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PLWH: Decreasing Antiretroviral Regimens in an Aging Population

Investigators wanted to look at real world experiences with combination therapy in older people living with HIV.

As people living with HIV (PLWH) age, there is a move to have them taking less antiretrovirals, and ones with fewer drug-drug interactions (DDIs), and long-term side effects.

Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) is an example of one antiretroviral that is a combination therapy looking at this population.

Past clinical trials of B/F/TAF demonstrated favorable efficacy and safety in older adults, however, data from real-world experience are needed to validate results.

As such, investigators did a retrospective analysis evaluating medical records from PLWH aged ≥ 50 years who had switched their regimen to B/F/TAF between 2/7/2018 and 5/31/2019.

The study included 306 PLWH and they identified the primary endpoint as maintaining HIV-1 RNA< 50 copies/mL at week 48. They also wanted to see if there was any impact of switching regimens to B/F/TAF on DDIs, if there were any adverse events, and safety parameters.

“At Week 48, 287 (94%) participants maintained an HIV-1 RNA< 50 copies/ml and 19 (6%) had an HIV-1 RNA between 50-200 copies/mL (Figure 1). 1 patient discontinued due to lack of efficacy,” the investigators reported. A total of 123 potential DDIs were identified in 104 (34%) patients taking a boosting agent or rilpivirine at baseline.”

In terms of ancillary benefits, there was a significant median decline in total cholesterol (15.5 mg/dL, 95% confidence interval [CI]: 9.5; 21.5), LDL cholesterol (9.5 mg/dL, 95% CI: 4; 15.5) and triglycerides (20 mg/dL, 95% CI: 9.5; 32.5). Participants median weight increased by 2.5 pounds (95% CI: 1.5; 3.5). AEs occurred in 33 (11%) patients (all Grade 1-2) and led to 7 (2%) discontinuations.

“In this real-world cohort, switching to B/F/TAF was associated with maintenance of virologic control, improvement in lipid parameters, and avoidance of DDIs in a large proportion of patients,” investigators concluded. “These data support use of B/F/TAF as a treatment option in older PLWH.”

The study, “Efficacy, safety and tolerability of switching to bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in HIV-1 infected virologically-suppressed older adults in a real-world setting,” was presented virtually at ID Week 2020.