# Two or Three? Clinical and Proteomic Perspectives on Dolutegravir/Lamivudine Versus Bictegravir/Emtricitabine/Tenofovir Alafenamide as Initial HIV Treatment

## TL;DR

This study compares two HIV treatment regimens and finds that both reduce inflammation over time, but with different immune effects based on patient profiles.

## Contribution

The study links clinical profiles with proteomic changes in HIV treatment regimens, revealing distinct immune trajectories.

## Key findings

- Patients on BIC/F/TAF had higher baseline inflammation and more advanced disease profiles.
- Both regimens reduced inflammation, but with distinct protein pathways and immune trajectories.
- Baseline viral load and CD4+ counts predicted proteomic changes, especially in the BIC/F/TAF group.

## Abstract

While triple-drug regimens (3DR) have long been the standard of care for HIV infection, two-drug regimens (2DR), particularly dolutegravir/lamivudine (DTG/3TC), have emerged as viable first-line options. However, there is limited understanding of how baseline clinical profiles associated with regimen choice relate to underlying inflammatory states and long-term immune trajectories.

We performed a retrospective observational study using data from the Spanish CoRIS cohort, including ART-naive individuals who initiated either DTG/3TC or bictegravir/emtricitabine/tenofovir alafenamide (BIC/F/TAF) between 2016 and 2023. We applied propensity score modeling to identify predictors of regimen choice. In a matched subset of participants with plasma samples at baseline and 24 months post-ART, we carried out longitudinal inflammatory profiling using the Olink Target 96 Inflammation panel. We then conducted differential expression and enrichment analyses and explored associations between clinical variables and proteomic changes over time.

Among 3145 participants (69.5% on BIC/F/TAF and 20.5% on DTG/3TC), those with higher baseline HIV-1 RNA and lower CD4+ T-cell counts were more likely to initiate BIC/F/TAF. In a matched subset (n = 174), 11 proteins were significantly overexpressed at baseline in the BIC/F/TAF group, suggesting a heightened inflammatory state. Both regimens led to significant downregulation of inflammatory markers over 2 years, though each displayed distinct proteins and functional pathways. Baseline viral load and CD4+ counts correlated with specific proteomic profiles and predicted longitudinal changes, particularly in the BIC/F/TAF group.

Regimen selection was associated with baseline disease severity and inflammatory burden. Despite being used in patients with more advanced profiles, BIC/F/TAF effectively reduced systemic inflammation over 2 years. Both regimens attenuated inflammatory activity, though with distinct trajectories that may carry implications for immune recovery and long-term outcomes.