Real-world persistence of bictegravir versus dolutegravir single-tablet regimens: A retrospective cohort study in a large urban Canadian HIV clinic.

BackgroundSingle-tablet regimens (STRs) with integrase inhibitors, bictegravir (BIC) or dolutegravir (DTG), are favored in HIV treatment for their efficacy and convenience. This study compares persistence-time from initiation to discontinuation-between BIC/emtricitabine (FTC)/tenofovir alafenamide (TAF) and DTG-containing STRs at a Toronto HIV clinic.MethodsA retrospective cohort analysis was conducted on 1732 adults with HIV at Maple Leaf Medical Clinic who initiated or switched to BIC/FTC/TAF or DTG-containing STRs from 2016 to 2022. Persistence was measured in days until discontinuation. Kaplan-Meier curves and Cox models evaluated time-to-discontinuation and associated risks. Reasons for discontinuation were categorized into adverse events, patient preference, cost, compliance, physician preference, virologic failure, and others.ResultsAmong 1732 participants (median age 48 years, 88.7% cisgender men), 387 (22.3%) discontinued their STRs after a median of 402 days. BIC/FTC/TAF had a lower discontinuation rate (18.9%) compared to DTG-containing STRs (29.9%) (HR = 0.74, 95% CI: 0.60-0.92). Adverse events were the primary reason for discontinuation, with BIC having lower rates (9.6% vs. 12.5% for DTG).DiscussionBIC/FTC/TAF demonstrated higher persistence and fewer adverse events than DTG-containing STRs, aiding personalized HIV treatment decisions for better long-term outcomes.