “I could have stripped my clothes off and run naked all the way home. The anxiety and stress I had been feeling all vanished,” she says.

She secured another job shortly afterwards, but she has some concerns about applying for future work. “If they ask, I’ll just be honest and say, if you treat me good, I will not do that to you,” she says.

While most people revenge quit to stick the middle finger to their bad bosses, warning off prospective new employees can also be a motivation. Katie Ostler had been working in a supermarket in Melbourne, Australia for two years when the time came to call it quits. She had started doing the job at 16 years old. “It was a really toxic, high-paced work environment and there was a lot of turnover,” she says.

Ostler, who is now 29, and lives in Manchester, UK, said her bosses had not bothered to learn her name for the first six months. “It wasn’t a great place to be but I just kind of kept my head down and did what I needed to do,” she says.

As she approached 18, a whole new set of job opportunities were opening up, specifically bar work. She was already handing her CV out to local pubs when an incident at the supermarket tipped her over the edge. One day, a customer began shouting at one of Ostler’s 15-year-old colleagues over a refund. Instead of backing up the young female employee, their manager took the side of the customer and joined in on the yelling. “I thought it was a good time to go,” she says.

Soon after, she was offered a job behind a bar and went to the supermarket to hand in her resignation with the one-week obligatory notice. She tried to give the letter to a supervisor, who said it needed to be handed directly to her manager. Ostler asked where he was, but was told that he was in the middle of an interview. They let slip where it was being held. She barged into the interview, handed her manager the letter and said aloud: “Don’t work here – here’s my resignation.” The room went silent and the interviewee gave her a confused expression. “It took a lot of bravery. I walked out before [my manager] could say anything,” she says.

It wasn’t the last she heard from him. She was on her way to start her new job when he called her and told her not to finish her final week because he “didn’t want my toxic energy” around the team. “I remember thinking, have you looked in the mirror?” she says. She did have to nip back to the supermarket for some groceries a few times afterwards. “I avoided it when I could, but people would recognise me and say hello. Unfortunately, no one was cheering when I came in,” she says. Still, resigning had felt triumphant enough. “I felt like a boss. It was a very empowering moment.”