Jose Ramon Arribas

Introduction The use of tenofovir alafenamide (TAF) has been associated with increased cholesterol and body weight. Real‐life data on the metabolic effects of switching from a TAF‐based triple regimen to a dolutegravir (DTG)‐based two‐drug regimen (2‐DR) are scarce. Methods A retrospective cohort study of patients who have switched from a triple TAF‐based regimen to a 2‐DR [DTG‐lamivudine (DTG‐3TC) or DTG‐ rilpivirine (DTG‐RPV]) with at least 6 months of follow‐up. The primary endpoint was the absolute change in lipid fractions at 6 months. Secondary outcomes were percentage changes in lipid fraction, effectiveness and safety at 6 and 12 months [intention to treat (ITT), missing = failures]. Results A total of 118 patients (87 on DTG‐3TC, 31 on DTG‐RPV) were included. Median age was 51 years (interquartile range: 43–59), 86% were male, CD4 T‐cell count was 692 cells/μL, and 98% viral load (VL) < 50 copies/mL. At 6 months there was a decrease in total and low‐density lipoprotein cholesterol of 10.7 mg/dL [95% confidence interval (CI): 2.2–19.1; p ≤ 0.001] and 8.3 mg/dL (95% CI: 0.74–15.9; p = 0.026), respectively. There was a reduction in cardiovascular risk from 4.5% at baseline to 4% at 12 months ( p = 0.040). Virological effectiveness as determined by ITT analysis was 85.6% at 6 months and 66.1% at 12 months. Seven patients (5.9%) withdrew from the 2‐DR and there was no virological failure. Conclusions In real life, switching from a triple regimen with TAF to DTG‐3TC or DTG‐RPV dual therapy improves the lipid profile and is an effective and well‐tolerated strategy.