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Background Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) is one of the most used and well-tolerated regimens. Nevertheless, a minority of people with HIV (PWH) discontinued treatment. We aimed to investigate the reasons for B/F/TAF discontinuation and the regimens to which PWH were subsequently switched.Methods Consecutive PWH enrolled in the SCOLTA project switching to or initiating their first antiretroviral treatment (ART) with B/F/TAF were included. PWH were followed up until treatment discontinuation and information about the following regimen was collected if possible.Results Of 1180 enrolled PWH, 1004 had at least one follow-up visit and entered the analysis. Mean age was 48.0 years (standard deviation 12.6), 75.9% were male, and 27.9% were naïve (N) to antiretrovirals at T0 ( table 1). The median observation time was 28 months (interquartile range 14-42). During the follow-up, 211 PWH (21%) discontinued the treatment.The most frequent causes of B/F/TAF discontinuation were: simplification to dual therapy in 47 (22.3%) PWH, switch to long-acting treatment in 29 (13.7%), adverse events in 28 (13.2%), switch to other regimes due to drug-drug interactions in 17 (8.8%), death in 9 (4.3%), treatment failure in 6 (2.8%), patient’s preference in 2 (0.9%) and pregnancy in 2 (0.9%). Other reasons were listed in 14 PWH (6.6%, 9 changes of referring center and 5 enrollments to a trial) and 57 (27.0%) PWH were lost to follow-up (table 2).Eighty (37.0%) had no known subsequent regimen (9 PWH died, 14 changed center or started a trial, 57 were lost to follow-up). Of the 131 remaining, we had information on the following treatment in 102 (76.7%), of which 1 was suspended for 9 months. Fifty-six (55%) PWH switched to another INSTI-based regimen, while 29 (28%) to a long-acting treatment.Conclusions In our cohort, B/F/TAF confirmed its durability and safety with very few adverse events or treatment failures. In real-world practice, discontinuation of B/F/TAF was unrelated to toxicity or failure. Instead, it reflected proactive strategies, including switches to long-acting therapy or simplification to dual regimens driven by clinical decision-making.Abstract SC35 Table 1Characteristics of 1004 people with HIV (PWH) according to treatment status at last visitAbstract SC35 Table 2Post-discontinuation regimens and csuses of discontinustion