Metabolic impact of switching from EFV/TDF/FTC to two INSTI-Based regimens (B/F/TAF vs. DTG/3TC): a real-world study in virologically suppressed individuals
Year: 2026
Type: article
Study design: Observational Study
Abstract: Objective To compare metabolic outcomes in virologically suppressed PLWH switching from EFV/TDF/3TC to either B/F/TAF or DTG/3TC. Methods In this retrospective real-world study of 326 patients, weight, lipid (TG, TC), glucose (GLU), and uric acid (SUA) changes were assessed over 24 months. Generalized linear mixed models and logistic regression identified factors associated with metabolic trends and clinically significant weight gain (>5%). Results The B/F/TAF and DTG/3TC groups showed no significant between-group differences in the longitudinal trends of TG, TC, GLU, or SUA, the incidence of metabolic abnormalities, or the risk of >5% weight gain (all P > 0.05). Within-group analyses indicated the B/F/TAF regimen increased TC ( P < 0.001) and decreased GLU ( P = 0.013), whereas DTG/3TC did not significantly alter TG, TC, or GLU levels. Both regimens increased SUA and body weight (B/F/TAF: +2.5 kg; DTG/3TC: +3.3 kg; both P < 0.001). Modifiable risk factors were associated with metabolic outcomes: smoking with increased TG and TC; hypertension and BMI≥25 kg/m 2 with increased TC, GLU, and SUA; age≥50 years with increased GLU and SUA; and regular alcohol consumption with >5% weight gain (adjusted OR = 1.92, P = 0.008). These findings remained consistent in participants with hypertension. Conclusion In virologically suppressed PLWH, switching to B/F/TAF or DTG/3TC provides comparable metabolic safety profiles. Clinical management should prioritize individualized regimen selection alongside proactive management of traditional metabolic risk factors.
Source: Frontiers in Pharmacology
Institutions: Zhejiang Chinese Medical University, Hangzhou Xixi hospital
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7143593058