Efficacy and safety of switching to dolutegravir plus emtricitabine/tenofovir disoproxil fumarate ( TDF ) or elvitegravir/cobicistat/emtricitabine/ TDF in virologically suppressed HIV ‐infected patients in clinical practice: results from a multicentre, observational study

Objectives The aim of the study was to compare the efficacy and tolerability of switching antiretroviral therapy to dolutegravir + emtricitabine/tenofovir disoproxil fumarate ( TDF ) with those of switching to elvitegravir/cobicistat/emtricitabine/ TDF in clinical practice. Methods In a multicentre real‐life observational study, we analysed data for HIV ‐infected patients on antiretroviral treatment with viral load < 50 HIV‐1 RNA copies/ mL switching to dolutegravir + emtricitabine/ TDF (dolutegravir group) or elvitegravir/cobicistat/emtricitabine/ TDF (elvitegravir group). Follow‐up was censored at 48 weeks. Results The 48‐week estimated proportion maintaining virological efficacy was 96.1% with dolutegravir ( n = 123) and 95.4% with elvitegravir ( n = 186; P = 0.941). Patients in the dolutegravir group showed more treatment discontinuations, but these were mainly as a result of simplification. The elvitegravir group showed more discontinuations because of renal adverse events (2.7% versus 0% with dolutegravir). Interestingly, no difference was observed between the two regimens in central nervous system toxicity‐related discontinuations. Switching to dolutegravir was associated with a better blood lipid profile. Conclusions Switching to dolutegravir + emtricitabine/ TDF was associated with similar efficacy and tolerability to switching to elvitegravir/cobicistat/emtricitabine/ TDF in virologically suppressed patients in clinical practice, although reasons for discontinuation showed differences between regimens. These results should be interpreted with caution, as this is a nonrandomized comparison.