Opinion|Videos|May 9, 2025
Phase 3 HIV Treatment Switch Studies: Key Findings From Recent Clinical Trials
Author(s)Sharon Walmsley, CM, MD, FRCPC
A panelist discusses how a new drug combination of doravirine and islatravir was compared to a standard bictegravir-based therapy in patients with HIV, showing noninferiority with over 90% of patients maintaining viral suppression without excess toxicity.
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New Drug Combination - Doravirine and Islatravir
Key Themes:
- Novel Combination Therapy: A late-breaker study presented at the Conference on Retroviruses and Opportunistic Infections showed noninferiority of doravirine (nonnucleoside reverse transcriptase inhibitor [NNRTI]) plus islatravir (nucleoside reverse transcriptase translocation inhibitor [NRTTI]) compared with a standard bictegravir-based regimen.
- Patient Selection Criteria: The study enrolled patients suppressed for at least 3 months on bictegravir with T-cell counts greater than 50 and no prior virologic failure.
- Safety Monitoring: Special attention was given to effects on CD4 counts and lymphocytes, as earlier studies with islatravir showed potential toxicity.
- Hepatitis B Considerations: The new combination lacks anti–hepatitis B virus (HBV) activity, requiring HBV screening before switching.
Notable Insights From Dr Sharon Walmsley:
- The doravirine/islatravir combination maintained viral suppression in more than 90% of patients over 144 weeks.
- No cases of treatment resistance were observed in participants experiencing virologic failure.
- Unlike in earlier studies, no evidence of lymphopenia or CD4 cell count reduction was observed with the islatravir component.
Only 2% to 3% of patients discontinued due to adverse events, indicating good tolerability.
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