Makinson A, Bani-Sadr F, Palich R, et al; DAT’AIDS Study Group. Switch to BIC/TAF/FTC or DTG + TDF/FTC in virologically suppressed PWH: outcomes in real-world setting with and without tenofovir resistance. Clin Inf Dis. 2026 Jan 9:ciaf726. doi:10.1093/cid/ciaf726.

DAT’AIDS investigators evaluated whether switching to BIC/TAF/FTC or DTG plus TDF/FTC in people with virologic suppression increased risk of virologic failure and whether this was influenced by tenofovir resistance. Participants included people suppressed on ART for over 12 months who had no history of DTG or BIC exposure: individuals were excluded if they had no available genotypes or known DTG or BIC resistance based on cumulative RNA and DNA resistance testing. People who transitioned to DTG-based dual therapy or paired DTG with backbones other than TXF plus XTC were censored. 1393 people who switched to the combinations of interest (“switchers”) were compared to 8434 “non-switchers”: switchers had a longer duration of ART, higher number of prior regimens, and higher proportion of M184V/I and possible or definite tenofovir resistance. There were 75 (5.4%) cases of virologic failure (primary outcome was defined as VL > 200 copies/mL) among switchers and 523 (6.2%) in non-switchers. Among VF cases in the switch group, 60 (80%) continued their combination and suppressed after a median of 1.4 months. Two people in the switch group with VF acquired DTG or BIC resistance. In logistic regression analyses, there was no association of switching to BIC/TAF/FTC or DTG plus TDF/FTC with VF (out to 60 months) and no association of tenofovir resistance with VF.

In this real-world analysis of treatment experienced people with HIV who switched to a second generation INSTI plus TXF/XTC backbone, 2-year rates of virologic failure remained low. Additionally, the presence of tenofovir resistance and/or M184V/I mutations was not associated with virologic failure after switch – providing further evidence to support the robustness of these combinations across diverse populations of people with HIV. Broad access to these well-tolerated and highly effective options remains vital to advance progress in HIV care.