TOPLINE: 

In a European cohort of patients with late‑diagnosed HIV infection, starting first-line therapy with either dolutegravir-lamivudine (DTG/3TC) or bictegravir-tenofovir alafenamide-emtricitabine (BIC/TAF/FTC) resulted in similar 48‑week virologic suppression and treatment discontinuation rates.

METHODOLOGY:

• Researchers conducted a retrospective, multinational study across 15 European treatment centers to assess the efficacy and tolerability of DTG/3TC vs BIC/TAF/FTC as first‑line therapy in late-diagnosed, antiretroviral treatment‑naive patients with HIV infection from July 2019 to July 2023.
• They included patients with a CD4 cell count < 200/μL and/or an AIDS-defining condition, of whom 69 were on DTG/3TC and 190 were on BIC/TAF/FTC. The analysis was performed on propensity-matched pairs (n = 62; mean age, 40.8 years; 91.1% men).
• The primary endpoints were discontinuation rates of antiretroviral therapy at or before weeks 16 and 52, and the secondary endpoints were reasons for treatment discontinuation or switch, as well as CD4 changes at weeks 12 and 48 during follow‑up.

TAKEAWAY: 

• Viral suppression rates at week 48 were comparable between the groups, with 96.2% in the DTG/3TC group and 91.8% in the BIC/TAF/FTC group achieving an HIV-1 RNA concentration < 50 copies/mL (P = .244).
• No significant differences were observed in discontinuation rates at week 48 between the DTG/3TC and BIC/TAF/FTC groups (5.5% vs 9.4%; P = .301). Poor adherence was the most common reason for discontinuation in both groups.
• No significant differences were observed between the groups in mean CD4 cell counts and clinical outcomes after 48 weeks.  

IN PRACTICE:

“Given the growing emphasis on minimizing long-term toxicity, pill burden, and cost, our study helps to position [two-drug] DTG/3TC as a treatment strategy in late-diagnosed people living with HIV when appropriate selection criteria are met,” the authors wrote.

SOURCE:

The study was led by Gundolf Schuettfort, University Hospital Frankfurt, Germany. It was published online on October 7, 2025, in HIV Medicine.

LIMITATIONS: 

The sample size was small. Additionally, the study was potentially limited by prescribing bias related to sociodemographic factors, loss to follow‑up, and missing data inherent to its retrospective design. The number of participants with viral loads > 500,000 copies/mL was too low to allow a stratified analysis in this subgroup.

DISCLOSURES:

No funding information was reported. One author served as an investigator or subinvestigator in clinical trials and real-world studies for Gilead Sciences, GSK, MSD, Johnson & Johnson, and ViiV Healthcare. Several authors disclosed receiving honoraria, speaking fees, or travel grants for scientific conferences or having other financial ties with various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.