The Evolving Landscape of HIV Therapy

Modern antiretroviral therapy (ART) focuses on long-term safety and ease of use. Consequently, many clinicians consider an HIV treatment switch INSTI strategy for virologically suppressed patients. Second-generation integrase strand transfer inhibitors (INSTIs), such as bictegravir (BIC) and dolutegravir (DTG), have become the gold standard. A recent study from the ANRS-CO3-AquiVIH-NA cohort provides valuable real-world evidence. This research highlights how these regimens perform in aging populations with significant health burdens.

Efficacy of an HIV Treatment Switch INSTI Strategy

The cohort included 2,275 people living with HIV (PLHIV) who switched to BIC- or DTG-based regimens. Notably, all treatment groups maintained exceptional viral suppression. At month 18, suppression rates reached 97% for B/F/TAF and 95-97% for various DTG combinations. These findings reinforce that switching to second-generation INSTIs is an effective strategy. Furthermore, these results align with clinical trials, proving reliability in daily clinical practice.

Comparing Treatment Persistence

While effectiveness remained high, treatment persistence varied between specific regimens. Persistence was similar for B/F/TAF, DTG/RPV, and DTG/3TC. However, patients on DTG/3TC/ABC showed significantly lower persistence. Discontinuation in this group reached 37.5%, often driven by adverse events. In contrast, other regimens saw discontinuation rates around 16-17%. Therefore, the choice of the companion drug remains a critical factor for long-term adherence.

Managing Comorbidities in an Aging Population

The study specifically addressed the high prevalence of comorbidities among middle-aged and elderly PLHIV. Around 71% to 75% of participants lived with at least one chronic condition. Specifically, hypertension affected over 57% of the cohort. Additionally, diabetes and chronic kidney disease were prevalent in nearly 20% of patients. These figures highlight the importance of holistic HIV care. Clinicians must adapt ART to meet the specific needs of patients with multiple health issues.

FAQs

Which INSTI regimen showed the highest persistence?

B/F/TAF, DTG/RPV, and DTG/3TC showed similar high persistence rates. Conversely, the DTG/3TC/ABC regimen had a significantly higher discontinuation rate due to adverse effects.

What are the most common comorbidities in aging PLHIV?

Hypertension is the most common condition, followed by diabetes and chronic kidney disease. This study emphasizes that clinicians must monitor these conditions closely when managing long-term HIV therapy.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or a professional relationship. Refer to the latest local and national guidelines for clinical practice.

References

1. Leleux O et al. Real-world use of second-generation integrase strand transfer inhibitors (INSTI) as switch therapy in the prospective ANRS-CO3-AquiVIH-NA cohort. HIV Med. 2026 Mar 07. doi: 10.1111/hiv.70220. PMID: 41795213.

2. National AIDS Control Organization (NACO). National Guidelines for HIV Care and Treatment. Ministry of Health and Family Welfare, Government of India. 2021.

3. World Health Organization. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. 2024 update.