Decrease in drug-drug interactions between antiretroviral drugs and concomitant therapies in older people living with HIV-1 switching to bictegravir/emtricitabine/tenofovir alafenamide.

Abstract

Clinical trials of triple regimen bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) demonstrated potent efficacy and favorable safety in both antiretroviral therapy-naïve and -experienced people living with HIV (PLWH), in association with a low risk of drug-drug interactions (DDIs), but data about older people are still lacking. This retrospective cohort study evaluated records from suppressed PLWH aged ≥60 years and who switched to BIC/FTC/TAF. One hundred and nine patients were included: median age was 67.2 years (range, 60-81) and 82% were men. The most common reasons for switch were DDIs (in 66% of cases), followed by simplification (51.3%), and toxicity (26.6%). Overall, 139 potential DDIs between antiretroviral drugs and other concomitant agents were registered in 72 individuals. The most common DDIs included statins in 45 cases (33%), antidepressants in 27 (19%), cardiologic drugs in 23 (17%), proton pump inhibitors in 15 (11%), and benzodiazepines in 12 (9%). After the switch to BIC/FTC/TAF, the number of potential DDIs decreased significantly (from 139 to 18, -87%; p<0.001). The median DDI score also decreased significantly after the switch (from 0.64 to 0.14, -78%; p<0.001). After 12 months, 101 patients (92.7%) had HIV RNA <20 copies/mL. Eight patients discontinued BIC/FTC/TAF: three for virological failure, two for adverse events, and three for missing data. In this real-world cohort, switching to BIC/FTC/TAF in virologically suppressed PLWH aged over 60 years led to a remarkable reduction in potential DDIs, in association with high virological efficacy and good tolerability profile.