Efficacy and safety of switching to dolutegravir plus emtricitabine/tenofovir disoproxil fumarate (TDF) or elvitegravir/cobicistat/emtricitabine/TDF in virologically suppressed HIV-infected patients in clinical practice: results from a multicentre, observational study

Objectives: The aim of the study was to compare the efficacy and tolerability of switching antiretroviraltherapy to dolutegravir+emtricitabine/tenofovir disoproxil fumarate (TDF) with those of switchingto elvitegravir/cobicistat/emtricitabine/TDF in clinical practice.MethodsIn a multicentre real-life observational study, we analysed data for HIV-infected patients onantiretroviral treatment with viral load<50 HIV-1 RNA copies/mL switching to dolutegravir+emtricitabine/TDF (dolutegravir group) or elvitegravir/cobicistat/emtricitabine/TDF (elvitegravirgroup). Follow-up was censored at 48 weeks.Results: The 48-week estimated proportion maintaining virological efficacy was 96.1% with dolutegravir(n=123) and 95.4% with elvitegravir (n=186;P=0.941). Patients in the dolutegravir groupshowed more treatment discontinuations, but these were mainly as a result of simplification. Theelvitegravir group showed more discontinuations because of renal adverse events (2.7% versus 0%with dolutegravir). Interestingly, no difference was observed between the two regimens in centralnervous system toxicity-related discontinuations. Switching to dolutegravir was associated with abetter blood lipid profile. Conclusions: Switching to dolutegravir+emtricitabine/TDF was associated with similar efficacy and tolerabilityto switching to elvitegravir/cobicistat/emtricitabine/TDF in virologically suppressed patients inclinical practice, although reasons for discontinuation showed differences between regimens. Theseresults should be interpreted with caution, as this is a nonrandomized comparison.