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Bictegravir-lenacapavir maintains viral suppression with 0.3% difference compared to bictegravir-emtricitabine-tenofovir alafenamideTrial shows new daily pill option for people with HIV

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Key Takeaway
Note that bictegravir-lenacapavir maintains viral suppression comparable to bictegravir-emtricitabine-tenofovir alafenamide.

This Phase 3 randomized controlled trial enrolled 574 virologically suppressed people with HIV-1 across 100 hospitals and clinics. Participants were assigned to either switch to a bictegravir-lenacapavir (75-50 mg) once daily regimen or continue on bictegravir-emtricitabine-tenofovir alafenamide (50-200-25 mg) once daily.

The primary outcome was the proportion of participants with HIV-1 RNA of 50 copies per mL or higher at week 48. In the bictegravir-lenacapavir group, 5 (1.3%) had high viral loads compared to 2 (1.0%) in the bictegravir-emtricitabine-tenofovir alafenamide group. The difference was 0.3% (95.002% CI -1.9 to 2.4).

Regarding safety, drug-related adverse events occurred in 40 (10%) of the bictegravir-lenacapavir group and 23 (12%) of the comparator group. Serious adverse events were reported in 27 (7%) and 13 (7%) respectively, though none were deemed related to treatment. Tolerability data was not reported.

Bictegravir-lenacapavir may serve as a novel single-tablet antiretroviral regimen for virologically suppressed individuals. However, the small absolute difference in viral suppression and the lack of long-term tolerability data should be considered when evaluating clinical utility.

How this fits prior evidence

How this fits prior evidence: This finding extends the existing evidence regarding bictegravir-emtricitabine-tenofovir alafenamide as a safe option for long-term management in treatment-experienced people with HIV-1. While previous data established its favorable lipid and renal profile, this trial evaluates the addition of lenacapavir to the regimen. Additionally, it builds upon evidence that islatravir and lenacapavir fixed-dose combinations show similar bioavailability to single agents.

Living with HIV requires consistent treatment to keep the virus suppressed. A recent trial looked at a new daily pill option for people who already have their virus well controlled. The study tested a switch from a three-drug regimen to a two-drug combination of bictegravir and lenacapavir.

Researchers followed 574 people across 100 hospitals and clinics. At the end of 48 weeks, both groups performed very similarly in keeping the virus levels low. In the new pill group, only 1.3% had high virus levels, while 1.0% had high levels in the current treatment group. The difference between the two was very small.

Safety data showed that both treatments were well tolerated. While some people experienced drug-related issues, the number of serious events was similar across both groups and none were linked to the medication itself. This new combination could offer a simpler daily routine for those seeking a different treatment path.

What this means for you:
A new two-drug daily pill shows similar success in controlling HIV compared to current three-drug treatments.

Common questions

How does this new medication compare to current treatments?

The study found that the new two-drug combination (bictegravir and lenacapavir) worked very similarly to the current three-drug treatment. At 48 weeks, only 1.3% of people on the new pill had high virus levels, compared to 1.0% on the standard treatment. The difference between the two options was small.

Is the new daily pill safe for people with HIV?

The trial included 574 people and showed that both treatments were manageable. While about 10% of people on the new pill had drug-related events, the number of serious issues was similar in both groups (7%). None of these serious events were caused by the medication itself.

Who is eligible for this new treatment option?

This specific study focused on people with HIV-1 who already have their virus suppressed. Because every person's health needs are different, you should talk to your doctor to see if a switch to a two-drug regimen like bictegravir and lenacapavir is right for you.

Study Details

Study typeRct
Sample sizen = 574
EvidenceLevel 2
Follow-up216.0 mo
PublishedAug 2026
View Original Abstract ↓
BACKGROUND: There is a continued need to expand the repertoire of effective single-tablet regimens to address the diverse needs of people with HIV-1. We aimed to evaluate the safety and efficacy of switching to bictegravir-lenacapavir compared with continuing bictegravir-emtricitabine-tenofovir alafenamide in virologically suppressed people with HIV-1. METHODS: This double-blind, multicentre, randomised, controlled, phase 3, non-inferiority trial was conducted in 100 hospitals and HIV clinics across Argentina, Australia, Canada, Dominican Republic, Germany, Italy, Japan, Mexico, Puerto Rico, South Korea, Spain, Taiwan, the UK, and the USA. Eligible participants were aged 18 years or older, receiving bictegravir-emtricitabine-tenofovir alafenamide (for ≥6 months), and virologically suppressed (HIV-1 RNA <50 copies per mL for ≥6 months). Participants were randomly assigned (2:1) using an interactive response system (stratified by geographical region) to switch to bictegravir-lenacapavir (75-50 mg) or continue bictegravir-emtricitabine-tenofovir alafenamide (50-200-25 mg) once a day as single-tablet regimens for 48 weeks. The primary endpoint was the proportion of participants with HIV-1 RNA of 50 copies per mL or higher at week 48 (as per the US Food and Drug Administration Snapshot algorithm) assessed in the full analysis set (defined as all randomly assigned participants who received any dose of the study drug), with a non-inferiority margin of 4%. This trial is registered with ClinicalTrials.gov, NCT06333808 (active, not recruiting). FINDINGS: Between March 25 and Oct 30, 2024, 666 people with HIV-1 were assessed for eligibility, 89 were ineligible, and 577 were randomly assigned (384 to bictegravir-lenacapavir and 193 to continue bictegravir-emtricitabine-tenofovir alafenamide). 574 participants received at least one dose of the study drug (full analysis set). The median age was 49 years (IQR 39-58). 111 (19%) of 574 participants were female and 463 (81%) were male at birth. At baseline, the median duration of HIV-1 treatment was 12·0 years (6·5-18·7). At week 48, five (1·3%) of 383 participants in the bictegravir-lenacapavir group and two (1·0%) of 191 in the bictegravir-emtricitabine-tenofovir alafenamide group had HIV-1 RNA of 50 copies per mL or higher (percentage difference 0·3% [95·002% CI -1·9 to 2·4]), meeting the non-inferiority criteria. Drug-related adverse events occurred in 40 (10%) participants in the bictegravir-lenacapavir group versus 23 (12%) in the bictegravir-emtricitabine-tenofovir alafenamide group; and serious adverse events occurred in 27 (7%) versus 13 (7%), with none deemed related to treatment. One participant in the bictegravir-emtricitabine-tenofovir alafenamide group died due to coronary artery disease. INTERPRETATION: Bictegravir-lenacapavir has the potential to be a novel single-tablet antiretroviral regimen option for virologically suppressed people with HIV-1. FUNDING: Gilead Sciences.
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