For older individuals living with HIV who are virologically suppressed, two-drug dolutegravir/lamivudine (DTG/3TC) and three-drug bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) led to long-term viral suppression without drug resistance, according to a retrospective study presented as a poster at IDWeek 2025.
Given that older persons living with HIV (PLHIV) tend to have more comorbidities and higher potential for polypharmacy and drug-drug interactions with antiretroviral therapy (ART), data on real-world effectiveness of multidrug combinations is critical in this population. For this study, the research team conducted a chart review of 1,144 individuals aged ≥50 years who were on ART, virologically suppressed for at least 24 weeks, and initiated either DTG/3TC (n = 593) or BIC/FTC/TAF (n = 551).
Of the individuals receiving DTG/3TC, 24.6% were older than 65 years, and 74.5% were taking a non-ART comedication. In the BIC/FTC/TAF group, 18.7% were >65 years old, and 69.7% were on a non-ART comedication. Prior virologic failure had occurred in 6.2% of participants in the DTG/3TC group and 7.7% of the BIC/FTC/TAF group.
Around one-quarter of patients had 240 weeks of follow-up. Total follow-up was 1,463.3 and 1,481.9 person-years in the DTG/3TC and BIC/FTC/TAF groups, respectively.
Overall, virologic failure occurred in 1 person in each treatment group, with an incidence rate of 0.07 (95% CI, 0.00-0.14) per 100 person-years. There were no cases of resistance.
“In older, virologically suppressed PLHIV with age-related comorbidities and comedications, switching to either two-drug DTG/3TC or three-drug BIC/FTC/TAF maintained long-term viral suppression
without resistance,” the authors concluded.
Reference
Fraysse J, Kuretski J, Letang E, et al. The Global REGAL cohort: A REtrospective real-world study of the effectiveness and tolerability of the antiretroviral treatment reGimens DTG/3TC compAred to BIC/FTC/TAF in older persons Living with HIV. P-357. Presented at: IDWeek 2025, Oct. 19-22, 2025, Atlanta, GA.
