HIV Therapy Without Integrase Inhibitor: Practical Advantages and Targeted Patient Populations

Switch Study From Any Prior Antiretroviral Therapy

Key Themes:

• Broader Switch Strategy: A second companion study examined switching from any stable antiretroviral regimen to doravirine/islatravir.
• Noninferiority Results: The new combination demonstrated similar efficacy to continuing prior therapy with 90% to 95% virologic suppression.
• Resistance Analysis: Few cases of treatment failure were attributed to preexisting resistance mutations.
• Practical Considerations: Positioning of this nonnucleoside reverse transcriptase inhibitor–based combination in current treatment paradigms dominated by integrase inhibitors

Notable Insights From Dr Sharon Walmsley:

• Several virologic failures were detected, but analysis revealed these were due to preexisting mutations in patients who should not have been enrolled.
• The new combination offers an alternative to integrase inhibitor-based regimens, which currently dominate treatment guidelines.
• Clinicians will need to determine appropriate patient selection criteria, with potential advantages for those with integrase inhibitor resistance or intolerance.
• More adverse events were reported when switching to the new combination vs staying on established therapy, which is expected with any regimen change.