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Background Data on the effectiveness and durability of B/F/TAF in people with HIV (PWH) switching from DTG-based two-drug oral regimens (2DR) are limited. We aimed to characterize treatment-experienced PWH switching from DTG-based 2DR to B/F/TAF and to evaluate virological, immunological, and metabolic outcomes.Methods OPTIMIZE-BIC (GS-IT-380-7670) is a retrospective analysis including PWH from the ICONA cohort who switched from DTG+3TC or DTG+RPV (single- or multi-tablet regimens) to B/F/TAF, between Jul-2019 and Apr-2025, regardless of HIV-RNA at switch. We included only PWH with ≥1 HIV-RNA measurement post-switch. Participants were stratified by HIV-RNA at switch: <50 copies/ml (uVL) or ≥50 copies/ml (dVL). The primary endpoint was virological suppression (HIV-RNA <50 copies/ml) at the last follow-up. Secondary endpoints included time to: -virological failure (VF, 2 consecutive HIV-RNA >50 or single >1000 copies/ml followed by ART-change) among uVL; -virological suppression (VS) among dVL; -treatment discontinuation (TD) for any reason and for toxicity. Changes in CD4 count, CD4/CD8 ratio, liver enzymes, and lipid profile were assessed. Kaplan–Meier methods and mixed linear regression models were used.Results Eighty-three PWH were included; median age 48 years (IQR 38–58), 69.9% male, and median ART exposure of 7.7 years (IQR 3.6–11.4). At switch, 47 (56.6%) were in the uVL group and 36 (43.4%) in the dVL group ( table 1). After a median follow-up of 1.4 years (IQR 0.6–2.6), overall 74/83 PWH (89.2%, 95%CI 80.4–94.9) had HIV-RNA <50 copies/mL at last observation.In the dVL group, 83.3% (95%CI 67.2–93.6) had HIV-RNA <50 cps/ml at last assessment. Median time to suppression was 3.5 months (95%CI 2.8–5.3), with 81.8% (95%CI 67.2–92.6) of PWH reaching VS by 1-year (figure 1A).In the uVL group, HIV-RNA was <50 cps/ml at last measurement in 93.6% (95%CI 82.5–98.7). Only 1 VF occurred with a probability of 3.1% at 1 year (95%CI 0.45–20.2, figure 1B).17 PWH discontinued B/F/TAF during follow-up. The cumulative probability of TD for any reason was 10.1% (95% CI 5.0–20.2, figure 1C) at 1 year, with no significant differences between dVL and uVL (p=0.498). Discontinuations were mainly driven by treatment simplification (n=7, 6.4%), lack of virological control (n=3, 3.6%) and toxicity (n=3, 3.6%). At 1 year the probability of TD for toxicity was 3.2% (95%CI 0.8-11.6, figure 1D).The CD4/CD8 ratio significantly increased in both groups. Among dVL, CD4 counts increased significantly at 12 months (figure 2). Liver enzymes and lipid parameters remained stable, with a modest increase in HDL cholesterol (figure 3).Conclusions In this real-world cohort, switching from DTG-based 2DR to B/F/TAF resulted in high rates of virological suppression, rapid viral control in viremic PWH, low virological failure, and good treatment durability, with favorable immunological trends and a neutral metabolic profile.Abstract OC68 Figure 1–3Abstract OC68 Table 1