Abstract

Objective: Although the tenofovir alafenamide/emtricitabine/bictegravir (TAF/FTC/BIC) regimen is recommended in national and international guidelines for changing treatment in treatment-experienced patients living with HIV (PLwHIV), there are limited real-life data reported in Türkiye. We aimed to evaluate the changes in virological and immunological indicators, renal functions, and lipid profiles in the follow-up of patients who switched to TAF/FTC/BIC.

Methods: The study included treatment-experienced PLwHIV aged 18 years or older who were followed at the infectious diseases outpatient clinic between January 2020 and December 2021. Follow-up parameters before and after switching to TAF/FTC/BIC were evaluated retrospectively.

Results: A total of 77 PLwHIV were included. Of those, 71 (92.2%) were male, and the median age was 42 years. The 24th and 48th week median HIV RNA values of patients whose viral loads were measured were 35 (27-77) copies/ml and 34 (24-49) copies/ml, respectively, after switching. We did not detected a significant difference in CD4⁺T lymphocyte count, CD4⁺ T lymphocyte percentage, and CD4⁺/CD8⁺ ratio when compared with pre-treatment values. Virological suppression was not maintained in 24.7% (n=19/77) of PLwHIV. While “incomplete virological response” was not detected in any patients, 2.6% (n=2/77) had virological rebound, 1.3% (n=1/77) were virological non-responders, 10.4% (n=8/77) had low-level viremia, and 20.8% (n=16/77) had virological blip. Glomerular filtration rate (GFR) (101 ml/min./1.73m² vs. 96 ml/min./1.73m², p=0.05) and total cholesterol level (199 mg/dl vs. 185 mg/dl, p=0.05) decreased at 48th week. In switching from tenofovir alafenamide/emtricitabine/elvitegravir/cobicistat (TAF/FTC/EVG/Cob) to TAF/FTC/BIC, significant decreases were detected in GFR (101 ml/min./1.73m² vs. 95 ml/min./1.73m², p=0.016) and total cholesterol levels (205 mg/dl vs. 182 mg/dl, p<0.001).

Conclusion: Even if virological suppression is achieved before switching, virological suppression may be impaired in patients after switching to TAF/FTC/BIC. Moreover, renal functions should be closely monitored due to the significant decrease in GFR, especially when switching from TAF/FTC/EVG/Cob to TAF/FTC/BIC.