Switching from EFV/TDF/3TC to B/F/TAF or DTG/3TC in virologically suppressed PLWH shows no significant between-group metabolic differences over 24 months.

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Frontiers in Medicine Published April 18, 2026 Medically reviewed April 25, 2026 DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Consider individualized regimen selection alongside proactive management of traditional metabolic risk factors in virologically suppressed PLWH.

This retrospective real-world study included 326 virologically suppressed persons with HIV (PLWH). Participants switched from efavirenz/tenofovir disoproxil fumarate/lamivudine to either bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) or dolutegravir/lamivudine (DTG/3TC). The primary outcome assessed metabolic changes including weight, lipid, glucose, and uric acid over a 24-month follow-up period.

Between-group comparisons revealed no significant differences in longitudinal trends of triglycerides, total cholesterol, glucose, or uric acid (P > 0.05). Similarly, no significant differences were found in the incidence of metabolic abnormalities or the risk of >5% weight gain between the two new regimens (P > 0.05).

Within-group analyses showed that B/F/TAF was associated with increased total cholesterol (P < 0.001) and decreased glucose (P = 0.013), while both regimens were associated with increased uric acid (P < 0.001). Body weight increased by +2.5 kg with B/F/TAF and +3.3 kg with DTG/3TC (both P < 0.001). Risk factors for metabolic changes included smoking, hypertension, BMI ≥25 kg/m2, age ≥50 years, and regular alcohol consumption (adjusted OR = 1.92 for >5% weight gain).

Safety data, adverse events, and discontinuations were not reported. The study notes that clinical management should prioritize individualized regimen selection alongside proactive management of traditional metabolic risk factors.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedMar 2026

View Original Abstract ↓

ObjectiveTo compare metabolic outcomes in virologically suppressed PLWH switching from EFV/TDF/3TC to either B/F/TAF or DTG/3TC.MethodsIn 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%).ResultsThe 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/m2 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.ConclusionIn 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.