Factors influencing antiretroviral therapy switching in people with virologically suppressed HIV-1: a cross-sectional multicenter study in France.

Introduction: In France, over 90% of people with HIV-1 (PWH) achieve virological suppression with effective combination of antiretroviral therapies (ART), but limited data exist on the motivation for switching ART.

Objective: To describe the reasons and determinants for switching ART, with a particular focus on doravirine-based regimens, in routine clinical practice in France.

Design: This analysis of cross-sectional baseline data is part of the DoraVIH study, a French, multicenter (15 sites), two-step observational cohort study that includes prospective follow-up for a subset of participants.

Methods: Eligible participants were PWH under ART regimen, virologically suppressed for at least 6 months, doravirine-naive and switching ART regimen. Sociodemographic and clinical data, ART history and reasons for switching ART were assessed at baseline.

Results: Inclusions occurred between 13 December 2021 and 21 September 2022. Of the 291 PWH included, whose data were analyzed, 143 switched to doravirine-based regimen (DOR PWH) and 148 to another combined regimen (non-DOR PWH). Mean age was 51.6 years, and 206 participants (70.8%) were men. At baseline, 35 (25.0%) DOR PWH and 15 (10.6%) non-DOR PWH had BMI at least 30 kg/m 2 ( P  = 0.007). The most common reasons for switching were treatment simplification, tolerability and drug-drug interactions, accounting for 79.7% of all reasons. Among the 68 participants with prior tolerability issues, 47 (69.1%) switched to doravirine-based regimen.

Conclusion: Primary reasons for switch were treatment simplification and tolerability. Participants with obesity were more likely to switch to doravirine, reflecting physicians' favorable perception of doravirine potential benefits, particularly in managing weight gain.