Outcomes in people with HIV who resume or switch to bictegravir/emtricitabine/tenofovir alafenamide following a treatment interruption

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OBJECTIVE: Treatment adherence remains critical in maintaining HIV RNA suppression on antiretroviral therapy. High genetic barrier regimens constructed with three long half-life agents may prevent resistance emergence and can be potentially started or restarted after antiretroviral treatment interruption. METHODS: Data from the TRIO US HIV cohort were used to identify adult people with HIV initiating a new ART regimen from January 2021 to November 2023 and describe prevalence of treatment interruptions (defined as ≥90 days without dispensed ART). Virologic outcomes were assessed among those restarting or switching to B/F/TAF after treatment interruption. RESULTS: Of 2710 people with HIV, 765 (28%) experienced treatment interruption. Compared to individuals without treatment interruptions, those with treatment interruptions had higher proportion of women (24 vs. 19%), Black race (50 vs. 35%), substance use (14 vs. 9%), CD4 + cell count less than 200 cells/mm 3 (15 vs. 8%) and lower proportion with commercial insurance (48 vs. 62%) or virologic suppression at initiation (76 vs. 85%). Among 379 who restarted or switched to B/F/TAF following treatment interruption, 245 (65%) were suppressed at restart; 137 (56%) had at least one viral load after treatment interruption, of whom 129 (94%) maintained suppression. Of 87 with unknown viral status at restart, 46 (53%) had at least one viral load during follow-up, of whom 44 (96%) achieved suppression. Among 47 viremic at restart, 27 (57%) had at least one viral load after treatment interruption. Of them, 70% were suppressed during follow-up. No integrase inhibitor resistance emergence was observed. CONCLUSION: High levels of suppression following treatment interruption may suggest B/F/TAF regimen forgiveness making it an appropriate choice for treatment switch or restart.

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