Lipids and Body Mass Index in Antiretroviral-Experienced People With HIV on Doravirine-Based Treatments: A Comparison Between Dual or Triple Regimen Versus Bictegravir-Based Triple Regimen

Objective: To evaluate the lipid profile and body mass index (BMI) in antiretroviral-experienced people living with HIV (PLWH) starting therapy with two doravirine (DOR)-based regimens (dolutegravir (DTG)/DOR or lamivudine (3TC)/tenofovir disoproxil fumarate (TDF)/DOR). Methods: Data from the Surveillance Cohort Long-Term Toxicity Antiretrovirals (SCOLTA) prospective database, including all experienced PLWH who started treatment with DTG/DOR and 3TC/TDF/DOR. To obtain a comparable sample, subjects on emtricitabine (FTC)/tenofovir alafenamide (TAF)/bictegravir (BIC) were matched 1:1 (by sex, age (±1 year), at least one between dyslipidemia and statin use) with those on 3TC/TDF/DOR. Results: Among 355 PLWH on viral suppression, the median age was 53 years; men represented 74.9% of the sample. At baseline, 147 people treated with FTC/TAF/BIC had a better lipid profile and lower CD4 cell count than 147 people treated with 3TC/TDF/DOR; diabetes was less frequent in the latter group. After 6 and 12 months, the BMI did not significantly change in any of the groups. Total cholesterol (TC) level significantly declined in PLWH on 3TC/TDF/DOR but not in FTC/TAF/BIC and remained unchanged in DTG/DOR. LDL-C showed a similar trend, with the most marked decline in the 3TC/TDF/DOR group and no difference in FTC/TAF/BIC. The TC/HDL-C ratio declined significantly in 3TC/TDF/DOR and DTG/DOR but not in FTC/TAF/BIC. Over the entire observation period (median 18 months, interquartile range 10–30), 43 (12.1%) PLWH interrupted the cohort drug, mainly because of adverse events (n = 15), with 12 lost to follow-up and 12 simplifications. Conclusions: The regimens were well tolerated in terms of lipid profile and BMI. Persons treated with 3TC/TDF/DOR triple regimen showed a better lipid profile, as expected, whereas those on DTG/DOR did not show any significant changes.