Patient Characteristics and Reasons for Switching to Bictegravir/Emtricitabine/Tenofovir Alafenamide: A Retrospective Cohort From a Large Urban HIV Clinic

TL;DR

This study examines why patients with HIV switched to a new drug regimen called B/F/TAF, finding that simplifying treatment was the main reason, influenced by a national policy.

Contribution

The study provides real-world insights into patient motivations for switching to B/F/TAF in a diverse HIV population, highlighting the impact of procurement policies.

Findings

Regimen simplification was the most common reason for switching to B/F/TAF.

The UK National Procurement Policy increased the number of patients switching to B/F/TAF.

Toxicity and virological failure were also significant reasons for switching.

Abstract

Introduction

Second-generation integrase strand transfer inhibitor (INSTI)-containing regimens have been preferred in almost all international guidelines for the treatment of human immunodeficiency virus-1 (HIV-1) since the early 2010s. This study aimed to determine patient characteristics and primary reasons for switching to a bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) regimen in a large, inner-city cohort of people living with HIV-1 in London, United Kingdom (UK), and to assess the impact of the 2022 UK National Procurement Policy on prescribing patterns.

Methods

A retrospective review of electronic patient records was conducted for all individuals on antiretroviral therapy (ART) who switched to B/F/TAF at the Royal Free Hospital, London, United Kingdom. Sociodemographic data, clinical markers including HIV-1 viral load, CD4+ T cell count, and previous ART regimen, and the documented reason for the switch were collected. Data were censored on 20 November 2022, allowing for a comparison of switch frequency before and after the implementation of the UK National Procurement for HIV Treatment and Prevention on 1 February 2022. Data collection was completed in the timeframe of 20 November 2022 till 30 June 2023.

Results

The cohort included 386 individuals who switched to B/F/TAF, of whom 74.1% were male, 25.9% were female, 56% were White, and 27% were African/Caribbean, with a median age of 58.5 years. Median duration of living with diagnosed HIV-1 and ART exposure prior to the switch were both 20 years. The most common reason for switching was regimen simplification (n=169, 43.8%), followed by toxicity (n=115, 29.8%); nearly 10% (n=38, 9.8%) switched due to virological failure. Number of switches increased from 74 in the observed period from April-November 2021 to 168 between April-November 2022 following the implementation of the National Procurement Policy.

Conclusions

The primary reason for switching to B/F/TAF was the desire for regimen simplification, a trend that appears to have been reinforced by the National Procurement Policy. However, toxicity, adherence issues, and virological failure were also key clinical motivations for switching. These findings highlight the role of B/F/TAF in ART optimisation for a diverse and treatment-experienced population of people living with HIV.

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