BioScience Trends. 2026;20(2):205-216. (DOI: 10.5582/bst.2025.01335)

Comparative safety and efficacy of BIC/FTC/TAF versus DTG+3TC in antiretroviral treatment-naive patients with HIV as first-line regimens: A real-world cohort study

Sun L, Jiang Y, Isnard S, Chen J, Li Y, Wang H, Zhao F, Rao M, Jia X, Huang J, Wu J, Luo Y, Zhao D, Liu C, Li X, Routy JP, Liu J, He Y, Cen P, Lu H

While bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) and dolutegravir plus lamivudine (DTG+3TC) are first-line regimens for treatment-naive people with HIV (PWH), long-term real-world head-to-head comparisons of their metabolic and renal outcomes remain limited. We conducted a retrospective cohort study of ART-naive PWH initiating these regimens in China, utilizing 1:2 propensity score matching (PSM) to balance baseline covariates for 1,445 participants (901 BIC/FTC/TAF; 544 DTG+3TC). Over a 24-month follow-up, the study demonstrated comparable virologic suppression (99.7% vs. 100.0%; p = 0.623), weight changes, and cumulative incidence of metabolic abnormalities between the two groups. Conversely, although the crude 24-month incidence of eGFR decline was higher with DTG+3TC (54.8% vs. 40.7%; p = 0.039), adjusted Cox models revealed that the regimen was not independently associated with this decline (HR 1.20; 95% CI 0.97–1.48; p = 0.18).These findings indicate that both regimens offer comparable long-term virologic efficacy and metabolic safety profiles, supporting their routine clinical utility while highlighting the need for cautious interpretation of renal markers during integrase inhibitor-based therapy.

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