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TOPLINE
Among antiretroviral therapy (ART)-naive people with HIV and baseline viral loads ≥ 500,000 copies/mL, more than 90% achieved viral suppression at week 48 with dolutegravir/lamivudine (DTG/3TC). Suppression rates were not significantly different with bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF).
METHODOLOGY
- Researchers conducted a retrospective cohort study at a tertiary hospital in Spain to compare the effectiveness of DTG/3TC vs BIC/FTC/TAF at week 48 among ART-naive people with HIV-1 RNA ≥ 500,000 copies/mL and CD4+ counts ≥ 200 cells/mm³.
- The study included a total of 40 patients: 21 (median age, 31 years; 95.2% men) received DTG/3TC, while 19 (median age, 28 years; 94.7% men) received BIC/FTC/TAF between January 2019 and January 2024.
- The primary outcome was the cumulative probability of achieving virologic suppression (HIV-1 RNA < 50 copies/mL) by week 48.
- Secondary outcomes included virologic suppression among patients with primary HIV infection (PHI), CD4+ recovery, weight gain, lipid changes, and changes in serum creatinine.
TAKEAWAY
- At week 48, virologic suppression was achieved in 90.5% of patients receiving DTG/3TC and 94.7% of those receiving BIC/FTC/TAF, with no significant difference between groups.
- Among patients with PHI, virologic suppression at week 48 was achieved by 87.5% of those receiving DTG/3TC and 93.9% of those receiving BIC/FTC/TAF, with no significant difference between groups.
- In patients with baseline viral loads above 1 million copies/mL, there was no significant difference in virologic suppression rates between the DTG/3TC and BIC/FTC/TAF groups.
- No significant differences were observed in CD4+ recovery, weight gain, serum creatinine, or lipid profile changes between groups.
IN PRACTICE
"In ART-naive PWH [people with HIV] with HIV-RNA ≥ 500,000 copies/mL and CD4+ ≥ 200/mm³, including those with PHI, DTG/3TC and BIC/FTC/TAF showed similar effectiveness and comparable safety profiles at week 48," the authors wrote.
SOURCE
The study was led by Juan Martin-Torres of University Hospital 12 de Octubre in Madrid, Spain. It was published online on August 21, 2026, in the Journal of Antimicrobial Chemotherapy.
LIMITATIONS
The study was limited by its retrospective observational design, small sample size, and single-center setting, which may have limited generalizability. The study also excluded patients with CD4+ counts < 200 cells/mm³, so findings may not apply to this subgroup.
DISCLOSURES
The study was conducted as part of the authors' routine work and received no specific funding. Several authors reported fees, grants, or other support from Gilead Sciences, ViiV Healthcare, Janssen, and MSD; other authors reported no relevant conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
