| Description: |
Background While the long-term efficacy and durability of dolutegravir-lamivudine (DTG-3TC) are well established, the risk of viral blip (VB) and virological failure (VF) in real-life settings remains to be fully assessed. This study compared VB and VF rates in people living with HIV (PLWH) receiving DTG-3TC versus bictegravir/emtricitabine/tenofovir alafenamide (B-F-TAF) and analyzed therapeutic decisions following VB in a large monocentric cohort from northern Italy. Methods This retrospective monocentric cohort study included PLWH diagnosed after 2009 and treated with DTG-3TC or B-F-TAF. VB was defined as a transient HIV RNA >50 and 1000 cp/mL or two consecutive HIV RNA >50 cp/mL. VB and VF risks were analyzed using Cox and GEE models, adjusting for sex, age, CD4+/CD8+ ratio, and number of previous regimens. We also assessed whether VB led to therapy modification. Results Among 1261 participants, 550 (43.6%) received DTG-3TC and 711 (56.4%) B-F-TAF (population characteristics are described in Table 1). The GEE model showed a lower crude VB risk with DTG-3TC (OR 0.46, 95%CI 0.25–0.83, P = 0.010), but after adjustment, this difference was no longer significant (OR 0.50, 95%CI 0.24–1.07, P = 0.075). No significant VF risk difference was found between regimens (OR 0.39, 95%CI 0.10–1.49, P = 0.2). The Cox model revealed that a higher CD4+/CD8+ ratio was associated with reduced VB (HR 0.40, 95%CI 0.21–0.76, P = 0.005) and VF (HR 0.27, 95%CI 0.08–0.89, P = 0.031) risk, independent of treatment. Following VB, therapy was modified in 6 (14%) DTG-3TC and 7 (6.7%) B-F-TAF recipients, with no significant difference (OR 0.43, 95%CI 0.13–1.43, P = 0.2). Conclusions A lower crude VB risk was observed with DTG-3TC, but this difference disappeared after adjustment. No significant VF risk difference was found between regimens. Additionally, it appears that ARV switching following a blip did not occur more frequently in ... |